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.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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192 thoughts on “How to Interpret Cholesterol Test Results”

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    1. 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…

    2. i am a 58 years male,what should be the standard reading of my lipid profile?

  1. 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!

    1. 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.

  2. 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.

    1. 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*

    2. 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!

  3. great topic, definitely one of my big interests as I have genetically very high LDL. Can’t wait to read the future articles!

  4. 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.

    1. 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.

      1. 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!

    2. 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!

    3. 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.

    4. 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!!

    5. 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!

  5. 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!

    1. 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.

  6. 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 🙂

    1. 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.

    2. 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…

  7. Recently had mine checked for a health screening, and my total was 262, but HDL was 95 of that! I’ll take it. 🙂

    1. 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!

  8. 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.

  9. 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.

      1. 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! 🙂

        1. 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

    1. 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.

    2. 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.

    3. 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.

    4. 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.

  10. 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.

  11. I am due for my first screening shortly. I’ll certainly be bookmarking this page for future reference.

  12. 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.

  13. 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

  14. 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.

    1. 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.

    2. 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!

    3. 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.

    4. 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.

    5. 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!

    6. 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

  15. 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

    1. (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)

    2. 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 !

    3. join the discussion of six years ago?? ha ha. oh well. i just gave up egg yolks, cheese, meat “fat” but not the meat. ate peanut butter, oatmeal, fish oil pills and cheerios!!!! got all better!!!!

  16. 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.

      1. 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.

        1. 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.

        2. 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.

  17. 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. 🙂

  18. 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

    1. 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).

    2. since your Triglyceride to HDL ratio is .62 that is lower than 1. So that is good. Lower indicates Larger LDL

      1. Thank you so much for your replies! That makes me feel so much better! I ? paleo!

  19. 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:


  20. 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)?

    1. 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.

  21. 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

  22. 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.

    1. 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!

      1. 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.

    2. 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?

  23. 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.

    1. 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

      1. 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.

    2. 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.

      1. 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.

  24. 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!!!

    1. After totally abstaining from grains, my own LDL dropped 100 points.

  25. 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?

    1. 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.

  26. 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

    1. blood glucose shouldn’t be 105…ouch.
      Did you fast before the test?

  27. 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.

  28. 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.

    1. 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.

    2. 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.

    3. 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.”

  29. 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.

  30. 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…

  31. 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.

  32. 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

    1. Triglyceride levels are influenced by what you ate in the previous 12 hours….a high carb meal could elevate them temporarily.

  33. 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.

    1. 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.

  34. 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.

  35. 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?

    1. 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!

      1. Karen, you are a lot kinder than I am,
        I’d have been a lot rouhger on “clueless” Jeremy!

    2. 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.

    3. 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”

    1. Jeremy, read “Wheat Belly” by William Davis. You’ll never say “healthy” whole grains again!

  36. I’ve read extensively about all of this (including Gary Taubes and others). The weight of evidence seems to support the hypthesis embraced by the Primal community that:

    – Excess carbohydrates are more likely to be the cause of various health problems and poor blood lipid profiles than dietary cholesterol or saturated fat;
    – Elevated cholesterol (even LDL) is not a significant CHD risk factor UNLESS triglycerides are elevated.

    While I was already slim, fit and healthy, that research convinced me to pursue a restricted carbohydrate (primal) diet for the last 4 months.

    Of all the blood lipid numbers, I’m most disappointed to see that my Triglycerides increased from a ‘safe’ 97 to 177, suggesting an increased risk of CHD. My total Cholesterol (308), HDL (58) and LDL (208) also rose and my ‘ratios’ deteriorated. Based on my understanding of the true CHD risk factors, I’m only really concerned (and of course surprised) about the tg level.

    While there is much debate about whether increased Cholesterol in the blood in and of itself is a significant risk factor for CHD, NOBODY disagrees that elevated tg’s are a risk factor.

    My personal view is that everyone’s body is different and while this restricted carb diet ‘feels’ good, my blood apparently doesn’t respond well to it. Wish that weren’t the case.

    1. What did you eat prior to the test, the night before? Triglycerides flactuate with every minute of the day and if you have weak glands it would take longer to get rid of the inflammation temporarily caused by whatever you ate.
      Some people get inflammed eating fibrous plants with indigestible cellulose…others drink ultra-heated milk and get severe inflammation for 3 days or more…

      My Triglycerides were 140 on an ‘organic’ whole grain (mostly sesame bread and soy spread) diet combined with periods of starvation to keep weight off.

      Now I eat like a ‘pig’, chow down on lard daily, eat butter, bacon, egg yolks…but NO grains and my TG dropped by 90 points!
      My LDL went from 110 mostly small dense….to 150 mostly fluffy,billowy, which protects against invaders. I haven’t had the flu or even the slightest sniffles or headache or anything else since going primal.

      I’ll take the billowy 150 LDL over the small,dense 110 LDL ANY day!

  37. I’m 52. Primal 2 years. Numbers are
    TC 177
    HDL 102
    Trig 63

  38. Mark,

    Excellent post. Nothing irritates me more than when my patients are stressed over their “high” cholesterol and I have to tell them to ignore the “normal” values. I was going to write a post on the topic, but it looks like you covered everything…

  39. excellent article. My triglycerides plunged when I went Primal. They were exceptionally high before and are now in the normal range right now.

