75 Responses to “Cholesterol – what does the blood cholesterol test actually measure?”

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  1. avatar Ruth Brennan says:

    Surely we should remember that people with an inherited condition that raises their cholesterol to high levels die at an early age from CHD.Statins do help them to live longer.

  2. avatar Zoë says:

    Hi Ruth – that’s what the statin promoters want you to believe. Read the works of Uffe Ravnskov on Familial Hypercholesterolemia – that’s what you’re referring to.

    Here’s an extract from an article I wrote on Cholesterol – hope this helps
    Best wishes – Zoe

    “It is time to mention Familial Hypercholesterolemia (FH). FH is a genetic condition caused by a gene defect on chromosome 19. The defect makes the body unable to remove LDL from the bloodstream, resulting in consistently high levels of LDL. Bearing in mind that FH is rare to start with – one in 500 people – in some cases of FH the LDL receptors work to an extent (just not very well); in other cases the LDL receptors work barely at all.

    The problem with FH is that the LDL receptors don’t work properly and therefore the LDL (lipoproteins) cannot get into the body’s cells in the way that they are supposed to. This means that cells don’t get the vital LDL, carrying the vital protein, lipids and cholesterol needed for the cell’s health. LDL in the blood stream is high because the LDL has stayed in the bloodstream and has not been able to get into the cells – where it is supposed to go. Hence high LDL blood levels are the sign that someone has FH. The high LDL levels are, however, a symptom and not a cause or a problem per se. The problem is that the health of every cell is compromised by LDL not getting to the cell. This includes heart, brain and muscle cells – all cells. An FH sufferer can therefore have heart problems – because of too little LDL reaching the heart cells – not because of too much LDL. How differently things can be seen when one is not blinded by thinking that cholesterol or lipoproteins are bad.

    This also explains why high HDL would be seen as good. HDL is the lipoprotein that carries used lipids and cholesterol back to the liver for recycling. If the LDL were not able to get to the cells to do its job then there is little for HDL to carry back to recycle. Hence HDL would be low and this would be seen as bad with impaired understanding as to why.

    When someone takes statins, the cells are impaired from making cholesterol (thankfully not stopped entirely or the statin consumer would die instantly) so the cells try to take cholesterol from the blood stream. The LDL receptors on each cell go into overdrive and try to ‘receive’ more LDL from the blood stream to compensate for the fact that the cell can’t currently make as much itself. This lowers the cholesterol in the blood stream. However, statins have also blocked the critical mevalonate pathway in the body – the pathway by which cells rejuvenate. That’s how statins lower cholesterol and that’s how statins kill us one cell at a time (see Yoseph & Yoseph “How statin drugs really lower cholesterol and kill you one cell at a time”).

    Ironically, the most serious form of Familial Hypercholesterolemia would receive no ‘benefit’ from statins anyway. As the extreme form of FH is characterised by LDL receptors working barely at all, even the body going into crisis mode, and trying to take LDL from the blood stream with increased LDL receptor activity, will not work if the LDL receptors are not working well enough in the first place. Hence the LDL will stay in the blood stream with an extreme sufferer of FH and yet the statin has reduced what little chance the FH sufferer’s body had of making cholesterol within the cell. The FH sufferer should ideally be given medication (if anything existed) to stimulate cholesterol production within the cell, so that the cell would at least get the vital cholesterol it needs, even when it couldn’t get it from the blood stream.”

  3. avatar Tim Grant says:

    Thank you Zoe for all this wonderful information. Fifteen years ago my doctor told me my cholesterol was 8. So I asked what 8 meant. He said it was very high so I asked for a break down, he said 8 cholesterol was high, I again said 8 what? And so he said I should start taking statins, so I said why should I? He said I would have a heart attack if I did not take them.( I should at this point say that I’m a nurse and have read everything about cholesterol)I asked him if he would take them or his family? He replied NO. Therefore I do not take them and am proud to say that I refuse to have my Cholesterol tested. I’m now 65 years old and eat anything I like, and I still work full time.

  4. avatar Zoë says:

    Hi Tim – great story! 7-8 used to be the true population average for cholesterol and then 6-7 million Brits were put on statins and the true mean was artificially lowered.

