Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
21 Dec

How to Interpret Cholesterol Test Results

Before we get into the big job of interpreting cholesterol numbers, let’s review what cholesterol actually is.

Cholesterol is cholesterol: a waxy steroid of fat that serves as an essential structural component of cellular membranes and in the production of steroid hormones, vitamin D, and bile acids. Contrary to what the terminology indicates, there’s actually only one “type” of cholesterol in the human body, and it’s called, quite simply, cholesterol. What we think of when we use the word “cholesterol” is actually a lipoprotein – a fatty conglomerate of protein and lipids that delivers cholesterol and fat and fat-soluble nutrients to different parts of the body. It’s not just free cholesterol floating around in your blood; it’s cholesterol bound up by lipoproteins.

So LDL, HDL, VLDL, all those (in)famous measurements we get at the doctor’s office are just different types of lipoproteins. They’re not actually cholesterol. I discussed this briefly a couple years back, and there’s always Griff’s big primer in the forum, so take the time to go check out both. And also take a peak at The Definitive Guide to Cholesterol for review.

Okay, let’s talk about the most commonly bandied-about cholesterol numbers: LDL-C and HDL-C. What do they really mean? What are they actually measuring?

To understand what these numbers mean, let’s play the freeway analogy game. Both LDL-C and HDL-C, the standard, basic readings you get from the lab, do not reflect the number of LDL or HDL particles – the number of lipoproteins – in your serum. Instead, they reflect the total amount of cholesterol contained in your LDL and HDL particles. Hence, the “C” in LDL/HDL-C, which stands for “cholesterol.” Measuring the LDL/HDL-C  and then making potentially life-changing health decisions based on the number is like counting the number of people riding in vehicles on a freeway to determine the severity of traffic. It’s data, and it might give you a rough approximation of the situation, but it’s not as useful as actually counting the number of vehicles. A reading of 100 could mean you’re dealing with a hundred compact cars, each carrying a single driver, or it could mean you’ve got four buses carrying 25 passengers each. Or it could be a couple buses and the rest cars. You simply don’t know how bad (or good) traffic is until you get a direct measurement of LDL and HDL particle number.

Say you go ahead and get those particle numbers directly measured. You’re still limited, because that is just a single datapoint from a specific time in your life/day/week. Analogies are fun and helpful, I think, so let’s take this traffic and freeway stuff further. To get an accurate idea of traffic, you need constant updates, right? Imagine you counted the number of cars on the freeway at 12:05 on a Saturday afternoon four weeks ago. That’s great, but what does it tell you about traffic at 5 PM on a Thursday? Even though it’s the same stretch of asphalt/artery, we can’t divine much at all from that single measurement. You need more data points. That traffic fluctuates wildly is entirely uncontroversial. Any southern Californian could tell you that. But did you know that LDL, HDL, and total cholesterol readings in the same person can fluctuate just as wildly, oftentimes enough to move that person from “desirable” to “high risk” and back to “desirable” lipid status without any nutritional or lifestyle changes in the span of a few mere weeks?

In biology, a single snapshot rarely, if ever, tells the whole story. Who woulda known?

But just because the standard cholesterol test is but a snapshot of a dynamic system in flux doesn’t negate the potential usefulness of getting your cholesterol checked. As much as Conventional Wisdom has gotten things wrong when it comes to cholesterol and heart disease, the two do have a relationship together. There is a connection; contrary to what the AHA might think, we just don’t have it ironed out yet. In my opinion, the most persuasive hypothesis about the real causes of atherosclerosis and heart disease comes from Chris Masterjohn and is highlighted in his recent AHS talk, “Heart Disease and Molecular Degeneration,” and on his blog. It’s a synthesis of the two prevailing notions regarding cholesterol and heart disease – the one which says elevated blood cholesterol plays no causal role in heart disease and the one which says elevated blood cholesterol is the primary cause of heart disease – and it goes something like this:

LDL receptors normally “receive” LDL particles and remove them from circulation so that they can deliver nutrients and cholesterol to cells, and fulfill their normal roles in the body.

If LDL receptor activity is downregulated, LDL particles clear more slowly from and spend more time in the blood. Particles accumulate.

When LDL particles hang out in the blood for longer stretches of time, their fragile polyunsaturated fatty membranes are exposed to more oxidative forces, like inflammation, and their limited store of protective antioxidants can deplete.

When this happens, the LDL particles oxidize.

Once oxidized, LDL particles are taken up by the endothelium – a layer of cells that lines the inside of blood vessels – to form atherosclerotic plaque so they don’t damage the blood vessel. This sounds bad (and is), but it’s preferable to acutely damaging the blood vessels right away.

So it’s the oxidized LDL that gets taken up into the endothelium and precipitates the formation of atherosclerotic plaque, rather than regular LDL. OxLDL, poor receptor activity, and inflammation are the problems. But since measuring oxidized LDL in serum is difficult (oxidized LDL gets taken up out of serum and into the endothelium rather quickly) and expensive, we need other, more realistic, more obtainable methods. We need to work with what we’ve got. It would be great if a doctor could quickly order up an “LDL receptor activity” test, but I don’t see that happening anytime soon.

Enter the various lipid panels.

First up is your basic lipid panel, the standard test the average doctor is going to order for a patient. If you go this route, you’ll typically get four measurements: total cholesterol (TC); high density lipoprotein cholesterol (HDL-C); low density lipoprotein cholesterol (LDL-C); and triglycerides.

Total cholesterol

What they say: Get that TC below 200, or else (you’ll have a heart attack or you’ll have to pay a higher health insurance premium, if we take you on at all).

My take: Mostly meaningless. Even though the epidemiological evidence suggests a TC between 200 and 240 mg/dl is best for all-cause mortality, we can’t hang our hats on it. First off, total cholesterol is limited because it’s only telling us the amount of cholesterol contained in all our lipoproteins without saying anything about what kind of lipoproteins we have or how many there are. Second, total cholesterol is limited because it’s determined by a bizarre formula – HDL-C+LDL-C+(Triglycerides/5) – that reduces various types of blood lipids, each with a different role in the body and a unique impact on our risk for illness, to mere numbers. Someone with low HDL and high triglycerides could easily have the same TC as someone with high HDL and low triglycerides, so long as the numbers work out. Whether it’s being used to predict wellness or disease, total cholesterol by itself is mostly meaningless.