  40. I have experienced the same thing.
    May 2011 (pre-primal) my labs:
    TC 203, HDL 76, LDL 117 and trig 48 (I have never been a big bread person but did eat lots of cheese. these results are consistent with my past history and my ratio is always good.
    Sep 2011 (primal for 4 months)
    TC 284, HDL 87, LDL 177, trig 71, but I had a VAP done and my real LDL 143, with real size particles A (good particles), LP (a) 14. Believe me, I monitor my lipid profile carefully and I freaked when I saw my TC and LDL numbers-but glad they were big and fluffy. I requested a retest.
    Nov 2011, consistent with the Sep results so there were no errors.
    The increase can only be attributed to primal eating and I understand I should not be concerned but yet I am since it has never been this high. I had never had a VAP prior to primal.
    Why is it some people go up and some go down? I was very glad to see this blog to know I am not alone with the elevated results. thanks for the info and I look forward to more information.

    1. At least your ratio’s and trigs are still all ok and don’t raise CHD red flag. Since primal – 4 months – mine have all entered danger zone. I think everyone’s body is different. I’m not going to risk it. Will cut back on meat and cut out dairy. Doesn’t leave much left to eat though !

      1. Eat more fish instead of red meat or chicken.
        Fish raises HDL and lowers LDL.

  41. Mark,
    First off let me say that I really like your blog and have appreciated your straightforward approach to nutrition and exercise. I equally appreciate your insistence to continually come back to the science of the matter. That is lacking in many nutrition and exercise blogs. You never seem to steer away from the more technical aspects of good nutrition and exercise.
    I’ve got to say though that this posting isn’t up to those usual standards. This particular article uses the flawed straw man argument to build your case. You reference “what they say” repeatedly in order to lump the entire health community together into a senseless, unthinking, amorphous drug pusher. Then you turn around and argue against it. That’s an easy and unfair argument. It’s not like you take that approach.
    There are many physicians out there that continually push the scientific edge and know full well that cholesterol testing has it’s limits as do all other tests. We’ve been very pleased with having some the advanced cardiac testing come on line and be affordable. But it’s never the test that diagnoses a problem anyway it’s the reasoned and observant mind.
    Many physicians out there also use nutrition and exercise as the preeminent method to better health. My practice in particular uses no less than six staff member to run a full time wellness, exercise, and nutrition program. No gimmicks just real food and real exercise. In spite of that the majority of my patients aren’t interested in that type of change.
    I have the opportunity to use pharmacology to help extend a patient’s functional years in the hopes they make the appropriate nutrition and exercise changes. When they do it is unbelievable to watch how quickly we can stop their medications.
    To stretch your car analogy a little you can think of my job like being a car manufacturer in a world where most people drive too fast while partially blindfolded and on the wrong side of the road. I work extra hard to build the safest, most crash resistant car imaginable. When they decide to slow down, look around, and get in their lane I become unnecessary to large extent.
    Anyway, thanks again for a great blog. I continue to enjoy your work and am pretty sure I’m getting your 21 day total body transformation book for Christmas. I’m looking forward to it.


  42. Anyone know what the lipid profiles of exclusively breastfed babies are?

  43. Strength training has been shown to increase LDL, this article needs more info or at the very least a follow up article on factors that influence these numbers. My doctor tried to put me on medication for this, have been paleo for yrs and was on an intense strength training regime a the time, my LDL levels were through the roof, oh wait, except my VLDL was almost unmeasurable… Doctors are idiots.

    Many primal people will experience a raise in LDL (the building block of muscle) for this very reason and freakout.

    1. Yes, because LDL is a shuttle of cholesterol trasporting nutrients to the repair sites of your body 🙂

      You were building muscles HARD !

  44. You say you recommend the NMR test, but you failed to mention that NMR stands for Nuclear Magnetic Resonance.
    Research shows that MRI(s) cause cancer and my guess is that the NMR will do the same!
    I would also avoid anything with the term NUCLEAR in it!
    Thanks anyway!

    1. The NMR is a blood test just like a lipid panel. Your blood is sent to the lab and is ran on the Liposcience machine. You have no exposure to an radiation. Please do your research before posting incorrect information.

  45. The NMR is a superior test compared to the VAP. I’m in the healthcare industry and I’ve actually sold both tests. The LDL Particle Number is by far one of the most important values to know. Subcomponents like Lp(a) don’t really give much clinical significance compared to the LDL-P. A patient with an LDL-C of 70 and an LDL-P of 2000 are at much greater risk of having a cardiac event than a patient with an LDL-C of 130 and an LDL-P of 400. See how the standard lipid panel doesn’t give you the whole picture?

