High Cholesterol – Low Triglycerides

I recently got my lipids tested. Unfortunately I do not have access to detailed subfraction tests so I was only able to get the high level numbers.

I’ve been low-carbing for quite a while now. I’ve generally had good cholesterol figures so this would be telling for the increased consumption of fat in my diet.

The results, however, were a bit confusing:

Total cholesterol
  229 – high
54 – low


My total cholesterol number has climbed significantly over the past 2 years (it was ~170 before) which is a concern. However the low triglycerides with the high cholesterol figure gives contradictory risk indications for heart disease.

Now I’m aware that not all LDL are created equal but I wanted some definitive advice on this point (it wasn’t coming from my doctor who didn’t even remark on the triglyceride number).

In my searching, I found this interesting and succinct comment on the subject here which I am reprinting as it addresses my question directly:

LDL cholesterol can be broken down into two kinds, pattern A and pattern B. LDL pattern A is large fluffy particles that are less dense than pattern B and not easily oxidized. LDL pattern A is essentially benign with respect to heart disease. LDL pattern B on the other hand is small dense particles that are easily oxidized and more closely associated with heart disease. It has been theorized that the harm to the arteries is associated with oxidized cholesterol. Ok, enough about that. To summarize, LDL pattern B (think small dense BBs) is bad, LDL pattern A (light and fluffy) is not a problem.

Now you would think that the lab actually measured your LDL, but they likely didn’t. Most labs just calculate LDL from the following equation:

LDL = Total Cholesterol – HDL – triglycerides/5

So from this, you don’t know if you are predominately LDL pattern A (no big deal) or predominately LDL pattern B (much more risk). Some labs do have the capability to measure the LDL gradient and can determine your predominate LDL pattern type. However, there is another way. Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (the non risky kind), and conversely, a high triglyceride/low HDL level is strongly associated with LDL pattern B (the harmful kind). This is one reason that high triglycerides alone are an independent risk factor for heart diease.

Ok, where am I going with this with respect to your situation. Other studies have shown that a high triglyceride/HDL ratio is the best indicator for heart disease risk (approximately 8x better at predicting heart disease risk than high total cholesterol alone). A triglyeride/HDL ratio of 5.0 is moderate risk and the higher the number, the higher the risk, while a ratio of <2.0 is very low risk.

From what I have just described, you can see that with your very low triglyceride level (<100) and moderately high HDL level (>50) you are at very low risk of heart disease. Also, your very low triglyceride level indicates that your LDL is predominately pattern A, the harmless kind. If you are still concerned, you can have your LDL gradient measured to determine your LDL pattern type.

I wouldn’t even remotely consider cholesterol lowering medications without knowing your LDL pattern type to see if there is any risk associated with your lipid levels because there are potential significant side effects (muscle damage, neurological damage, liver damage, even death – i.e. the Baycol recall) associated with many cholesterol lowering medications (statins in particular).

Oh, and I think that your low sugar, lower carbohydrate diet is the way to go to lower your risk of heart disease because of the positive effects it has on triglycerides and HDL.


Unfortunately the mystery man Alan does not provide any references however this is broadly in line with what I have read elsewhere. My triglyerides/HDL = 1.18 which suggests, according to Alan, that I am very low risk for heart disease.

I will, however, get my LDL gradient tested at the first opportunity.



Follow Up Here: How Gluten Free Impaired my Cholesterol Numbers



42 thoughts on “High Cholesterol – Low Triglycerides

  1. I am in a very similar situation with very low triglycerides, high total cholesterol and LDL, high HDL, very good ratios. My doctor wants me on Zocor, and doesn’t much care about anything but the high total and LDL. I’ve read about the subcategories of LDL, and would be interested in whether anybody here has has test results. Next week, I’m going for the Life Line Screening to see what if any damage has been done.

    On another note, you should all know that a friend of mine, who has never measured above 190 total cholesterol, went through the screening 5 years ago just to be sure all was well and was found to have 4 times the blockage of a normal person of his age, and this was verified later by his doctor. There are other factors involved, obviously.