What they say: “Good” cholesterol. It’s the “garbage truck” that cleans up “excessive” cholesterol and fat from tissues, so the higher the better! Though men and women should strive for levels exceeding 60 mg/dl, above 40 is acceptable for the former and above 50 is acceptable for the latter.

My take: Higher HDL-Cs correlate strongly with better cardiovascular health. No real argument here. Higher HDLs are desirable. Just remember, it’s only a snapshot of a glimpse into the cholesterol content of your HDL particles. Among most groups tested, the TC:HDL ratio is actually a strong indicator of heart disease risk, with higher ratios corresponding to higher risks. Note, though, that no Primal Blueprint adherents were among the groups analyzed, ever.


What they say: Get it as low as humanly possible! I want that low density lipoprotein so low as to be nearly nonexistent. Your body obviously hates you; otherwise, it wouldn’t be producing a potently toxic substance and sending it directly into your endothelial cells to form atherosclerotic plaque! Of course, we’re not actually measuring the number of low density lipoproteins, just the amount of cholesterol contained in them, but still!

My take: While a high LDL-C may indicate a problem, remember that LDL-C only indicates the total amount of cholesterol in your LDL particles. You could easily have a few large particles (good) or a bunch of smaller, denser ones (bad, might indicate poor LDL receptor activity and an LDL that likes to hang out in the blood), but LDL-C alone isn’t enough to know. It’s also just a moment in time, whereas what you’re interested in is the trend. If the trend indicates a steady rise in LDL-C, however, that could hint at poorer LDL clearance and lower LDL receptor activity (and greater susceptibility to oxidation).


What they say: Lower would be better, sure, but you really gotta do something about that LDL! Anything less than 150 mg/dl is fine.

My take: High triglycerides correlate strongly with low HDL and smaller, denser LDL. High triglycerides, then, could indicate more oxidized (or oxidizable) LDL. The triglycerides of most Primal eaters, especially those on the lower carb side of things, usually hover well below 100 mg/dl. Triglycerides come packaged in VLDL, or very low density lipoproteins (which are calculated by dividing your triglyceride count by 5).

So, what can we learn from a standard lipid test? Not much, actually. We can learn from standard lipid tests, however. If we take a series of regular ol’ lipid measurements, preferably one pre- and several peri-Primal, we can get an idea of our metabolic health. Look for:

  1. Trends – Are your triglycerides going down over time? That’s great. Is your HDL trending up? Also good.
  2. Normal fluctuations – Your numbers can jump around 20-30 points in either direction between readings without it necessarily meaning anything.
  3. TC:HDL-C ratioLower is better and indicates fewer LDL particles.
  4. Triglyceride:HDL-C ratioLower is better and indicates larger LDL (and, usually, fewer) particles. Ideally, this will be close to 1 or lower; one study (PDF) found that 1.33 was the cut off.

If you’re going to get your cholesterol tested, and the basic labs just aren’t cutting it, you might as well go for one of the premium lab tests: the NMR LipoProfile or maybe the VAP. Rather than rely on indirect estimates and formulas, NMR and VAP directly measure the  size of your lipoproteins. I find NMR to be far more useful, because in addition to measuring particle size, it measures particle count (whereas VAP only estimates the count).

But you probably have holiday shopping to do, and I don’t want to drone on for too long, so I’ll leave it at that for now. Next week, I’ll pick up where I left off and get into what you can expect from NMR and VAP testing, including the downsides and the advantages. After that, I’ll go into some strategies for improving your numbers – or, rather, improving your health which in turn should improve your numbers.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I love to learn it but I’m certainly glad that applying it doesn’t take an advanced degree.

    Grokitmus Primal wrote on December 21st, 2011
    • Thank you, Mark, for spelling this stuff out so well. Seems like an overarching theme is inflammation aiding the process of oxidation which turns those dense LDLs into plaque-forming foam cells. Seems like fructose and grains and too much PUFA significantly increase inflammation. Not to mention, fructose increases triglycerides packaged in VLDL (from Dr. Lustig’s “Sugar: The Bitter Truth”), and high VLDL correlates with low HDL and smaller, denser LDL. Seems like removing or significantly reducing fructose, grains and PUFA would significantly reduce the ability of LDLs to “catch fire.” I’d like to find more info about the role of inflammation (and what causes inflamm) in the process of developing heart disease. I’ll check out Chris Masterjohn and stay tuned to MDA…

      hew wrote on December 25th, 2011
    • i am a 58 years male,what should be the standard reading of my lipid profile?

      lalit pandey wrote on January 8th, 2013
  2. Great article I will definitely pay more attention to my next test results, hopefully they will bring good news, I am currently trying a product name cholesterol control from this website, I heard very good things about it so decide to try it let see what happens!

    Diego wrote on December 21st, 2011
    • Looks like spam to me!

      JMarra wrote on December 24th, 2011
    • I tried this product as well. It’s a pretty good buy. I actually did notice results. I’m usually very skeptical when it comes to “natural alternatives” but I found that it really helped my cholesterol.

      Joanne wrote on November 9th, 2012
  3. As an RN, I’ve seen plenty of people prescribed statins based on the results of a single lipid panel. “Surely you jest”, I’ve screamed in my head! Thank you for not only presenting this complex subject in terms we can understand, but for pointing out that fluctuations exist and trends need to be studied in order to get a better picture of one’s metabolic health.

    Michelle wrote on December 21st, 2011
    • Frustrating working in a broken system isn’t it? Makes me wanna scream sometimes when I see all of our cardiovascular patients on the usual low fat, low cholesterol diets.

      *bang head*

      Dave, RN wrote on December 21st, 2011
    • This Primal diet works and I am off Lipitor!