  46. Well done article. Im glad that an article such as this can shed light on a fact that evidentally most providers do not explain to patients or maybe even understand themselves. However, im not feeling the love as a provider myself as some are lumping all of us into one class that is against the primal lifestyle. I have been eating primal for about 2 years and have even referred many patients to the primal way of life. Sometimes i joke with them and tell them we are all allergic to carbohydrates. I myself do use standard lipid profiles in order to be able to order further testing such as VAP. Why you ask should i order a seemingly unnecessary test before the VAP? Insurance companies, every one that i have personally called say the same, require an abnormal result on a standard lipid profile prior to allowing an order for further studies. I wish we lived in a world where i could treat everyone the way i and we think is best all the time. Unfortunately i serve a population that must pick between food and testing if their ins co says they will not cover testing. I do not charge an office visit and do not charge a draw fee as others do and still cannot have a VAP covered before an abnormal result and Even then only a select few companies will cover the testing without a significant charge to the patient. Anyway, hopefully we can win some victories on that front. With that being said, i myself agree with primal eating and adding Healthy fats into the diet. I do however Pay attention to my lipoprotein profile and try not to be excessive with my high cholesterol high triglyceride foods. Excessive is a broad/vague term for sure. So i use the test to get a better test. Not the way i want to practice but the way i am required to. Hello healthcare delivery problem. The nasty dictator called your insurance company. To end this rant my point is not all providers are against this incredibly healthy way of life. Love the psyllium suggestion by the way which i also recommend to everyone through my door regardless of ldl numbers. Love living primal and will continue to recommend it to my patients. I have even talked a few into joining Crossfit. Fighting the good fight one 30 minute visit at a time.

  47. “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 determines the size of these particles?

    And, Cholestorol levels are higher the hours after food intake due to fat intake. Every time we eat high fat low carb we get higher cholesterol. This is an argument used by doctors in Sweden why we shouldn’t eat to much fat. What is your take on the importance of cholesterols post meal hours and its effect on long-term health?

  48. As a Brit I was a little horrified at your 160s and 200s my cholesterol is 4.7!

    Obviously moral of the story is check your units! Mine are mmol/l whereas you all are using mg/dl.

    4.7mmol/l = about 180 mg/dl

  49. Cudos to everyone that wants to go beyond a standard lipid test, after all it’s a bit antiquated and the same calculation has been used since the 70’s. Speaking of calculations, both NMR and VAP are calculated tests as well. Though they give more info than a standard lipid panel, they aren’t entirely direct measurements. Both tests use mathmatical equations to give particle sizes. If your going to invest the $100 for an advanced test go with a Berkeley HeartLab test that does true direct measurements and you can also get other markers of inflammation measured. After all it’s about cholesterol quality and inflammation. This testing is available thru Quest Diagnostics. If your Dr’s can’t interpret Berkeley has Clinical Educators that will interpret the test and help the patient understand their risks.

  50. Mark Sisson, I think you ought to talk about Chris’ hypothesis for the dominant cause of decreased liver LDL receptor activity: low thyroid activity. Maybe in a later post?

  51. Anyone know something about cholesterol and menopause? I’m 53. My TC has been around 225 for many years..LDL 121, HDL 77 & Trig 75. I have a genetic predisposition to high cholesterol…my Dad died at 59 of heart disease. Since menopause my TC is 333, LDL 240, HDL 74 & Trig 96. I’ve been following a moderately primal diet for sugar and very little, if any grains. I exercise regularly, mostly weights and cardio intervals. I’m not sure what to do now.

  52. Such an informative post. I never really cared about my cholesterol levels because I figure the docs really have no idea, and I know there is no direct link between cholesterol and CHD. It’s awesome to gain all this extra info, thanks!!

  53. No I am not new to this as some of you claim. I have read extensively of Marc’s tirades and the comments here. I am well aware of Primalology. I am not anti-primal but I question it.

    But it is clear, not all, but at least some people here on this thread have shown that Primal has elevated their cholesterol and triglycerides, which is what I expected. We have the facts right here above us. Eating loads of animal fat, which is what Marc preaches about, such as telling you to eat the skin of chicken, lots of lamb, and eggs, and even bacon to be eaten freely.

    Entire civilizations around the world eat rice and grains, and many of them are very thin and live long lives. The only point this makes is that grains do not equal evil nor equal overweight. That doesn’t mean they are entirely good, but obviously, if 99% of the world lives on it, it can;t be ruled out as nonsense.

    Now wheat is a whole different story. Wheat has many problems, that other grains do not have.

    Marc’s whole theory on evolution being the reason we shouldn’t eat grains is irrelevant. The only thing that matters is what diet is the most healthy for long term health. It makes no difference what cavemen ate.

    I, personally, do not know the best way to eat. So I am not saying I have anything better to offer. I do know, everytime I take grains out of my diet, I have no energy to lift weights and I feel very weak. I also know many body builders did not go primal, and many centurions did not go primal.

    What I do know is there is some evidence above that shows cholesterol and triglycerides have risen in SOME people after going primal.

    And the one thing we all know for sure, is Marc’s main goal is to sell products, as almost any diet guru, and there is no real way to know if he even follows what he preaches or not. For all we know, he could be eating rice and Cheerios. He may follow what he preaches 100%. All I am saying is we don’t know.

    In conclusion, I really don’t know, but I try my best.

    1. Your way out of your depth and need to do some reading especially seeing as though you question the motives of the site owner. Fool.

      For most people, cholesterol going up is a good thing, a very very good thing.

      99% of the world live of grain because they are either addicted, cultural/religious reasons or its simply the cheapest way that they can put food into their bellies.

      Eat your grain.

    2. I am an example of the SOME people. My TC, LDL and TGs all went from safe to dangerous after 4 months of high (good) fat and severely restricted carbs primal diet. No 2 bodies are the same.