    You may like this book - I don’t believe that any doctor who reads it could ever again prescribe statins.
    Good on you!
    Best wishes – Zoe

  5. avatar Jean says:

    I have a friend who is 77, female, normal BP, normal weight, works out, walks everywhere, eats healthily, no other cardiovascular problems, but cholesterol is 8.6 So they put her on statins – simvastitin. I asked her if she had been to the doc with her persistent cough – she said no, she didn’t think it was important. So I searched around and found that indeed cough can be an effect of statins. She also had muscle pain in her knees and had been taking turmeric to try to counteract it. when I told her the statins were causing both she stopped taking them and after 2 weeks, got a dreadful headache and neck pain. that eventually stopped and the doc agreed that she should stop. Latest CH was 8.6 so they put her on a different one. Within one week, the cough was back and pain in knees and elbows. She is now going back to stop again and maybe wean off slowly to avoid the headache. It’s so hard to convince someone that the doc might just be wrong! Does her CH of 8.6 matter?

  6. avatar Zoë says:

    Hi Jean – I’m on hols at the moment so please forgive the brief reply – here’s everything I’ve written about cholesterol. Hope it helps!
    http://home.theharcombedietclub.com/2012/10/cholesterol-special-plus-free-report/
    Very best wishes – Zoe

  7. avatar Mary says:

    I eat a plant based diet and my total cholesterol without any medications is 3.88 Closer to all those countries in the world that also eat plant based diets and experience very few heart events (ie. heart attack is not common). When people eating a meat and dairy based diet compare themselves with each other, it is not a good comparison, because the heart attack level is so high in the Western World. I think it would be better to compare with countries where the heart attack level is not 50%.

  8. avatar Geewiz says:

    Hi Zoe. Very interested in your work and the sources you quote. I’m 47 and just had a cholesterol score of 8.7 and HDL of 1.3 and spent a miserable morning worrying about it till I started to check the Web for information. So, feeling a bit better(!), my question is what about ‘Atherosclerosis’ – the clogging up of arteries. Is there a link between this and high cholesterol?
    Alos I’ve sen articles stating that ration HDL/total is the key indicator of risk.
    What’s your comments on thos questions?

  9. avatar Zoë says:

    Hi Geewiz – keep reading! This may help. (http://home.theharcombedietclub.com/2012/10/cholesterol-special-plus-free-report/) and this http://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/

    Atherosclerosis is a term to describe the build up of plaque in the arteries. The process goes as follows – something damages the lining of the artery. Chief suspects should be smoking, stress, sedentary lifestyle, sugar “the S’s.” When you damage your skin on the outside of your body a scab forms and then the skin underneath the scab heals and eventually the scab falls off (or you pick it!) When you damage the lining of the artery, a similar healing process needs to take place but under no circumstances can the scab be allowed to break away – or it could block a blood vessel and you could have a heart attack or stroke. So the very clever body forms a plaque over the damage (technically atherosclerosis) so that the healing can take place under a protective cover.

    If further damage occurs (more smoking/stress/sugar) then plaques can form on top of plaques and you can get a narrowing of the arteries to the extent that you have a heart attack or stroke. What has cholesterol got to do with this? There are 5 lipoproteins: chylomicrons, VLDL, IDL, LDL and HDL (largest to smallest). Chylomicrons take dietary fat from food around the body to do vital repair work. LDL lipoproteins (called ‘bad’ cholesterol by ignorant people – they are not even cholesterol) are the key lipoproteins that travel to damage in the body to repair that damage. These ‘taxis’ carry cholesterol, protein, phospholipids and triglyceride. They will pass a plaque, notice the damage, and the LDL components can be taken by the cells at the scene of the damage to repair the area.

    So what’s the link between plaques and high cholesterol? Cholesterol repairs plaques. The idea that it causes them would be funny if it had not led to such terrible actions.

    Below is an extract from my book: The Obesity Epidemic: What caused it? How can we stop it? to answer the question about HDL and total cholesterol. The short answer is – it’s just a moving of the goal posts by those who want to keep the cholesterol nonsense theory going. “It’s cholesterol.” “No it’s not.” “It’s good and bad cholesterol.” “There’s no such thing – cholesterol is cholesterol.” It’s the ratio of one bit over another.” “Oh just shut up and admit the body is not making cholesterol because it’s out to get us!”