      Sandra Miller wrote on December 21st, 2011
    • I was told with a Total of 198 and HDL of 59, LDL 133 (bit high yes) and Trigly of 30 I would probably need to go on statins if it wasn’t down by my next visit. Guess what, I didn’t go back! I was GF at the time but not primal, this spring I might see what my numbers are but I decided I didn’t want to worry about it. Being 33 or so at the time I think the risk of the meds was higher than the benefits! So YES they do do that!

      EZ wrote on December 22nd, 2011
  4. great topic, definitely one of my big interests as I have genetically very high LDL. Can’t wait to read the future articles!

    Burn wrote on December 21st, 2011
  5. A couple of months ago I began an effort to raise my cholesterol. For a few years, my doctor and I have been trying to treat my hypothyroidism and raise my hormone levels (progesterone, DHEA, good estrogen) with little luck. Then one day I read something about a stong correlation between high cholesterol and hypothyroidism. That threw me because every time I have my cholesterol checked, my LDL doesn’t even register. Plus, my blood pressure has always been extremely low. Then I read and article on Mom on a Mission about the importance of cholesterol in making hormones and a light went on. I talked to my doctor and she agreed that it made sense. She encouraged me to go for it. I’ve been loading up on coconut oil, organic butter and other good stuff. Since then, the gold in my rings no longer turn my fingers black (a sign of low progesterone) and I’m feeling much better. I’m still battling candida so it’s not a complete victory yet, but it’s a clearly a step in the right direction. It’s a subject I can’t find much information on, so I hope my little story helps someone with similar issues.

    Suzanne wrote on December 21st, 2011
    • Can you talk more about the gold rings turning your finger black? I haven’t heard of that as a symptom of a hormone imbalance before- do you have any links? Or know of the mechanism via which it happens?

      My stainless steal watch sometimes turns my wrist black and I’m wondering if this is the same sort of thing.

      SophieE wrote on December 21st, 2011
      • Unfortunately, I can’t find anything online on the subject. Years ago, a doctor told me it meant low iron. My current doctor had tested all my mineral and vitamin levels and when she had made a long grocery list of supplements, I noticed iron wasn’t on it. I asked why not when I obviously had low iron and showed her my ring finger which was black from hand to knuckle. She immediately stated that it wasn’t low iron but low progesterone and then we tested all my hormone levels. Sure enough, they were in the basement. I have since noticed that my rings only turn my fingers black during that time of the month when progesterone is at its lowest. Hope that helps!

        Suzanne wrote on December 27th, 2011
    • Yes please, any sources? This happened with my gold wedding ring when I was pregnant. I could use it to literally write on my skin. I searched and searched for an answer and never found anything about it. It was a great party trick!

      Kim wrote on December 21st, 2011
    • If you’re having issues with hypothyroidism (Hashimoto’s), read this book.

      It’s basically about “quieting” the autoimmune response. Mineral supplements + primal eating have eliminated the majority of my symptoms — some I didn’t even realize were thyroid-related. The number one thing is that wheat is a total no-no. It exacerbates the immune response brought on by Hashimotos.

      Nolene wrote on December 21st, 2011
    • Try Pau d’Arco bark for candida. It is a bark that you make into a tea. They ae banning it across europe as it works so well!!

      mark wrote on December 21st, 2011
    • Seriously? THAT’S why my fingers turned black? Earlobes too. I thought I was allergic to gold but did wonder why it would turn my skin black but cause no itch which would be an expected sign of contact allergy. Jeesh! Thank you!

      lisa wrote on December 29th, 2011
  6. Thanks for this, I was looking forward to an article on cholesterol since mine was way higher on the post-primal tests compared to the pre-primal ones and I freaked!
    Triglycerides and HDL was ideal though!

    Theodora wrote on December 21st, 2011
    • Make sure your mineral levels are correct. If Iron, Copper, Magnesium, etc are out of whack it can drive bad cholesterol up. I have found out the hard way that when you make dramatic changes to your diet it’s easy to screw up your minerals and electrolytes. If you are having muscle cramps and your blood tests show either too high or too low Iron these are all symptomatic of poor mineral intake or balance.

      Correcty Fairy wrote on December 21st, 2011
  7. Here’s a relevant article by Dr Kurt Harris that may be of interest on this topic:

    Austin wrote on December 21st, 2011
  8. Nothing can get you to worry more than a number on a piece of paper or a Google search for a condition you think you have. Don’t. You are in much Better shape than you think :)

    Morten klint wrote on December 21st, 2011
    • please DO. yes, you might get led astray on your path, and go places you didn’t need to go, and get worked up about something you don’t need to get worked up about for a time, but in the end you will learn about how to actually take care of your own body, and you will learn more than any doctor will tell you. how can you put a value on that? ignorance is not bliss. it’s just a way to keep you reliant on a system that is not working.

      Anon wrote on March 11th, 2014
    • additionally, the “your fine, no problem” response is the common one doctors everywhere give to people who come into their office looking to find out what’s going on with their body when something has CHANGED. If it CHANGED, then it’s not normal is it? There is such a thing as subclinical illness. When it becomes clinical is only when it’s time to purchase some medications. I think most people would like to get their problems sorted before that point…

      Anon wrote on March 11th, 2014
  9. Recently had mine checked for a health screening, and my total was 262, but HDL was 95 of that! I’ll take it. :)

    Karen P. wrote on December 21st, 2011
    • You look relatively young, too. I’m late 20’s and had mine checked by mistake a year ago. Came back with total in the 280s, but HDL was in the 80s and trigs were in the 30s. Those aren’t anything to complain about!

      Mica wrote on December 22nd, 2011
  10. Interesting, not that I’d bother having my cholesterol checked since I don’t eat modern foods.

    Peggy The Primal Parent wrote on December 21st, 2011
  11. Love the car analogy. If you can’t measure it you can’t improve it, but we also need to be asking the right questions to get better answers from our doctors.