  2. Let us know how the screening goes.

    Your friend’s experience underlies the point that cholesterol is a very rough indication of risk of plaque. The key is to find out the small LDL particle number.

    This is exactly your friend’s story in a nutshell…
    Why average cholesterol values can be so bad: http://ow.ly/2Tni

  3. By the way, Dr. Davis JUST did a post on this very same phenomenon…


    My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John’s or Sam’s:

    LDL cholesterol 154 mg/dl
    HDL cholesterol 93 mg/dl
    Triglycerides 36 mg/dl
    Total cholesterol 255 mg/dl

    My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.

  4. I’m pretty sure that low triglycerides and high HDL are the God gene. I’m a 57 yr old male with 185 TC
    76 HDL
    103.5 LDL
    29.3 Triglycerides
    BP 106/60
    resting pulse 48
    This is similar to my entire family. My maternal grandfather died at 104, my maternal grandmother died at 92, my paternal grandfather died at 94 and my paternal grandmother died at 101. Both parents are alive and healthy at 87.

  5. Cheap Labs use something I call it the Phizer Formula.

    LDL = (Total Cholesteral) – (HDL) – (triglycerides * .2)

    It pretty much ensures that anyone who eats their fish and vegetables and exercises and has a doctor that doesn’t read medical journals once a decade gets put on a statin drug

    LDL is expensive to determine. But total cholesterol is easy and so is HDL. HDL is fluffy and stuff, so it’s easier to separate out. Anyway for the OP:

    LDL = (Total Cholesterol) – (HDL) – (triglycerides * .2)
    in your case that’s
    229 – 64 – 11 = 154! surprise

    If you wanted to decrease your LDL and thus total cholesteral, you could simply raise your triglycerides. Lets say your triglycerides were 200. Then:
    229 – 64 – 40 = 125! Much better! You should work your triglycerides up to 400.

    It is Phizers chewbaca defense. In order to lower your cholesterol, you must increase your triglycerides. It makes no sense. So why not just accept the $100 a month statin your doctor is pushing on you? Pharmaceuticals helped pay for his school, show some sensitivity you insensitive clod.

  6. Pingback: Why Are My Triglycerides Low

  7. Hi, just found your blog. Your cholesterol/triglyceride profile is like mine. It’s been like this for years through different health problems too and I was confused. Naturally the doctors just smile and say “next” or once recommended statins. So now I have an explanation and proof that there are other people like me –i.e. very low trig, high cholesterol and borderline high LDL.

  8. I’m a little confused. I’m 30 and my total Cholesterol is 216. My LDL is 161 HDL 39 and Triglycerides are 82 TC/HDl Ratio is 5.6. My doctor tells me I need to be on a lovastatin 20mg but my triglycerides are normal? Can someone share their thoughts?

  9. I am 22 years old (female) and eat a pretty healthy diet. I recently started taking Krill Oil to help my #s because my cholesterol is extremely high. Of course, the only advice I got from my doctor was to take Lipitor. I am 22 for god’s sake. Here are my numbers (pre-Krill oil, I will take a blood test in a few months to see if it effectively lowered my #s):

    Cholesterol: 321
    Trigs: 58
    HDL: 63
    LDL: 247

    What do you guys think? I read that cholesterol does not matter if you are a woman. I appreciate your feedback!

    • Irina, I too have been confused on this cholesterol tests. I had one doctor who said everything was great, but more recently they don’t like the high LDL’s. I thought I was doing everything right, fish oil, lots of fruits and veggies, nuts, avacado, olive oil chia seeds. I juice, work out several times a week, intense as well as pilates and yoga. My HDL is higher which I know is good 70, my trigs are the same and my LDL is 186. Blood pressure is low, blood sugar is good and no health problems. However, got this crummy LDL stuff that the doctors do not like, but they would dislike yours even more. Now, since I do love protein and low carbs I realize I eat of lot of cheese, dairy. This has kept my bones stronger than a 20 year old along with the exercise as I my reading was off the chart for women in their 20s for bone mass, and I am only 21% body fat. however, I think I when I get my readings I have a lot of fat circulating around. Possibly fluffy and not getting stuck, but I am going to eliminate the dairy fat for a few months and see how the reading goes then. I am 50 and did have EKG’s and stess tests and they were normal. Haven’t hit any perimenopause yet either. So try eliminating dairy fats if you aren’t now. Thanks Trina