    Hope this helps
    Are you a fellow Welshy?
    Best wishes – Zoe

    The fasting blood cholesterol test is the traditional way to measure the level of LDL, but it doesn’t measure LDL directly. We can only measure total cholesterol and HDL with the standard blood test and Triglycerides (VLDL) and LDL are together assumed to account for the difference. The estimation is refined further using the Friedewald equation (named after William Friedewald, who developed it). This uses the fact that VLDL is 22% cholesterol to establish the equation:

    Total cholesterol = LDL + HDL + Triglycerides/5 which leads to:
    LDL = Total cholesterol – HDL – Triglycerides/5.

    You can also now see the problem with trying to assert any meaningful relationship between HDL and total cholesterol. Total cholesterol/HDL = LDL/HDL + 1 + Triglycerides/5HDL and we have one equation, with four variables, only two of which can be measured. We need at least one more equation or known variable, to avoid circular references.

    As the November 2004 Harvard medical school publications note, “You have to fast for about 12 hours before the test because triglyceride levels can shoot up 20%-30% after a meal, which would throw off the equation. Alcohol also causes a triglyceride surge, so you shouldn’t drink alcohol for 24 hours before a fasting cholesterol test.” They also caution “At a triglyceride level of about 250 or higher, the Friedewald equation becomes less reliable because dividing triglycerides by a factor of 5 provides a less accurate estimate of VLDL.”

    These complications and inaccuracies aside, the fact that LDL is estimated means that:
    - All other things being equal, LDL will rise if a) total cholesterol rises and/or b) if HDL falls and/or if c) VLDL falls.
    - All other things being equal, LDL will fall if a) total cholesterol falls and/or b) if HDL rises and/or if c) VLDL rises.
    No wonder an inverse association is observed between LDL and HDL – it is by definition. More surprising is that a fall in VLDL (triglycerides), which would be welcomed by doctors, would be accompanied by an automatic increase in LDL, all other things being equal, which would not be welcomed by doctors. There was me thinking this was scientific.

  10. avatar Geewiz says:

    Many thanks Zoe, I’ll read on through those links……and, last point, yes I am! Diolch yn fawr, a hwyl am y tro ;-) (Thanks, and bye for now)

  11. avatar Marise Riddell says:

    Great to find your site! It happens that ‘high cholesterol’ runs in my family, but our those members of our extended family who have not succumbed to cancer before their 6oth birthdays are quite long lived – mostly dying in their late 80s or early 90s. As for me, my cholesterol has been 7.2 or more since at least age 32. Recently I came across Robert Kowalski’s “The New 8-week cholesterol cure”. Therein I read about using ‘slow release Niacin at pharmacological doses’ as a method, not only of lowering LDL and Triglyceride levels, but doing other nice things such as 1. raising levels of HDL 2. reduces fibrinogen high levels of which are touted as an independent CHD risk factor 3. increases the presence of prostacyclin, a substance which makes platelets less “sticky” thus reducing the likelihood of clots 4.significantly reducesthe risk of dying of a heart attack. I have long refused to take statins, but I decided to see what Niacin would do. For 8 weeks I have been taking 500mgm slow release Niacin (marketed as Endur-Acin) 6-8 hourly (3 times per day). My readings changed as follows: HDL 1.6 – 2.1; LDL 8.4 – 5.0; Trigs 1.23 – 0.93; Tot/HDL 6.6-3.6; Chol 10.6 – 7.5. My results are almost exactly as he said they would be, in percentage terms! Mr Kowalski recommends supplementing this regimen with a modified diet – enjoy unprocessed foods cooked at home with lots of herbs and spices; add as many sources of soluble fibre to your diet; continue to enjoy red wine in moderation; increase exercise, especially walking, Grateful And ENJOY life! I am working on the last two especially with a daily ritual of listing 10 things I am grateful for, feeling the gratitude, sending love to 3 people i don’t much care for, or am negative about, and 3 people I know and care for + sit quietly for 5 minutes to wait upon Spirit. (This is Mr Bob Proctor’s ritual prescription). Life has never been more joyous!