    Richard wrote on December 21st, 2011
  12. Any suggestions on a lab where I can order these tests without having to go through my HMO. My doc/hospital will only order the standard cholesterol screening, and I’m not interested in getting badgered for “unhealthy” results. I’ve been paleo for 12 months and I’m reluctant to get a physical knowing their first question will be “So how is the low fat, high fiber diet going for you?” Ya right! Last time I got that, I felt compelled to lie.

    Jennie wrote on December 21st, 2011
    • You can buy a test kit for home. The reviews say to let the blood come out on its own instead of squeezing the finger and you will get a more accurate number. I haven’t purchased one myself.

      Carrie S. wrote on December 21st, 2011
    • Directlabs ( has all kinds of fun tests that don’t require a doctor’s note (they’re also cheap). Search for NMR or VAP.

      validvibe wrote on December 21st, 2011
      • You may have just given millions of people a Christmas present–how to cut the so-called “doctor” out of the picture between you and your health. All they do is collect an office fee while spewing AMA-sanctioned crap about the Big Pharma drugs you *may* need to get your health down to THEIR parameters (notice I said DOWN).

        In my case, my health insurer demands I use LabCorp anyway for all my testing done, and by going to them directly for blood draws from now on, I will be saving $110/visit from no more doctor fees.

        Imagine if EVERYONE got their health care down to simple blood draws done directly from labs that were required by their insurer in the first place…the cost of an office visit X the millions who go in multiple times yearly for CW lectures and a blood draw = billions saved!

        I, for one, never knew you could enter these facilities on your own–I thought they only did lab work from doctor office.

        I’m DEFINITELY checking into this! :)

        Wenchypoo wrote on December 22nd, 2011
        • You’d think I work for them, but I’m just a happy customer. Sign up for their newsletter…some of the tests go on 50% off sale on occassion. For example, they had a ‘Cyber Monday’ sale on their ’10 most important tests’ for $189. A total steal.

          More info on the 10 tests: I try to do that series yearly — highly recommended to suss out issues for those older than 30

          validvibe wrote on December 22nd, 2011
    • I almost lied, but decided to see the response. Doc sent me to a nutritionist who, after had her log on to the Incredible Dave blog, said keep on with the primal! My total C count was 201(bad! bad! bad!). I refused statin drug and after 2 more months primal total was 163. hmmmm wonder how that happened. I don’t get the Cholesterol talks anymore.

      Mary Anne wrote on December 21st, 2011
    • I hear you. I am so afraid for my upcoming yearly physical, feeling like I have to memorize all this stuff so I can argue effectively with my doctor if he yells at me. I know that he won’t, but I’m afraid of getting my defense botched. In the real world of living, I am so much happier being strong and energetic, that’s got to count for something.

      Kathy wrote on December 21st, 2011
    • I am getting a VAP test tomorrow. It’s $105 through You pay online, then make an appt at a local Labcorp. I just had a standard test two weeks ago via my doctors office, so I’ll be curious to see how this one varies, and the actual measurements for LDL vs. calculated on the standard test.

      Peter wrote on December 21st, 2011
    • I use They offer sales quite often.

      Steve wrote on December 21st, 2011
    • Jennie I replied with a link but its awaiting moderation, google accessa labs to get to their site, and you’ll find you can order and pay online ($105 for a VAP) and then you set up the draw at a local Labcorp office.

      Peter wrote on December 21st, 2011
  13. I got a lipid panel done a while ago when they were talking about the possibility of putting me on accutane (another story another time). The doctor said they were the best results he had seen in 2 years. Then I looked at it and realized my overall cholesterol was LOW. I bruised easily, I was sick all the time, and I had a ton wrong with me. There’s no way that this was an indicator of my health. I won’t list all of the other stuff that was wrong at this point, but let’s just say that over time, my overall level of health has improved, all of my numbers have gone up, but the ratios are fantastic. The most dramatic improvement was after cutting gluten (hmmmm) and there’s been a little more progress after adopting Paleo/Primal.

    This just goes to show that even though we may have “awesome” numbers according to a doctor, our overall health can still be compromised, and the only thing the doctor could be using to determine the “awesomeness” of your results can be that total number. Which. Means. Nothing.

    Erin wrote on December 21st, 2011
  14. I am due for my first screening shortly. I’ll certainly be bookmarking this page for future reference.

    Happycyclegirl wrote on December 21st, 2011
  15. Note that most modern lab tests typically measure total cholesterol, HDL-C, and triglyceride levels, using the above formula to calculate LDL-C levels. Unfortunately, said formula assumes triglycerides are 150 or higher, so for primal / low-carb eaters will overestimate LDL-C levels. Dr. Eades wrote a blog post on this awhile back if you are interested in the details.

    As a side note, my total cholesterol is around 220 (up to 245 at one point) and my doctor has been trying to get me to take statins or aspirin for years. However, my HDL-C is around 60 and triglycerides similar, so I have always politely refused. I tried to discuss it with him once, with little impact.

    Damien Gray wrote on December 21st, 2011
  16. Thanks for this because my doc wanted to put me on cholesterol meds a couple of years ago even though my HDL is around 75 and my triglycerides around 43-45. It was because my LDL was high than they wanted (i forget exactly what) but total cholesterol was around 230 or something.
    Anyway I refused the medication

    Gayle wrote on December 21st, 2011
  17. Great timing! Got a standard panel back last week and the doc wanted me to “come in to talk about getting my cholesterol managed”. I deferred, and instead went in to get a copy. Total: 287, TG: 103, HDL: 59, LDL: 207. That’s after six months of primal, unfortunately no baseline was taken pre-primal.

    I have ordered on my own a VAP test I’m getting tomorrow, I am going to check into the NMR and maybe upgrade to that if possible.

    I have been consumed with thinking about this all week, so I’m glad for the timing on this. One area where I don’t want to just “hope” I’m right. I intend to get all the facts and make as informed a decision as I can. This is one area of primal that probably is the most in conflict with CW, which makes it so hard to get comfortable with it…every where I look, I’m being told I’m treading on thinning ice.