    • Are you on the birth control pill? My 19 year old daughter had extremely bad numbers. High LDL, low HDL, high triglycerides. She eats a pretty healthy diet. Her doctor recommended she go off the pill for a few months and retest. We won’t know until May, but it’s a thought. Google it and there are several mentions of it.

  10. Hi Irina,

    I suggest you get your LDL Gradient Test to see what LDL Pattern you fall in. My husband has almost the same numbers. Your Trigs are low and your HDL are high; which reflects the Pattern A LDLs which are the nice fluffy lipids that are benign to heart disease. It’s a good thing. You’re doctor is being lazy and a pill pusher. I know a lot of doctors (personally) and they know they tend to be that way because of the demand of their job.

    I hope this helps!

  11. Let me rephrase that last part. Not lazy, but they do what is suggested to them in the medical field, which is usually prescriptions for high cholesterol without any thought about the differences in types of LDLs.

  12. Can anyone help me with my son’s readings?? Please? About 6 months ago he developed Microcyntosis and in the last month, Cholesterol issues.
    Total Cholesterol- 215
    TRI- 56
    HDL- 62
    LDL- 142
    VLDL <60 (greater than)
    He is 8, very active, not obese, and no family history that we are aware of. We are in a small town, and just wondering if we need to get another doctor for these readingd. His psychiatrist is the one who ordered the blood work and told us. His pediatrician see's nothing wrong with any of this. Any help would be greatly appreciated.. Thanks!

    • Hes 8! He doesnt need cholesterol tests! His body is growing and changing, hormones are doing all sorts of jobs. That is not a concern for children. I WOULD NEVER listen to a psychiatrist for blood lipid control either. I would listen to his pediatrician. Breast milk, for babies, is LOADED with cholesterol. Should be make nursing mothers take statins so that can be reduced? F-NO!

      Sorry, Im not yellin at ya! Just see this too much. Your kids fine, if you feel uncomfortable read up on Chris Kresser, Chris Masterjohn, Dr Tara Dall, and many others. Google Cholesterol Sceptic etc etc.

      This is, of course, just my opinion.

  13. It will be interesting to see your gradient when you get it. You say you’ve been low-carbing, is this something you’re still doing? I am taking statins for my cholesterol but this is purely a result of my previously unhealthy diet and lack of excercise.

  14. My 47 year old husband has had routinely bad lipid numbers. We went totally vegan with only whole grains and no sugar for two months before his most recent lipids check. His numbers were worse!! Has anyone heard of this? He eats mostly fruits and veges, limited oil and then only olive oil. No processed anything! He started exercising three times a week and is not significantly overweight. The only think I can come across is perhaps hypothyroidism which his sister and niece have.

    • Your husband needs to have his thyroid checked asap as hypothyroidism runs in families and I would bet anything that he has it too if his levels were worse. I come from a hypothyroid family myself and yet no doctor ever told us that it ran in families so my sister and I suffered for years before finding out what it was and that our mother had had it (we now have both her daughter and my son who are also affected). We both had many symptoms and went from one doctor to another, without ever being sent for a thyroid test even though all our symptoms (high cholesterol being one of them) pointed to it.
      Good luck!

  15. Hi I am 53 years old, relatively healthy active female. I started gaining weight mostly in my abdomen, I thought I had ovarian CA, and really started working all angles. Thus far they can’t find anything , just a few small ovarian cysts small fibroids. However. since I have been really trying to get my abdominal girth down. my Triglycerides went from 47 down to 32. One would think this is good except abdomen keeps growing and now cholesterol is going up HDL 80, LDL 117 and Cholesterol 203. So I wonder as above says recipe for diaster… I eat so well obviously to me via triglycerides and also fasting blood sugar always 99 now climbing to 111. Something is wrong as far as I am concerned. In addition, I now have leg swelling and arm swelling by the end of the day. help.