  54. Very interesting article and comments. I have a newfound interest in this topic, just having received a new set of blood results and my doc recommending Lipitor. This was shocking to me as I work hard to stay fit and eat the right foods. I seek to avoid any drug meds whenever possible. I am writing to this forum to see if anyone has insight into these results. 50 yr male, outstanding health, competitive cyclist, supplement cycling with crossfit WODs, 5’11” 170#. I try to avoid all processed foods most of the time.
    TC 212, HDL 67, LDL 133, VLDL 12. TG 59. LpA 160
    Q1. With the TC and LDL borderline high by AMA standards, is this a concern?
    Q2. What could be the root cause of the high LpA? How can it be reduced? Does Lipitor reduce LpA?

    1. Are you paleo/primal? What does “eat the right foods” mean? I know plenty of people that eat the right foods as per the food pyramid, if your new to this site then you may have some further reading. Post more info about your diet. Do you eat grains?

      Your body likely needs to repair based on your work output. I would say get your diet right and you will have no problems. Regardless of what your doc says.

      1. No, I am not paleo. Tried it earlier this year and then fell off the wagon. Yes, I eat grains. By the ‘right’ foods I should have said that I avoid what I consider trash and junk foods, for example fast food places, junk foods, cookies, candy, all kinds of soda, etc. I guess the ‘right’ foods are in the eyes of the beholder. My typical diet includes stuff like daily oatmeal/blueberries, a daily almond milk/blueberry/kale/whey protein smoothie, fish and lean meats, yes – pastas, yes – some breads, mixed nuts, lots of vegetables, many Hammernutrition products before/during/after the workouts, etc. Your comment about my body needing repair is relevant.

        1. A competition athlete will need an amount of LDL in their system higher then a normal person by nature of the training they do, its a critical part of muscle repair. Most doctors do not know this.

          Someone with the discipline to be a competitive athlete can ditch the oatmeal, pasta, breads etc and not “fall off the wagon”.

          1 CHOL test is not enough anyway, you need regular monthly tests to see if its a trend. Why not get off your but and put as much discipline into your diet as you do your training and assess every month for 3 months.

          Go paleo, get your body fueling itself more on fats, and supplement with sweet potato and other tubers where necessary to support your endurance needs. Also, what is your CRP and HbA1c?

          I bet both are high and these are much more concerning then some cholesterol numbers.

    2. Lp(a) is an atherogenic particle attached to your LDL. It’s dangerous at levels over 30 b/c it can cause clotting. This molecule is inherited so mom or dad probably also had elevated Lp(a). Lipitor won’t treat it, only med that brings it down is Niaspan but your Dr may be thinking to address the LDL more aggressively since you have the additional risk factor of Lp(a). Niaspan however can treat both LDL and Lp(a).

  55. “Your way out of your depth and need to do some reading especially seeing as though you question the motives of the site owner. Fool.”

    So critical thinking is not allowed here?

    You do realize Mark became an olympic athlete with a stellar physique when he ate grains daily right?

    I just don’t see justifying high LDL and eating large of amounts of saturated fat. And please explain to me how most of the world eats grains daily and they are not all obese.

    You can read a website filled with testimonials of people who say being vegan was the best thing that ever happened to them. My Uncle is on a high fat, high carb, low protein diet and swears it helps keep his diabetes in check. Some people say Atkins is the way. Anything can be spun in any direction.

    Grains probably aren’t so great because they are a dead food. But what about sprouted grain? I don’t know, but I do know seeing grains as the root of all evil is a bit ignorant.

    1. what your doing is not critical thinking. your attacking motivations without even bothering to read.

      Your a waste of time.

  56. Dan,
    You said “Someone with the discipline to be a competitive athlete can ditch the oatmeal, pasta, breads etc and not “fall off the wagon”. I totally agree and will say it is a belief issue whether the paleo diet is far superior diet to what I currently eat. If I knew for sure it was superior, I would stay on it. But, the data overwhelms from both sides. How to know for sure that paleo is the WAY to go?? I read the paleo diet for athletes and found it somewhat convincing.
    Re: CRP, it’s 0.4. I have the lipids checked at least annually and have all the numbers in excel. They are practically constant aside for statistically deviations. I’ve got a request into my doc for a full lipid retest. Thanks for your candor. HbA1c is 4.5 from a few yrs ago.

    1. HbA1c is a measure of sugar in your system effectively over the last 90 days, you should prob check that out as I would say your diet might drive it higher, unless you have a very efficient pancreas and that will only last so long.

      CRP is frankly unbelievable. Seriously, 2 things that drive it up are a high work output aka athletic training and grains. You may be one of the very few genetic freaks.

      I wouldnt go the paleo diet for athletes, its old, there is better info around, especially this site.
      Even Cordain is revising a lot of it, the science is always evolving.

      If you cant make the switch, if the science is so great on both sides, try either of the following.

      1. Replace the “essential carbs” you get from breads/grains with another paleo friendly carb, what is your net result? Same carb intake (except a bulk of additional other nutrients from paleo friendly carb sources).

      2. Buy a blood glucose monitor, measure yourself before and every 30 mins after a meal until your blood sugar goes down. Then compare it to a paleo meal.

      Nothing convinces like watching your blood spike after that bowl of spagetti.

      Still unconvinced? Try the drugs. For my money it would be 3 months of this “fad” diet first before I put anything like drugs in my system.