    Peter wrote on December 21st, 2011
    • Same exact situation here…I go back to re-test in early January. My TC was over 300…and my HDL wasn’t as high as I’d like it but Trigs are really good. I eat so well and exercise…felt better than I have in years. I also recently lost 1/3 of my body weight over last 8 months or so…am thinking that I need to chill and monitor it over time to see the trends. I won’t go on statins. Good luck and please report back on how you made out.

      Cheryl wrote on December 21st, 2011
    • I know what you mean Peter!! Dealing with all my health issues has been so hard because doctors think such different things from us. Even if you’re confident in your diet, there’s always that little nagging voice saying, ‘well, what if they’re right?’ good luck with your cholesterol!! I was happy to see this post too. I love learning the science behind my body so I can feel even more sure of what I eat!

      Alyssa wrote on December 21st, 2011
    • Those LDLs are insane. Are you sure your iron levels are normal? Some athletes give blood regularly to keep their iron down. The blood bank volunteers will test and tell you your iron level as preparation for the blood donation.

      Correcty Fairy wrote on December 21st, 2011
    • Always ALWAYS ask for a copy to be mailed home–it’s your right. I had my doctor put a note in the med files of both my husband & I so I could play along at home.

      Wenchypoo wrote on December 22nd, 2011
    • TG 103? TG as in triglycerides?
      Sorry to say this but that’s high for eating primally.
      TG above 70 could mean either fluffy, billowy LDL or small, dense LDL.
      Up to 140 it’s a 50/50 chance the LDL isn’t the good kind.
      If TG is under 70 then LDL are always fluffy and no particle size tests are needed.
      Good Luck!

      Arty wrote on December 22nd, 2011
    • Hi,
      Just viewing this post (I noted it was started in 2011, and it is now 2014) but found your response interesting. I have close to the same numbers as you had at that time, after 6 months 100% primal (zero grains, very little fruit, carbs under 80 daily – and most of that from kale!). I actually expected my triglycerides to be lower, and HDL higher…but it is what it is.
      Point of this message to you is: 1) how did the VAT work out for you? and 2) if you are still primal, now about 3 years, did your lipid panel change for the better the longer you stayed on the Primal “diet”?
      Thanks, Jackie

      Jackie wrote on October 11th, 2014
  18. Note that the Triglyceride:HDL-C ratio, which should be less than 1.33, is actually calculated using mmol units. You can convert your mg/dL units by multiplying triglyceride readings by 0.01129 and you can convert your HDL-C readings by multiplying by 0.02586.

    So your (tg X 0.01129) divided by (HDL-C x 0.02586) should be less than 1.33

    Tom wrote on December 21st, 2011
    • (Or you can just divide your US TG/ US HDL-C and make sure it’s less than 3.05, which is the same as 1.33*0.02586/0.01129)

      Tom wrote on December 21st, 2011
    • THANKS!! I live in Australia so mmol is the scale. I crapped myself over the tg/HDL-C ratio until I read your comment here. I’ve been Primal 4 months and my TC, HDL, LDL and (most disappointingly) my tg all increased substantially, with some entering CHD risk zone. On USA scale my numbers were TC 301, HDL 58, LDL 208, tg 177. I would not worry about TC or LDL if tg was low. Bummer. But at least I know my tg/HDL is 1.33 not 3 !

      seppo wrote on December 21st, 2011
  19. Mark, or anybody “in the biz” who knows the difference:

    I am scheduled for a blood draw tomorrow for a VAP panel, which is $105, and the website say is:

    ‘The VAP Lipids & Cholesterol test, also known as the Vertical Auto Profile, includes your standard Lipids & Cholesterol test in addition to a variety of lipid subfractions and subclasses (15 components total).

    In contrast to the standard Lipids & Cholesterol test (which calculates the LDL level), the VAP Lipids & Cholesterol test directly measures LDL cholesterol independent of fasting status.

    LDL exists as a spectrum of particles consisting of small, dense molecules and large, buoyant ones. Recent evidence suggests that the small, dense particles increase the risk of coronary artery disease by as much as 4 times relative to the larger particles. In fact, direct measurement of LDL is recommended by the NCEP ATP III for most accurate risk stratification.

    This VAP test also measures your Lp(a), (Lipoprotein “A”) class. The Lp(a) marker is associated with an increased genetic risk of atherosclerosis.

    In addition, it measures HDL, LDL and VLDL subclasses with an assessment of the LDL density pattern. Additional measurements are made for the apoB100, LDL-R, Lp(a) Cholesterol and IDL Cholesterol.’

    They also offer an NMR for $90, which is:

    ‘The NMR LipoProfile test measures your standard Lipids & Cholesterol panel (LDL, HDL, Total Cholesterol and Triglycerides) as well as your lipoprotein particle number and lipoprotein subfractions.

    This test uses NMR spectroscopy to measure the actual number of atherogenic LDL particles. A number of recent studies have implicated the LDL Particles (a component of the total LDL) as more predictive of the overall risk of heart disease, even if the LDL is normal.

    Your results will also show your Insulin Resistance Score (LP-IR). Using the lipoprotein particle concentration, this score gives an improved assessment of insulin resistance and diabetes risk.’

    I am trying to read the difference to make sure I get the most useful test, or if I should get both??

    Any help here would be appreciated.

    Peter wrote on December 21st, 2011
    • Hi there,

      To answer your concerns about the varying tests, you should listen to Chris Masterjohn’s second podcast with Chris Kresser over at the Healthy Skeptic:

      Hope that helps.

      Wyatt wrote on December 21st, 2011
      • In short, tube gel electrophoresis, gradient electrophoresis, VAP and NMR give wildly different results. If the larger medical community can’t even agree on a the proper way to measure certain profiles, we cannot yet determine whether these profile offer valuable clues into heart health.