  12. avatar Marise Riddell says:

    I forgot to say – I have been delighted to find this site! My niacin improved cholesterol readings are Australian where it seems no one is interested in how useful the various components of ‘cholesterol’ are to the human organism. I am also pleased to see the warning regarding the use of statins in patients over 70. I shall be sure to tell my Mum. Thanks for keeping this on line and available.

  13. avatar dr.sanong says:

    is that correct VLDL/5 ? I think it’s TG/5

  14. avatar keith axelby says:

    Hi
    I am a 73 year old male, 6′ tall, been over 16 stone as long as I can remember ( left school at 13 stone ) Have been on statins for many years with a test level above 5.
    Lost my wife a few years ago and have become a couch potato, not good I know.
    In July I noticed I had lost a few pounds so I decided to try to lose more. Changed my diet to bacon and eggs for breakfast, coffee and plain biscuits throughout the day with several squares of Bourneville chocolate ( supposed to be good for you ). For tea I mostly have a stir fry with ketchup and beetroot added, followed by a yogurt and two small apples..
    My weight is now 13 stone 2lbs and still dropping, slowly now. My last test reading was of 2.3.
    Should I stop the statins please, no good asking the GP., doesn’t seem interested.
    Should I stop the

  15. avatar Zoë says:

    Hi Keith – I’m sorry to hear that you lost your wife so young and how it’s affected you since. Quite understandable that you haven’t felt much like going out but you also need cholesterol for ‘get up and go’ and your cholesterol seems scarily low – how on earth can you function at that level?!

    Your patient leaflet may help – I’ve checked a few and they usually have a warning that over 70 year olds shouldn’t be on statins. It is actually known, and quite widely accepted, that low cholesterol levels in elderly people are not good for mortality (dying!) (Low cholesterol levels are not good for mortality in any age group but that’s another matter). Your own leaflet may give you the answer.

    I can’t advise you and I’m sorry that your GP doesn’t seem interested. Maybe you could show them the leaflet or see another doc at the practice? I can tell you that a statin will never ever pass my lips and my hubby feels the same way. You need to find a doc to give this the serious attention that it deserves. At a level of 2.3 I would expect you to have poor memory, cognitive ability, muscle aches, tiredness, general loss of zest for life.

    If this sounds like you – get some help!
    Very best wishes – Zoe
    p.s. jolly well done on your weight – you’re probably not far off ideal for a tall male

  16. avatar Anees says:

    HI
    I am 26 years old male.height 161CM,weight 60KG,Before one month i have BP,that time doctor told me to do the blood test for cholesterol and sugar.
    My BP now 124/86(Left Hand) and 133/78 (Right Hand)
    Fasting Blood Sugar is 5.1 MMOL/L
    Total Cholesterol is 8.4 MMOL/L
    HDL Cholesterol is 1.3 MMOL/L
    LDL Cholesterol is 5.82 MMOL/L
    Triglycerides is 2.8 MMOL/L
    Then doctor prescribed tablet Viscor 20.
    I can start medication or not?
    if i will start medication now,it will need to continue long life or not?
    what i will do now?

  17. avatar Frank says:

    Hi
    Absolutely great reading for the cholesterol stuff. I am a 65 year old male who became interested in my cholesterol levels after visiting the doctor for a check up last year (the first in 25 years). Total cholesterol was 5.6. Exactly the same as it was 25 years ago. He suggested that I need to lower the readings by altering my diet and doing more exercise, or the dreaded statins may be forced down my neck. Now here is the funny part, I already exercise at least 5 times a week and use a heart rate monitor to regulate my training zones. I hill walk and go to the gym. My resting heart rate is 52bpm and my max heart rate is 174bpm. My blood pressure is 136/78. My diet is/was fairly balanced with no fast foods and a lots of vegetables. The latest test cholesterol test was 4.7 (ldl 2.8). Maybe it was the thought of the statins that scared my cholesterol into submission.
    Frank

  18. avatar Zoë says:

    Hi Anees
    All your results are within normal population distributions. However ‘normal’ is being redefined (i.e. lowered) for BP, sugars and cholesterol at the whim of the medical profession (and drug company influence). This means that normal people like you get medicated.