  57. Dan,
    Thanks, I will take your advice. I plan to remove all wheat and grains from my diet and replace them with the paleo friendly carbs, and go mostly paleo on everything else. I also plan to incorporate additional vit C, Niacin, l-lysine and l-proline into a daily cocktail. I’ll give it 90 days and get retested. The drugs will sit on the shelf for now. Have you seen anything effective at reducing Lp(a) levels? Niaspan? What is your background? Thanks!

    1. I havent seen anything that reduces Lp(a) frankly im yet to see ANYTHING that proves cholesterol of any kind causes CVD so take my sentence with a grain of salt.

      This is where this whole thing just falls over. No one can agree. The tests are useless. Humans are inherently difficult to study. Im sure Chol lowering drugs lower chol of all kinds, im also sure that if my body will make what it needs if it cannot get it from diet so why would I screw with that with drugs?

      For so many people, they make the connection between the failure to recommend a healthy diet, but cannot accept that they get cholesterol “science” wrong.

      I repeat for everyone. There is no science that says chol=cvd. Saying cholesterol causes heart disease is like saying breathing air causes heart disease. Everyone who has a heart attack was breathing air right before it happened. STOP BREATHING PEOPLE.

  58. I understand and believe that many primal/paleo eaters lower their cholesterol. However, I’ve been eating 90% paleo for 8 months and just got the results of my test. 282 total, 105 tri, 63 hdl, 198 ldl. All numbers are up significantly since pre-paleo tests. I’m not comfortable living with these numbers and plan to go back on a statin (5-10mg). But will continue to eat paleo since there are so many other benefits.

    1. The medical community got diet so wrong, not possible that they got the science of cholesterol so wrong?

    2. Triglyceride is strongly related to the carbohydrate content of your diet. Primal does not necessarily mean low-carb. Plenty of primal high sugar fruits and starches around.
      I strongly suggest you take a look at your diet and try to keep the carbohydrates low (under 100g for ex.), and then do the test again.

      I also think you should hold off on the statins. Besides the fact that they have serious side effects, they are supposed to lower cholesterol not trig.
      According to the mayoclinic, even “the AHA doesn’t recommend drug treatment to reach this level. Instead, for those trying to lower their triglycerides to this level, lifestyle changes such as diet, weight loss and physical activity are encouraged…”

  59. This is GREAT information and a much appreciated post. Just a month ago my CW doctor suggested “treatment” for my cholesterol (i.e., statins). I told her that although she was welcome to prescribe them it would be a waste of time because I wouldn’t take them. This was based on a gut instinct that after 10 months of revitalizing primal living, statins would do me more harm than good. This post confirms for me that I made the right choice, and I really look forward to learning more in further posts. Thanks again, Mark, for being such an inspiring resource!

  60. This is really unbelievable. All these people here who have cholesterol through the roof, yet so brainwashed by this Primal cult, that they still refuse to see this is not healthy and still will continue to eat a high saturated fat diet. Mark is not a physician. He is just taking info from other people’s books and posts to make blogs to sell products. He may not even write half the stuff. This is called blog marketing.

    Who in their right mind thinks a high saturated fat diet is healthy? Even Rob Wolfe Oh Holier Than Thou Mr. Paleo says eat lean meats.

    Primal people did not live long. You can spin it to say well, they died from infections or infant mortalities or blah blah blah. But all we know is they did not live long.

    Do what is healthy. If grains isn’t your thing than you don’t have to eat them. If you want to be anal like that then go do it. But can you rule out all the data showing high saturated fat leads to heart disease? I suggest you take a trip to Asia, where I lived for 4 years, where we see very thin people who eat rice 3 times a day.

    Red yeast Rice and Plant Sterols may help lower cholesterol. I suggest you look into it if you need to. There are a number of products on the market and I heard they produce stellar results. See, look, I told you more about lowering cholesterol than anyone else on this site and you don’t have to buy anything.

    1. After reading Gary Taubes and others, the science seemed to me to support the hypothesis that (1) carbs stress your system and (2) saturated fats are not a problem if you’re severely restricting carbs. So (as a healthy, fit, slim 46yo male), I tried the carb restricted-high fat primal/paleo diet for 4 months. I did get even leaner and felt good BUT (for the first time in my life) all my blood lipids entered danger zone, INCLUDING triglycerides.

      I don’t fault these paleo/primal believers as I’m sure it suits some people’s bodies/systems/health. But I must be one of those few people for whom dietary cholesterol indeed has a big impact on blood cholesterol and triglycerides.

      I’m gonna back off the animal fats and replace those calories by returning to some sprouted grain bread and more fruit.

      1. Im upset that you can make the connection towards the failure of science and what dietary recommendations made the world unhealthy in the first place, but cannot make the connection that perhaps they got it wrong on cholesterol as well?

        Maybe they dont know what they are talking about there? Really so hard to grasp?

    2. Your ad hauc criticism is pointless. All you do is exclaim about how this is a blog and how can people eat, *gasp*, saturated fat. Have you even bothered about reading the science behind all of this.

      Most of the people here who’ve got cholesterol through the roof, have that because they’ve been eating the typical American diet for years. Improving their health is why most people visit this blog.

      And if you’ve lived in Asia, I’m sure you’ll notice the very small quantities and portion sizes of the “white” rice they eat. Be specific. Not all asian diets are healthy, nor do all asian countries have the same life expectancy. Some are actually pretty bad. Being thin is not a measure of health.