    • Have you had your kidney function checked? I would suggest starting with a through metabolic panel. So glad it isn’t ovarian cancer! How scary to even go through thinking that! You are also at the menopause age, so this could be totally related to that as well. Maybe your gyno can check hormone levels.

    • Your fasting blood glucose is in the pre-diabetes/ metabolic syndrome level. This is why your belly is getting bigger and you can’t lose weight. Please look into this. It’s also called insulin resistance. I am a certified nutritionist so I’m trained to look for these numbers. Hope this helps ! It’s entirely controlled through diet , really! Cut out all sugars and refined carbs and eat a low carb Paleo style diet. Get a blood sugar monitor and measure every morning upon waking. Keep track. You can correct this !

  16. Thankyou , yes my hormone levels are low. Kidney funtion wnl. I am going for an MRI with contrast pelvic and abdomen this week just to make sure as I still have left lower quandrant pain.

  17. I think those of you here with high cholesterol need to have your thyroid levels checked as this is one of the first indications of a thyroid problem, especially if no other cause has been found. One person has mentioned that her husband has high cholesterol and his family members suffer hypothyroidism. I suggest he does the test quickly as it runs in families (and doctors do not tell you this, or the fact that high cholesterol levels can indicate a thyroid problem). They prefer to stick statins and other rubbish down our throats! Do not be fooled by the medical profession – They blindly follow what they’ve been told and bow to the pharmaceutical industry.

    And, a pointer – your blood tests should include TSH, FT3, FT4, a complete iron panel, sodium, potassium, Vit B12, folates, Vit D3 (these are levels which are also affected by the thyroid). Don’t be brushed off if your TSH is “within range” – that’s what they all brush you off with. Your FT4 should be high in the range, and FT3 should be at least mid range and not low – that’s what they should be watching for, not the darn TSH which is nothing more than an indication of whether your pituitary gland is sending the right signals to the thyroid. Many hypothyroid people still have levels within the ranges and yet their cholesterol is high and they have other symptoms of thyroid problems too (see all the symptoms online), which their doctors, wrongly, usually ignore or connect to other things.

    I hope this helps at least one of you to get to the bottom of your problems.
    best wishes

    • Alice,

      I think you bring up a very good idea to have thyroid levels checked if one has high cholesterol. I was always one to have very good cholesterol readings. I’m a 26 year old male and when I had my annual physical they did blood work as they normally do. My total cholesterol was 255 and HDL was 98, but LDL was 153. However my triglycerides were only 43. I figured if I had a bad diet my triglycerides would also be high. In the weeks prior I was eating a lot of salmon and in addition was also taking a fairly high potency fish oil. I did some research and found there is some evidence to indicate that fish oil supplementation may increase total and LDL cholesterol, so I’ve sinced cut out the fish oil. I’ve tried adding in more raw nuts like walnuts and almonds. The time I had a physical previous was almost three years ago, back in May of 2009 my cholesterol was off then for the first time in my life. I’ll admit that I wasn’t eating the best diet, but my weight was still good. I was 5ft10in and weighed 165lbs. The numbers were total cholesterol 248 HDL 64 LDL 145 and triglycerides 63. I was floored at that moment because it was my first ever high cholesterol reading. My previous blood work to that one was less than a year from that one was August of 2008 and the readings were total cholesterol of 160 HDL 85 LDL 63 and triglycerides of 58. Those are more like readings I’ve always had in my life. In any event, I really want to link this with my thyroid, but I don’t have a the #1 symptom of hypothyroid. That being weight gain. As a matter of fact, I can barely keep on weight. My weight at my last doctor’s appt, which was when I had my blood drawn was 153. But I do have a lot of other symptoms like fatigue, puffy eyes, dry cracked hands. I wanted them to check my thyroid, but my insurance didn’t cover it and I figured I’d have better cholesterol radings because I was eating such a clean diet. Anyway, if my thyroid levels are low the only justification I can think of is I still have my wisdom teeth and I’ve only read one anecdotal story to that effect. Althought I think it’d be worth investigation if my thyroid levels are low. Anyway, I’ve contacted my doctor and requested the blood test you mentioned to be done. We’ll see. Do you have any comments or suggestions for my situation?