    Viscor is a statin and your doctor should have told you that you’ve been put on a statin and what the side effects are (tiredness, muscle aches, loss of sex drive etc). Once on a statin, docs tend to like to keep people on statins for life. I can’t tell you what to do but I know that I would never ever let a statin pass my lips.

    I would recommend reading lots and then asking lots of questions of your doctor when things that you read trouble you:
    - This will show you that you should value your cholesterol level
    - This is a must read before anyone takes or prescribes a statin. See if your doc knows what statins actually do. This post will also show you the conflict in target setting.
    - Anything on this site: http://drmalcolmkendrick.org/

    That should do for starters!
    Very best wishes – Zoe

  19. avatar Zoë says:

    Hi Frank – you must be one of the healthiest 65 year olds on the planet!
    The cholesterol test is known to be very variable – it can vary by up to 20% between 2 readings for no known reason. It can vary for known reasons – fasting before hand vs didn’t; running late for the appointment vs chilled etc. It varies substantially during the year – during sun exposure cholesterol is synthesised into vitamin D and blood cholesterol levels are thus lower (as a consequence, not a cause of anything). Conversely – cholesterol will be higher the longer the time lapsed since sun exposure.

    Your cholesterol level will be what your body needs it to be (depending on illness/injury/repair needed etc). You may find these interesting too:
    http://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/
    http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-lower-cholesterol-and-kill-you-one-cell-at-a-time/

    Very best wishes – Zoe

  20. avatar Cindy Raphel says:

    Daer Zoë Good Morning
    Lovely article. One thing please clear,there are two types of formula given for calculating LDL which one is OK.
    i saw all clinics are not following the same formula.

    LDL = Total cholesterol – HDL – Triglycerides/5.
    Total cholesterol = LDL + HDL + VLDL/5

    with Best regards
    Cindy

  21. avatar Zoë Harcombe says:

    Hi Cindy – good question! This is a confusing area worthy of some clarity.

    First – the only difference between the 2 equations above is the use of “Triglycerides” or “VLDL”.
    The top equation can be rearranged to be:
    Total cholesterol = LDL + HDL + triglycerides/5 or the bottom one can be rearranged to LDL = total cholesterol – HDL – VLDL/5, so the only debate we’re having is VLDL vs triglycerides.

    What doesn’t help is that the two terms (VLDL and triglyceride) are regularly used interchangeably (I’ve clarified my original post in response to this query).

    The correct formula is Total cholesterol = LDL + HDL + triglycerides/5 or LDL = total cholesterol – HDL – triglycerides/5. However, just to complicate things further, the equation is TG/2.2 where mmol/L is used (the UK format) and TG/5 where mg/dl is used (the US format).

    The biggest takeaway from all this should be – stop measuring cholesterol! It’s not accurate, it’s not the cause of anything and it only leads to medical interference aka lowering!

    Very best wishes – Zoe

  22. avatar Cindy Raphel says:

    Hi Zoë Good Afternoon
    Thanks for the Propmpt Reply.
    My results were Total Cholstrol:205, Trigy:64,Vldl:13,HDL:55,LDL:148
    if i consider this Equation( Total cholesterol = LDL + HDL + VLDL/5) My LDL is 148
    and if consider( LDL = total cholesterol – HDL – triglycerides/5) LDL is coming 137
    Which one is correct 148 or 137.
    Seems my clinic calculatd my LDL based on first one(148).
    Cindy

  23. avatar Zoë Harcombe says:

    Hi Cindy
    Don’t go there! Remember that the entire test – as the post says – is about as reliable as the England football team in penalty shoot outs!

    You’ve got US readings there (mg/dl) so you’re into the TC = LDL + HDL + TG/5 – but remember what the post says: The standard blood test measures TC and HDL and the rest is guess work. Are you sure you’ve got trig and VLDL the right way round? (still all guesses mind). Notwithstanding all the guess work, even what they can measure is up to 20% out. You’re LDL could be 148 or 137 – it could be 110 – 178 with a 20% margin for error. And who cares what it is? Your body makes cholesterol – it will be what it will be. Understand the process by all means but don’t give it any credence or value!

    Very best wishes – Zoe

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