      Most of us have done our research and are not relying on just a couple of blog posts to change an entire way of life, and the reason we continue is because we’re seeing the results.

      1. Those are my test results after longer than 1 year paleo/primal and no carbs other than sweet potatos and veggies. My labs are ridiculous and there is no way to ‘spin’ them and say they are good. I have an extremely serious life threatening medical issue going on inside an otherwise SUPER HEALTHY (i can outlift, outrun 99% of human beings) body. I know that eating a chocolate cake 4 months ago didn’t cause this. And the apparent misinformation on the internet (Sat fat causes high LDL, Sat fat does NOT cause high LDL) is frustrating, infuriating and makes me want to bang my head against the wall.

        1. Hi Bill. My reply was for Jeremy.
          In any case, I’m not a doctor (though I do have familial high cholesterol… sigh) those are just one set of test results. I think you should definitely get tested again and hold off on the panic attack until then.

          Reading your link, “Whey\Casein protein most days”, might that be protein powder? You already follow a seemingly pretty low carb diet. Drinking protein powder on top of that could make this a very high protein diet if you’re not getting enough fat. Reading around, this can trigger problems in the kidneys/liver, which will really get your cholesterol up.

          On top of that, you seem to have a high lymphocyte monocyte count. Were fighting off a cold or something? Because cholesterol goes up when you’re fighting something off.

          Also, you seem to eating a very healthy diet in general. Why so many supplements. Run a typical day’s diet on a site like fitday or something, and see if you are getting all of your nutrients. You may be simply getting too much of something, I don’t know. I’m guessing here.

          I think you should stop all the supplements and whatnot for a while, eat real primal food, and make sure you include plenty of fat in there.

          Never rule out a mistake at the lab either.

  61. Bill, I totally empathize with your frustration. The fact of that matter is, that no one is going to be able to come up with the silver bullet answer that is going to definitively tell you exactly what is the perfect way to deal with your test results. Cholesterol impact and understanding is not clear in science, literature, or the body of anecdotal information, and your numbers are not something that screams out “YES! This is because of X and can be changed by not-X or Y!”

    My own personal suggestion: if your cholesterol levels are increasing your risk heart disease, and are affecting you dangerously, it would be identifiable by a cardio stress test. You can monitor that periodically and if you still are heart-healthy then keep eating paleo.

    A number of the suggestions like cut out the coffee, and cut out the whey, etc. are all reasonable suggestions – they’re trial and error, too, of course. Testing for familial hypercholesteremia might also give a reason for why yours are particularly high.

    I’m leery of the statins for the sake of simply bringing the number down, mostly because it seems that the folks who have had problems with them are the ones who are most healthy otherwise when doctors put them on the drug. There’s less understood about what they do than I’m comfortable with, and until something shows that this cholesterol level is truly harming you, you shouldn’t consider yourself to be unhealthy.

    I think finding out as much as you can about it is a good thing to do, but when evidence appears contradictory, it’s hard not to throw up your hands. Some more tests, some changes in your diet, they’re part of the process. But trust how you feel, too. You ARE healthy.

  62. I am not saying they take the place of statins, but Red Yeast Rice and Plant Sterols are showing some very good results in lowering cholesterol for some people. I’d suggest looking into these products n iherb or something if you need to lower cholesterol. Worth researching, that’s for sure.

    We need saturated fat just not a lot of it. Every medical study on the planet shows we need to eat a low saturated fat diet. The SAD is high in saturated fat and calories. A burger has extremely high fat content. It’s not because of grains. Your grandparents probably ate white rice and white flour and potatoes growing up all their lives every day and I bet they were damn skinny back then. The foundation will always be how many calories you eat. Calories in vs. Calories out is not a myth! Cutting out carbs you are eliminating a lot of calories throughout the day. It isn’t 100% but calories is the core.

    You see Ryan Reynold’s body? Brad Pitt Fight Club days? They ate grains. They weren’t primal. They didn’t have stomach bleeding out into their stools, and were;t rolling over in digestive discomfort all day. Grains may or may not be for you, but come on, let’s be realistic here. Medical science distorts the truth to sell drugs, but they aren’t totally off.

  63. Jeremy reminds me of an overly-opinionated middle schooler with a fundamentalist upbringing arguing with a developmental psychologist who researches adolescents that sex ed should focus on abstinence only curriculum because some people get stds or pregnant after honest sex ed curriculum.

    Diabetes is now ravaging Asia as high carb and transfat junk is unleashed on these new consumers by the transnationals.

  64. Obviously whole grains like brown rice and quinoa are way better than refined ones like white rice or white flour, but my point was healthy and thin people have been eating grains for a very long time without problems, so to chalk them all up as unnecessary or the root to all evil or even the sole reason why people are fat, seems unjustified. Go as what your grandparents ate when they were growing up.

    My example with Asia was referring to the traditional Asian diets wiseguy, veggies meat and white rice, noodles and fruit, not modern additions such as KFC or McDonalds and potato chips that seem to be infiltrating like mad there.

    The intelligent people, who aren’t bound by “Primal” Dogma will understand the point I was making. Those who are hell bent on upholding their belief system will get angry and insult me.

    Either way, Mark sells his products, which is the whole point of this site really.

  65. I meant “Go ask what your grandparents ate when they were growing up, to see the all grains are evil scare is nonsense.”

    What about the health benefits of fiber?