      • You have extraordinary HDL and low trigs, so this is the most important thing. Low HDL is the problem with cholesterol along with high trigs. Your ratio is excellent. Keep up the fish oils. Low HDL like the following post is not good, as 60 and above is the trick for a healthy heart.

  18. Pingback: High HDL, Low Triglycerides & Particle Count | Harpoon

  19. Pingback: Paleo Health: High Cholesterol — PaleoNonPaleo

  20. Good Calories, Bad Calories by Gary Taubes has all the detailed info as currently known on this issue as of the date the book was published.

  21. HDL in the 20’s of a 27 yo rides his bike 35 miles a day, weekends between 60-100 miles BMI 21, Chol 102, LDL 80, TRIGS 60. eATS HEALTHY, METABOLIC PROFILE ALL wnl

  22. I have always had a very high cholesterol level, last check was 247, high HDL (87) and low trigs (51), low T4 (.77), but very little other indications of thyroid problems. Good blood pressure and not overweight. The docs only focus on the cholesterol and refuse to look at any other numbers. I am sooo tired of fighting them. I will ask for the LDL gradient test and the metabolic panel. I have always been anemic as well.

    • Philip, so sorry, I only saw your comment now! I wasn’t overweight either – some people put on weight, but some people can lose it too, especially if you have an adrenal fatigue problem as well, as in my case. Look at the symptoms of adrenal fatigue here and see if it fits your profile –
      If you think you may have adrenal fatigue as well, the only reliable test for that is the saliva test where you take a saliva sample 4 times between morning and bedtime – the total cortisol urine test which most doctors will give you is hopeless as that will only give you a total and it won’t tell you the different levels throughout the day which the saliva test does (for instance if you have total cortisol of 200, your highest point should be in the morning, and then it goes down during the day to reach a lowest point just before you go to bed, in a normal person. In those with adrenal problems, the cortisol is too low in the morning and probably too high at night if you’re not sleeping well, depending on how stressed you are).
      Did you do the tests you were going to do and were they ok?
      Hope this helps.

      • I’ve actually just received my blood test results from my most recent physical. I asked about having those extra tests done, but my insurance only covers the basics unless I hit my deductable which is like $1000. So I got the basic work and I was really expecting the worse because I was 11 pounds heavier than the year before. I’m a 27 year old male who works out like a freak, btw. However, my total cholesterol went from 255 to 193, HDL was still great and was 97 and the LDL went from 155 to 93. And the triglycerides were 55. I don’t know what gives, but I like it!

  23. Arkiebarbie, That’s what doctors do – they focus on one thing only instead of looking at the whole picture. If you have low T4, high cholesterol,and low iron, your thyroid probably isn’t doing what it’s supposed to. You can see the long list of symptoms here, and see what I wrote to Philip above too as that may even be your case too.
    best wishes

  24. Hi Everyone- I would like to recommend the book “It Starts With Food” by Dallas and Melissa Hartwig.

    I followed what was out lined in the book for three weeks and saw my total cholesterol go from 290 to 218. My triglycerides went from 175 to 76, and my HDL went from 31 to 56. This was after I had quit taking cholesterol medication two years ago due to muscle damage.

    Also, more and more research is finally coming to light that shows cholesterol is not the boogeyman that it has always been portrayed as, and there may indeed be benefits to elevated cholesterol.

    Do your own due diligence, don’t take anything a Dr says as gospel, and make your own decisions. In the meantime, check out “It Starts With Food”. All you have to lose is your medication. There is also a website at http://whole9life.com/2012/08/the-whole30-program/.

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