        Wyatt wrote on December 21st, 2011
        • Tube gel electro and gradient electro aren’t even used by cardiologist that much unless they have a patient that has several risk factors as well as past cardiac events. The VAP and NMR do not give “wildly” different results. They give very consistent results if both are ran on one patient. Each just have a few other subcomponents compared to the other. Both are very good at detecting risk.

          waterlilly wrote on December 21st, 2011
        • Waterlilly (there was no reply button by your post.),

          In the podcast, Chris Masterjohn’s only example of wildly different results was between tube gel electro and VAP. Nonetheless he used that to illustrate his larger point that “There’s a lot of disagreement between these different tests. …Until we…get the science to the point where we can actually agree on the particle size, you know, on what tests we use, on what standards we use to classify someone as having this or that particle size or this or that distribution, I really don’t think we’re at the point yet where we should be ordering these tests for everyone or telling them to change their diet or do this or that thing in order to alter their particle size.” It could be true that VAP and NMR give very consistent result if both are ran on one patient. I do not know. But my impression is that there is still a great deal of uncertainty in the accuracy and proper interpretation of these tests as a means to assess risk.

          Wyatt wrote on December 22nd, 2011
  20. I have genetically high-cholesterol but my LDL are almost exclusively the “large and fluffy” kind. This is encouraging as I attempt to figure out how to live life without statins. I have done too much reading to subject my body to them!

    My take for heart health (thus far) is to have an anti-inflammatory lifestyle similar to what Chris Masterjohn’s research suggests. Thankfully I have found a doctor willing to work with me. :)

    Crunchy Pickle wrote on December 21st, 2011
  21. Hi, Im confused about the last part about the ratios: TC:HDL-C ratio – Lower is better and indicates fewer LDL particles.
    Triglyceride:HDL-C ratio – Lower is better and indicates larger LDL (and, usually, fewer) particles. Ideally, this will be close to 1 or lower; one study (PDF) found that 1.33 was the cut off.

    Can someone please help me understand this? I want to find out if I have big LDL (good) or small. My HDL=89, my Tri=55..
    Thank you

    andrea wrote on December 21st, 2011
    • Your triglyceride:HDL ratio is .62, which is well below what it should be (which is actually 3.05 if you’re American, as they use different measurements than in the linked study).

      Tom wrote on December 21st, 2011
    • since your Triglyceride to HDL ratio is .62 that is lower than 1. So that is good. Lower indicates Larger LDL

      Gayle wrote on December 21st, 2011
      • Thank you so much for your replies! That makes me feel so much better! I ♥ paleo!

        andrea wrote on December 23rd, 2011
  22. How timely! I just posted last week on my blog the results of my last few lipid tests, beginning with the number from prior to my eating primal/low-carb beginning late last year. The numbers speak for themselves, but basically your great explanations validate my test results – high HDL, low Trigs. My LDL is high enough that it might scare some but I’m not concerned. I’m in the best shape of my life and I know it because I can *feel* it. Being 60 pounds lighter helps too : )

    My cholesterol test results are located here for anyone who cares to see the results:


    Mark wrote on December 21st, 2011
  23. I didn’t see you mention it, Mark, but I think it’s widely accepted that eating animal foods contribute to cholesterol. Having said that and using your highway analogy, wouldn’t it be better to reduce traffic on the artery highways by cutting the total number of passengers (limiting animal foods/ cholesterol), rather than worry more about traffic accidents (oxidized LDL)?

    Kelly wrote on December 21st, 2011
    • Kelly,
      No. You are making the erroneous assumption that dietary cholesterol is directly converted to blood cholesterol. It also appears that you didn’t actually read this article.

      Doug wrote on December 21st, 2011
  24. I recently had my first lipid panel done at age 38, female, normal weight, 2 kids, paleo/primal 3 yrs, 90 % (or better)

    LDL 99
    HDL 97
    TRIGS 36
    TC 203

    My Primay Doc, who never sees me but understands how I eat, said “trigs are low, but nothing to worry about” LOL

    juliemama wrote on December 21st, 2011
    • I’d kill for those numbers! Awesome!

      Cheryl wrote on December 21st, 2011
    • Wow, that’s awesome.

      Mica wrote on December 22nd, 2011
  25. I’ve been eating primal for about 2.5 years and my cholesterol levels keep getting worse and worse. I am not really worried about it, but I am getting ready to take a life insurance test and I’d love some tips on how to improve my results.

    Karen C. wrote on December 21st, 2011
    • Karen, if you want to get your TC and LDL down fast, you may be able to do it with psyllium. I experimented on myself and both TC and LDL went down about 35% in 3 weeks. I took 2 Tbsp in a big glass of water twice a day (morning and night), and was amazed at the results. I recommend pure psyllium (no sugar) which you can get at Trader Joe’s or Whole Foods. Good luck!

      Rob wrote on December 21st, 2011
      • You can just eat oats, without the bad side effects of your chicken feed.

        Problem is, the grains are what supress the liver in making cholesterol to repair cells, fight invaders and produce bile and hormones for proper digestion of fat and fat soluble vitamins for healthy bone and teeth.
        This is why the older ppl get, the less bone density they have. It’s why ppl suffer from hair loss, blindness, colon cancer and high triglycerides.

        Psyllium falls under the category of grains, it isnt healthy.

        To raise HDL = wine, dark chocolate
        To lower LDL = anti-oxident supplements and a ton of bell peppers.

        Arty wrote on December 22nd, 2011
    • I’ve been primal dieting for 4 months. I feel good and am very lean but and all my cholesterol and triglyceride numbers went from ‘good’ to ‘bad’. Don’t you find that frustrating?

      seppo wrote on December 21st, 2011
  26. Good article. Especially on how meaningless one test is.

    I’ve got my own cautionary tale on that:

    My dad, whose cholesterol was always on the higher end of normal typical to our family history, was actually put on Statins because of a single really high cholesterol test result. Doctor scared the crap out of him. He was following a high fat/protein/vegetable diet per my recommendation, though not really primal as he does eat grains (white rice and whole wheat stuff).

    He’s a college professor, and less than a year later, he started having memory problems. He’d be in class and blank on an idea. He’d forget to close doors and turn off the stove. They were bad enough that I suggested he go get tested for Alzheimer’s. Afterward, I started reading up on statins and their side effects, and wondered if they might be causing this.

