Cholesterol – what does the blood cholesterol test actually measure?
This post is dedicated to Mat Cooke who asked a great question!
Cholesterol targets for USA, Australia and UK
The world is obsessed with cholesterol levels. The UK and Australia work in mmol/l and the USA works in mg/dl. Americans are told to have a total cholesterol level below 200 mg/dl and LDL below 100 mg/dl. These guidelines, issued by the National Cholesterol Education Programme, actually call LDL ‘cholesterol’, which is ignorant as we will see shortly. Appendix 1 has the drug industry conflicts of interest of the committee members setting these USA targets, just in case you thought that they had been set independently, with your health interests at heart, rather than in conflict, with drug industry profits in mind.
Australians are told total blood cholesterol levels above 5.5 mmol/l “are an indication of a greatly increased risk of developing coronary heart disease“.
Did you know that the National Institute for Clinical Excellence (NICE) has not issued cholesterol targets for the UK? NICE is the evidence based body for the UK and this summary states: “A target for total cholesterol or low-density lipoprotein (LDL) cholesterol is not recommended for primary prevention of cardiovascular disease.” The basis for recommendation is summarised as follows: “The National Institute for Health and Clinical Excellence (NICE) does not recommend the use of target levels of cholesterol for people taking statins for primary prevention of cardiovascular disease. This is because it found no clinical trials in primary prevention that have evaluated the relative and absolute benefits of achieving different cholesterol targets in relation to clinical events.”
This doesn’t stop the General Practice Notebook – a UK Medical Reference placing the British Hypertension Society and Joint British Societies (never heard of either of these) guidelines above the absence of NICE guidelines. The GP Notebook says that “The BHS and JBS2 guidelines stated that the ideal cholesterol targets are: to lower total cholesterol by 25% or LDL cholesterol by 30% or to reach < 4.0 mmol/l or < 2.0 mmol/l respectively, whichever is the greater – however a total cholesterol concentration < 5.0 mmol/l or LDL cholesterol < 3.0 mmol/l or reductions of 25% or 30%, respectively (whichever is the greater), provides a minimal acceptable “audit” standard.”
So the USA advise total cholesterol below 200 mg/dl and LDL below 100 mg/dl. To convert mmol/l (UK) to mg/dl (USA) we multiply by 38.66. To convert mg/dl (USA) to mmol/l (UK) we divide by 38.66. Hence 200 mg/dl equates to 5.17 mmol/l and 100 mg/dl equates to 2.58 mmol/l.
Australia favours total cholesterol below 5.5 mmol/l (213 mg/dl).
UK doctors are astonishingly aiming for total cholesterol of 4 mmol/l (155 mg/dl) or LDL of 2 mmol/l (77 mg/dl) although they consider total cholesterol of 5 mmol/l (193 mg/dl) or LDL of 3 mmol/l (116 mg/dl) as a “minimal acceptable audit“. I say “astonishingly” knowing the vital role that cholesterol plays in every cell in the human body.
But what are all these measurements? What exactly does a total cholesterol level mean?
The conversion factors & a good question
Mat Cooke spotted that, for triglyceride, the conversion is: To convert mmol/l to mg/dl for triglyceride you multiply by 88.6.
This is because of molar mass. The chemical formula for cholesterol is C27H460 with a molar mass of 386 g/mol. The chemical formula for triglyceride is C55H98O6 with a molar weight of 856 g/mol.
This led Mat to ask a clever question… “When they measure cholesterol levels.. They are presumably measuring the total molar mass of all of the lipoproteins in the blood. Who’s to say what proportion of that is actually cholesterol and what proportion is other lipids and proteins?”
The blood cholesterol level
We need to start by saying that the blood cholesterol level is about as reliable as the England football team in penalty shootouts. The time of day, the time of year, whether or not you fasted beforehand, how much sun you’ve had recently, current stress levels, even running late for the blood test appointment – all can impact blood cholesterol levels. When people talk about their test results as if they are accurate they should be made aware of all of this.
The formula for blood cholesterol levels is: Total cholesterol = LDL + HDL + triglycerides/5
Few people know that we can only measure total cholesterol and HDL with the standard blood test. Yes – 1 equation, 4 unknowns, 2 measurable = not very scientific.