  66. If there is anything to be taken away from this website, I would think it would be that PROCESSED FOODS are probably what has caused an increase in obesity. The chemicals inside the foods we eat today (which are VERY diffrent from what our grandparents ate) are probably messing with our insides in a way that isn’t completely beneficial for us.

    I don’t think anyone should be so hypnotized by one idea – whether diet, religion, politics, or brand name – that it causes anything against it to not even be worth talking about. However, I would say just about all of us have tried the “eat whatever we want when we feel we want it” diet, and had less than stellar results. Seeing as we’ve tried an alternative, it seems worth it to me to try this primal one.

  67. After completing a PhD in exercise physiology and teaching it for years, my research is helping me to ‘unlearn’ half-truths that we’ve been taught for years (even in Universities).

    You’ve done a great job of explaining these complex processes in a very simple way Mark.

  68. After 6+ months on a low-fat, liquid protein diet my cholesterol numbers dropped from 223 to 201 with corresponding changes in HDL, LDL and triglycerides.

    After 5 months on Paleo my cholesterol numbers rose from 201 to 225 with corresponding changes in HDL, LDL and triglycerides.

    When I see my cardiologist on Monday I expect to be chided and encourage to take statins, to which I am overly sensitive, e.g. severe & crippling muscle pain and weakness. I don’t view statins as an option, so what shall I do instead?

    Background: my grandmother died of a massive heart attach @ age 51. My mother had quad bypass surgery two years ago due to four clogged arteries. Obviously, my goal is to avoid their fates. Please help. Thanks!

    1. I wish I could have replied to this several years ago.

      You brought your TC right into the middle of the ideal range. “Ideal”, meaning lowest all cause mortality. What could be more important than that?

      Without knowing the other numbers nobody can comment on them but I’m willing to bet that the ratios aren’t the same at the end of that vs the start…

  69. Anyone care to comment on these numbers? I took a wellness screen January of 2011 through my employer. At the time of the screen I was less than a year out of college and had a terrible diet. Key points: I averaged around 6-8 beers per day, fairly SAD – lots of processed foods, decent amount of sugar. 6’1″ 210lbs. HDL = 39, LDL = 145, Tri = 164

    Around May I learned about LC, adopted in June essentially as Atkins. Slowly started finding Paleo/Primal and adopting that lifestyle. Completely cut bread & grains out, still had some dairy in the form of cheese and occasional ice cream. I’ve probably had 10 beers since Thanksgiving and now drink wine, mostly red, and not to excess like I did with beer. My meals are all homemade, I get local meats and veggies, I use A LOT of Kerrygold butter, and I’ve added white rice and some potato back into my diet the last few months as I’ve increased my workout intensity. Today I’m 6’1″ 165 lbs …Took another wellness screen 3 weeks ago and…drumroll…
    HDL = 41, LDL = 127, Tri = 191 …WHAT?!?! FYI, I was on an 11 hour fast at the time of testing.

    I’m confused and concerned at this point and once I finish this post am ordering an NMR test and will be taking that ASAP. I honestly am shocked at my Triglycerides and actually quite worried.

    1. Just read the follow-up to this post. Maybe I won’t go for an advanced test. Now I just don’t know what to do…

  70. Don’t mean to spam but I thought of a little more info that might be relevant. The last 4 months or so I’ve been intermittent fasting. My first meal is lunch around 11:30 and then depending on how hungry I am when I get home I may eat as early as 5 or as late as 8 or 9.

    This is quite frustrating, I’ve really prided myself that, with the exception of occasional ice cream, I essentially removed sugar from my diet quite abruptly. If you thought I drank too much beer I’d love to hear your comments on my Oreo addiction.

    Trying to give an accurate timeline of things I’m realizing that I’ve made quite a dramatic change, multiple actually, in my lifestyle in just 9 months. Maybe I should give it another 3 months or so and get another standard lipid profile. Maybe my body has never really adjusted to anything since I’m constantly tweaking things. Still, Trigs at 191 is ridiculous for a moderate carb paleo eater.

    For the time being it looks like ice cream and I will be parting ways 🙁

  71. had a blood test,and under the word Lipid was this comment CHOL/HDL RSK 2.9 L (3.8 – 6.9) I am asuming this mean my good cholesterol is low,Does anyone see it that way? Thanks, John

  72. Hi Guys,
    Could someone please help me understand my numbers? Do I need further blood work due to my present numbers, and if so what am I looking out for? I’m a 37 yr old male, 5.8, 7.5% BF, 160lbs, 29-30 waist size, exercise regularly. Been on a paleo type diet for about a year now. Very low carb, less than 100g per day. I’m gonna give you all my numbers from before I switched from a high grain high protein low fat diet to the paleo type diet with around 9-12 ounces of animal protein per day, I switch my fats through the day, roughly one TBsp of olive oil, 1 tbsp of walnut oil for lunch, I cook all my proteins in either raw butter or coconut oil, I may have one ounce of raw almonds or 1 tbsp of almond butter raw or 1 scoop of coconut butter for a snack each day. 2 whole organic eggs per day. Lots of salads and 3 servings of steamed or sauteed greens per day. All I drink is mineral water. Please help me understand my numbers!

    High Grain High Pro/low fat diet #’s

    Trig’s ?

    6 months into paleo diet


    12 months on Paleo diet


    Thanks for your time!