    Lo and behold, after halving his dose as a test (because he was scared to go off them right away), his memory got better. Now, after having gradually completely gotten off them for over 3 months now, his memory has gotten back to normal.
    As for his cholesterol post-statins: still normal.

    Thankfully, at 60, he’s medication free, and I hope to keep him that way.

    Wafaa wrote on December 21st, 2011
    • Just wanted to mention, I got tested for the first time last summer. Being female, 25 yrs old, 18.5 bmi, and eating somewhat primal, but still included wheats and whole grains.

      Total 217
      HDL 55
      LDL 153
      Trig 46

      Wafaa wrote on December 21st, 2011
      • Nice, those are my numbers almost exactly…eating primally, with an occassional ice cream cone, pudding (sugar and corn starch) and a slice of multi-grain bread once a month or so.

        Arty wrote on December 22nd, 2011
    • Happened to my grandmother, as well, and I also was the one who recommended seeing if the memory loss and dementia-type symptoms were statin-related. Statins can wreak havoc on some people, and physicians just are not looking out for those side effects being caused by them. Lots of people in the medical community think statins are wonder drugs and should be used for all ranges of things – an article this week discussed them being used for faster recovery from them flu. Let’s not just throw medication at things, people! When you’re put on a drug, monitor your before and after closely, even for symptoms that you don’t think are associates with it.

      Kat wrote on December 21st, 2011
      • My grandmother, who passed away at 96 last year, also had the memory loss and dementia-type symptoms after being on Lipitor. I wish I had known what I know now. She would often ask me, “why do I need to take these pills at my age?” I now think, why indeed? Her final years would have been SO much more fulfilling if she had had her memory. She was always as sharp as a tack. Losing her memory and needing us to all fill in for what she did easily until she went on Lipitor was one of her greatest sorrows. People say, “still, she was 96!” Yes, but 96 without memories is very sad.

        Mary wrote on December 23rd, 2011
  27. Okay folks, listen up! I stopped eating wheat…and my cholesterol dropped by 40 points! Don’t ask me ‘which one’…I don’t have the results in front of me. My doc was incredulous when I told him I still eat butter, eggs, bacon, chicken, turkey, steak, berries, and of course…veggies…but none of the ‘whole grains’ that he suggested I put back into my lifeplan. Now…stay tuned for the Dexascan results….I have a bet with him on that one!!!

    cjbrooks wrote on December 21st, 2011
    • After totally abstaining from grains, my own LDL dropped 100 points.

      Wenchypoo wrote on December 22nd, 2011
  28. Great info. Somebody needs to put these people in their place.

    It’s a total shame that they try like mad to lower cholesterol by scaring you, then you can’t make necessary sexual hormones so you have a wee wee that won’t work. Then you need viagra.

    Do I see a cycle here?

    Justin wrote on December 21st, 2011
    • Yes, you do–it’s called “create side effects so we can create and sell drugs to combat side effects, leading to more side effects”…lather, rinse, repeat. This is how the wheel of Big Pharma get greased, and how the money rolls in.

      Wenchypoo wrote on December 22nd, 2011
  29. Very intersting, My LDL is 199 so, I asked my doctor for the particle size test. She agreed and the results are below but, unfortunately she doesn’t know how to interpret the results so, I have to make an appointment with i lipidologist. Can anyone help me decipher?
    I have been VLC for about 18 months, lost 40# and was on a statin prior to this. I have been off of the statin for 6 months before this test was performed. BTW my HDL increased when I went off of the statin. These are my latest numbers:

    Cholesterol – 299 mg/dl
    Cholesterol/HDL – 3.4
    Crea .62 mg/dl
    Glucose 105 mg/dl
    HDL – 88 mg/dl
    HDL Particles – 42.5 (15332984) umol/L
    HDL Size – 9.8 nM
    INS Resistance Score – 4
    LDL – 199 mg/dl
    LDL Particle Numbers – 2202 nmol/L
    LDL Particle Size – 21.9 nM
    Large HDL Particles – 15.9 (15332984) umol/L
    Large VLDL Particles – < 0.7
    Non HDL Cholesterol 211
    Protein TOTA – 7.0 gm/dl
    Small LDL Particles – 179 nmol/L
    Trigs – 61
    VLDL Size – not applicable

    THanks for any information –
    Mary Jo

    Mary Jo wrote on December 21st, 2011
    • blood glucose shouldn’t be 105…ouch.
      Did you fast before the test?

      Arty wrote on December 22nd, 2011
  30. I think I’ll just continue to live Primal. I’ll continue to listen to my own body and do what I feel is best for it.

    Primal Toad wrote on December 21st, 2011
  31. I think that when it comes to figuring out if you’re in danger of heart disease and/or a stroke, the C-Reactive Protein Test is much more meaningful and reliable than any kind of cholesterol number. I’m amazed at how rarely anyone talks about the C-RP Test. That’s really what doctors should be looking at.

    Katherine wrote on December 21st, 2011
    • I’m going to ask for this when I go back for re-test after the holidays…do you have a sense of what is a good vs bad result? Would be good to have your view as well as my doctor’s. Thx.

      Cheryl wrote on December 21st, 2011
    • The CPR is very unreliable as it may has the tendency to detect other inflammatory markers not related to cardiac tissue. It has the ability to detect inflammation else where in the body and give a falsely elevated reading. The LDL Particle number is what you really need to know in order to assess your risk.

      waterlilly wrote on December 21st, 2011
    • From

      RED FLAG #7:
      “The University of Maryland Medical School study of more than 15,000 adults concluded that CRP appears to be closely linked to traditional heart disease risk factors, ***but is not an independent risk factor.*** The findings
      appear in the Oct. 10, 2008 issue of the Archives of Internal Medicine.

      CRP is a protein that can rise with short-term infections, injuries, or
      inflammatory process anywhere in the body. Elevated levels are associated
      with injury from anywhere and include even anger and stress. CRP is one of the body’s natural defenses against disease.