After measuring (albeit inaccurately and inconsistently) total cholesterol and HDL, triglycerides and LDL together are assumed to account for the difference. The estimation is refined with the Friedewald equation, using the two assumptions that i) virtually all triglyceride is carried by VLDL and ii) that the triglyceride: cholesterol ratio of VLDL is constant at approximately 5:1 (Friedewald et al 1972) (neither assumption being strictly true) to establish the final equation:
Total cholesterol = LDL + HDL + Triglyceride/5
There are five lipoproteins – in order of size (largest to smallest) they are chylomicrons, Very Low Density Lipoprotein (VLDL), Intermediate Density Lipoprotein (IDL), Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). (Ideally chylomicrons would be called Exceptionally Low Density Lipoproteins (ELDL’s) and then the density concept would be more consistent. However…). Confusingly, VLDL is also referred to as triglyceride. People will tell you their triglyceride levels after their blood test and are pleased when these are low. They don’t know that VLDL isn’t even measured, let alone triglyceride.
The National Cholesterol ‘Education’ Programme have no right to educate anyone about cholesterol if they don’t know that LDL is not even cholesterol. LDL is Low Density Lipoprotein. LDL contains cholesterol; it is not cholesterol.
All five lipoproteins contain four substances – cholesterol, triglyceride, phospholipids and protein. The proportions of each substance vary.
The Garrett & Grisham, book “Biochemistry” estimates:
– VLDL is approximately 50% triglyceride, 22% cholesterol, 18% phospholipids and 10% protein.
– LDL is approximately 8% triglyceride, 45% cholesterol, 22% phospholipids and 25% protein.
– HDL is approximately 4% triglyceride, 30% cholesterol, 29% phospholipids and 33% protein.
So, Total cholesterol = LDL (all approximate – 8% triglyceride, 45% cholesterol, 22% phospholipids and 25% protein) + HDL (all approximate – 4% triglyceride, 30% cholesterol, 29% phospholipids and 33% protein) + VLDL/5? (all approximate – 50% triglyceride, 22% cholesterol, 18% phospholipids and 10% protein) or just the triglyceride part of VLDL/5?
So what is the blood cholesterol measurement? Is it the cholesterol in each lipoprotein? Is it the whole lipoprotein? If the latter – then we’re back to the relevance of Mat’s original observation – if cholesterol is converted at a factor of 38 and triglyceride at a factor of 86 – how is this being allowed for?
Mat and I know that cholesterol is utterly life vital. We know that our body makes it – it is so utterly life vital that the body cannot leave it to chance that we could get it from food. We know that “There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along” to quote Ancel Keys – the man who arguably started the whole war on cholesterol.
We think that people who try to lower the blood cholesterol levels of their fellow humans are guilty of what will go down in history as one of the greatest crimes against humankind. The fact that one statin alone, Lipitor, has been worth $125 billion to Pfizer since 1997, should surely raise alarm bells. Lipitor is the most lucrative drug in the world. It is by no means the only statin.
Our request is this – please can someone tell us what the blood cholesterol test actually measures? Notwithstanding that we know it only ‘measures’ two from four unknowns, is it claiming to measure cholesterol? lipoproteins? triglyceride? a mixture? If anything other than cholesterol alone, how is the molar mass allowed for in conversion? It’s bad enough to have drug industry influenced targets to lower a life vital substance. It compounds the crime if you’re making up the numbers as well as the targets.
The 2004 NCEP financial disclosure report reveals that all members of the 2004 guideline participants had received payments and/or grant funds from the following organisations:
Dr Scott Grundy: Abbott, Astra Zeneca, Bayer, Bristol-Myers Squibb, Glaxo SmithKline, Kos, Merck, Pfizer, Sankyo.
Dr Bairey: Astra Zeneca, Bayer, Bristol-Myers Squibb, Kos, Merck, Novartis, Pfizer, Procter & Gamble, Wyeth.
Dr Brewer: Astra Zeneca, Esperion, Fournier, Lipid Sciences, Merck, Novartis, Pfizer, Sankyo, Tularik.