  73. Just got my blood test back and triglycerides were at 540…very high. I haven’t totally eliminated all sugar and grains in my diet yet, but I have reduced it. Completely stopped drinking sugared soda and changed to diet (I know, not ideal…but better than drinking the sugar).

    The LDL cholesterol was so low that he couldn’t measure it. HDL was over 200.

    Doctor wants me to get on medication. What do you guys think?

  74. Love the information! But as I live in Australia my lab results for cholesterol are not in the same value format as used in the USA. Do you have anyway to convert this?

  75. total : 215
    hdl: 57
    ldl: 142.60
    VLDL cholestrol: 15.40
    Triglyceride: 77
    tc:hdl : 3.77

    I have been primal for about 2-3 months. I have eaten clean for 90 p/c of the time. I had a few pizzas but it was totally within the 80-20 rule.

  76. I need help interpreting my blood test numbers. For reference I’m a 20 year old male who went low carb high protein February of 2012 and has been paleo for about 2-3 months. I used to weigh 155 and dropped to 130-135 with a fair amount pf running and swimming and pushups situps jump squats burpees etc. Lowered my blood pressure also. A typical diet would be
    Breakfast: two eggs, chopped onion, chopped carrot, dices tomato, handful of spinach, protein from dinner
    Snack: (2x)spinach salad with protein from dinner
    Snack: nuts, mostly almonds or walnuts
    Dinner: protein and whatever vegetable around
    My biggest concern was that my meat was normal supermarket bought. I couldn’t get my hands on grass fed. I don’t have blood test numbers pre paleo.
    TC 373
    HDL 81
    TG 61
    LDL 280
    Chol/HDLC 4.6
    Non HDL cholesterol 280
    Both my parents are on statins and I refuse to go on statins. My normal doctor is sending me to a cardiologist with pure hypercholesterolemia.
    It baffles me though. I used to NEVER exercise and would eat just about anything I wanted. I did follow the “low fat” diet but that only made me want candy, breads, white rice, pasta, etc even more. I don’t understand how losing weight and body fat while going on an all natural diet puts me more at risk for heart disease.

  77. Can someone tell me if it’s possible to do a self-referral cholesterol test in Aussie? Or, do you have to go through a doctor to get one?

  78. well . . my test reading for total cholesterol is 4.1, how to convert that to the other type of reading and mostly used

  79. I just got my cholesterol results and am curious about taking cholesterol medication. I’m 75, had a minor heart attack in 2006 and have had no problems since then.
    My LDL is 107, HDL 111, and Triglycerides 71. Total cholesterol is 232.
    With such high HDL and Triglycerides, why do I need to take medication? My HDL has always been high but this is the highest it’s ever been.

  80. Switching to a sorta (I’m just not a good follower; I tend to synthesize things and make up my own program) Primal/Paleo/Low-Carb diet that’s fairly heavy on fatty meat (I love the taste of it!) my triglyceride/HDL ratio fell by about 75%, from normal to really, really good (about .6). So much for the CW we’ve been fed about reducing meat consumption to improve blood work.

  81. I am totally happy and my Doc thinks I am a superman.

    74 years of age.
    Primal for 1 year plus.
    Quit smoking 4 years ago.
    Total cholesterol ~ 171
    Triglyceride ~ 101
    HDL ~ 52
    LDL ~ 99
    Ratio ~ 3.3
    I feel grrrrate!


  82. I suspect we are just beginning to understand the interplay between mind-body and spirit around the issue of hormones and blood fats. There is more to the problem than meets the eye here…


  83. Hello, my husband 59, with CAD (two stents ), Type 2 diabetes, Anemia , Blood Test on Dec 18, 2015 are : HCT 36.7 , HGB 11.7 , PLT 132
    Blood Test on Feb 3 2016 are : Cholesterol 148 , High Density Lipoprotein 29, Low Density Lipoprotein 98, 25 OH VIT D (TOTAL) 23 ,
    Please , explain something to me, I am worried.

    Thank you so much !

  84. Nice post. I learn something more challenging on different blogs everyday. It will always be stimulating to read content from other writers and practice a little something from their store. I’d prefer to use some with the content on my blog whether you don’t mind. Naturally I’ll give you a link on your web blog. Thanks for sharing.

  85. I am a healthy, athletic person who has been paleo for a few years. I did go to a higher carb phase over the past year due to wife’s pregnancy and mostly for convenience. Stress has been high due to baby and job change. Had my health screening at work today with shocking results:

    Total: 252
    HDL: 52
    LDL: 186
    Trig: 73
    Total/HDL ratio: 4.85
    Glucose: 90

    I loved that they mentioned stroke and other dire things. Not to mention asking if I ate red meat or a lot of “pigs.” In addition to going low carb , I plan on taking red yeast rice and fish oil but is this really anything to be concerned with?

  86. I have been looking for the cheapest cholesterol panel test in the US. Any ideas? I have checked a few and seems that may be the cheapest but want to make sure. Thanks

  87. I had a catherization 8 years ago, and the cardiologist- a very able man- told me “maurice you can go home you have arteries like an 18 year old. I was 60 at the time. I guess that would correlate to my LDL being 54 the last time I took a blood test. My total cholesterol was 177. The only problem is that my tryglecerides are high at 451, but it appears to be genetic, as my mother lives at 102!