      C-reactive protein is a relatively moderate predictor of coronary heart disease and added only marginally to the predictive value of established risk factors for coronary heart disease. These findings suggest that recent recommendations regarding the use of measurements of C-reactive protein in the prediction of coronary heart disease may need to be reviewed if one wants to actually make a recommendation based on science rather than wishful thinking.”

      cancerclasses wrote on December 22nd, 2011
  32. Low cholesterol level is way more dangerous than a high one. Cholesterol is a precursor to seratonin which is our feel good hormone. Practically all suicide victims and depression patients have very low cholesterol levels. Just go primal, enjoy the satisfying fat and protein and enjoy the best overall health available on this planet.

    patrick wrote on December 21st, 2011
  33. I haven’t had my cholesterol checked in years and will not worry about it. I eat 100% Primal and will continue. At age 64, at 5’6″, my weight is 133 lbs. and I do 200 pushups a day, plus run my 3 milers each morning. I eat no junk food. This morning, I went out to breakfast with friends. I brought along an apple and some grapes…

    Werner Kujnisch wrote on December 21st, 2011
  34. The single best article I’ve ever read about cholesterol was written by Dr. Natasha Campbell-McBride, who some of you might know from the GAPS protocol.

    Her explanations are so simple, yet so stunningly LOGICAL and SENSIBLE. This should be, without question, required reading for all medical students, nurses, nutritionists, and anyone else who likes to think they know anything about health.

    If you poke around the WAPF site, they also have an article about the dangers of statins, which is as fascinating as it is terrifying.

    Amy B. wrote on December 21st, 2011
  35. I just got my lipid panel results back, and my HDL and LDL results are “normal” but my triglycerides are high at 207. How could my HDL & LDL levels be fine, but my tri not be??

    TRI: 207.00
    HDL: 86.00
    LDL: 120

    Lisa wrote on December 21st, 2011
    • Triglyceride levels are influenced by what you ate in the previous 12 hours….a high carb meal could elevate them temporarily.

      Tys wrote on December 22nd, 2011
  36. Good article Mark! I’m only interested in triglyceride (mine are 79), the other numbers are crap. Doctors get fixated on them because drug companies brain wash them. Statin drugs can kill you or make you wish they would kill you. Go primal and feel good and live long enough to annoy the hell out of your mainstream MD.

    Linda RN wrote on December 21st, 2011
    • This is simply untrue. The standard lipid panel doesn’t give the full picture or detect residual risk. The NIH recommend using an expanded lipid panel to at least know your LDL particle number. New guidelines for using the expanded lipid panel such as the NMR will be out in no time. Please do your research and know your underlying risk factors.

      waterlilly wrote on December 21st, 2011
  37. I look forward to the day when we can wear a wristwatch-type device that will record our blood chemistry in real time and generate custom reports.

    Until then, I think the greatest hazard is overreacting to incomplete information.

    Timothy wrote on December 21st, 2011
  38. Don’t you think eating tons of animal fat will give you high LDL and Triglycerides? It’s why I don’t eat primal, besides the fact a life without grains is extremely depriving. I would get the facts about dietary cholesterol affecting one’s cholesterol before I blindly follow this Primal ideology. I really don’t know, but I am hesitant to eat loads of animal fat without monitoring it. I wonder the relation between insulin release from grains and it’s impact on absorbing fat and cholesterol. But still, is eating brown rice, skinless chicken breast and broccoli, really a bad thing?

    Jeremy wrote on December 21st, 2011
    • Dear Jeremy,

      Allow me to direct you to the button at the top navigation bar in red called “Start Here”.

      No, eating animal fat does not give you high LDL and tris.

      Skinless chicken breast? I guess, but I can think of many tastier, more nutritious options.

      Broccoli? We Primals eat plenty of it.

      Brown rice? Ugh. Why are even talking about this? Gut irritant, micro RNA, blood glucose spiker, oy vey!

      Karen P. wrote on December 21st, 2011
      • Karen, you are a lot kinder than I am,
        I’d have been a lot rouhger on “clueless” Jeremy!

        Paul wrote on December 23rd, 2011
        • Jeremy irrated be so much that I forgot
          how to spell rougher!

          Paul wrote on December 23rd, 2011
    • The Primal diet does not advocate eating “tons” of animal fat. You need to read Mark’s book, or search his website for info on a proper primal diet. As for going with grain and low-fat options, wait and see in 20 or so years when your dementia kocks in. I’m not trying to be a wise-ass, but our brains absolutely require cholesterol to thrive. Limit cholesterol and you are essentially causing your brain to atrophy. I predict with the current trend of most people in this country of the doctor-prescribed “low cholesterol diet”, that there will be a surge in Alzheimer and dementia cases as people age.

      Sue wrote on December 21st, 2011
      • Not to mention statins…now being prescribed for children as young as 8.

        Karen P. wrote on December 21st, 2011
    • For an addicted smoker – facing a life of no cigarettes could seem depriving, but its only just a shift in thinking.

      I agree that you should not in fact follow anything “blindly”, as it was that which got us into trouble in the first place – yes question everything and apply your own judgement.

      Apply primal law #10: use your brain. One of the key concepts of the primal blueprint is that “you are the driver”

      MetalStorm wrote on December 21st, 2011
  39. Jeremy – sounds like you’re new to this. Here’s one article you should read:

    Do a little more research, and you may find that yes, your brown rice, skinless chicken breast and broccoli combo are not a good thing. MDA offers a wealth of info – as a starting point.

    Melissa wrote on December 21st, 2011
    • Jeremy, read “Wheat Belly” by William Davis. You’ll never say “healthy” whole grains again!

      Hopeless Dreamer wrote on December 21st, 2011
  40. I’m amazed no-one has linked to this so far:

    Chris Kresser had Chris Masterjohn on a couple of his podcasts – they are information dense to say the least but after listening you will be considerably more knowledgeable regarding cholesterol and considerably less worried about it:

    RedYetiDave wrote on December 21st, 2011

Leave a Reply

If you'd like to add an avatar to all of your comments click here!

© 2016 Mark's Daily Apple

Subscribe to the Newsletter and Get a Free Copy
of Mark Sisson's Fitness eBook and more!