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



Ethical Quandary – Industry Money in Med Schools

Give your doctor a break, he doesn’t know he has been brainwashed:

In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

“I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”

More – New York Times

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Buckwheat to the rescue

BuckwheatVia Mark’s Daily Apple:

Proteins from tartary buckwheat and common buckwheat helped reduce cholesterol levels in rats on a high cholesterol diet by at least 25 per cent, report Japanese researchers.

The research, published in the Journal of Food Science, reports that supplementation of a high cholesterol diet with protein from common buckwheat (Fagopyrum esculentum Moench) and tartary buckwheat (Fagopyrum tataricum Gaertn) reduced serum cholesterol levels in rats by 32 and 25 per cent, respectively.

Now if we could just get the rats to cut back on cigarettes we’d be getting somewhere. More

Despite the common name buckwheat is not related at all to wheat – and it’s gluten free. In fact, it’s not even a grain. Buckwheat is actually a fruit, but is usually classified as a grain because it’s prepared and eaten like one. Buckwheat is nutritious as well. It’s a good source of protein and is especially high in the amino acid lysine. Buckwheat is also extremely high in calcium and a good source of B-complex and E vitamins.