Dr Clark: Abbot, Astra Zeneca, Bristol-Myers Squibb, Merck, Pfizer.
Dr Hunninghake: Astra Zeneca, Bristol-Myers Squibb, Kos, Merck, Novartis, Pfizer.
Dr Pasternak: Astra Zeneca, BMS-Sanofi, Pfizer, Johnson & Johnson, Kos, Merck, Novartis, Takeda.
Dr Smith: Merck.
Dr Stone: Abbot, Astra Zeneca, Bristol-Myers Squibb, Kos, Merck, Novartis, Pfizer, Reliant, Sankyo.
124 thoughts on “Cholesterol – what does the blood cholesterol test actually measure?”
That is a magnificent article. Thank you for the information Zoë.
So, what is the total cholesterol is? Is it the total cholesterol in all lipoproteins or is it the whole lipoprotein?
How exactly the approximations in each lipoprotein are measure and if they are approximations how inacurate they are? I mean what the heck is exactly measured if everything is so approximal…
I wonder how accurate the total cholesterol test is?
From David Getoff lectures I understood that high cholesterol is linked to toxicity of the body, can you elaborate on that?
Hi Vasily – I’m so sorry I missed your comment – it came in while I was on holiday. I still don’t know is the answer! All I know is that it is wildly inaccurate, there are 4 unknowns in 1 equation with 2 things that we can even vaguely measure and even then I don’t know if we’re measuring the lipoprotein or cholesterol and how the other things in the lipoprotein impact the test. It’s just as well that none of this matters eh?!
I don’t know anything about David Getoff. A quick look suggests that he also doesn’t fear cholesterol or fat, so he’s one of the sensible ones! I’ve quickly glanced at his toxicity stuff and there could well be something in it – he would know far more than me. The modern human is subjected to a cocktail of chemicals like never before – from tooth fillings to toiletries to fake food to pollution. As cholesterol is the body’s healing tool (one of them) – it may well be that the direction of causation can be toxins -> health compromised -> make more cholesterol. Defer to him though :-)
Very best wishes – Zoe
Hi Zoe, my second post. In a NZ lipid test the following are measure. total cholesterol, triglycerides, and HDL.
I could not find the info on the internet so I called the Palmerston North Medlab branch (I live in Auckland but PN much easier on phone). I talked with someone in QIC who knew what they were talking about, answered without hesitation. LDL and ratios are calculated.
Using lab tech all of the cholesterol is extracted from all the blood lipoprotiens, Chylomicrons, VLDL, ILDL, LDL, HDL. The same is done for the triglycerides. The LDL calc still seems a bit dubious and would use assumptions about percentages of triglycerides and cholesterol in the various Lipoproteins. Assume LDL means LDL+ILDL+VLDL but not sure. Talk with Dave Crowles if you ring PN medlab.
The following is a note on Lipids from Laboratory Tests in General Practice form. Good to see that LDL particle size is making it into health literature. It is still wrong that Satins are being prescribed for something that is not measured directly.
Lipids: HDL is adequate when >1mmol/L for men and >1.39mmol/L for women. HDL will usually increase with better nutrition and increased physical activity over time, and decrease in inflammation. If the HDL is high (above 1.5 -2.2mmol/L) often LDL-C particle are big and fluffy (as opposed to small and dense), has a low oxidation state and rises with HDL. In New Zealand there is no routine particle size testing, but if triglyceride levels are below 1mmol/L then small dense oxidised LDL-C is less likely (15). Triglycerides drop well/quickly with high vegetable (and nut) intake. A trial of increasing vegetable and fruit (to 5-9 portions a day) with reducing or stopping junk food is very important. Non pharmacological interventions particularly increasing vegetable and fruit should be first line interventions (16-18). Consider the Tot/HDL-C ratio before prescribing statins (especially in aged people), and consider the benefits to the particular individual.
What does the roll of Homocysteine play into this equation?
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).
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
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
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
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.
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:
Very best wishes – Zoe
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?
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
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
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
is that correct VLDL/5 ? I think it’s TG/5
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.
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!
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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)
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?
Hi Geewiz – keep reading! This may help. (http://home.theharcombedietclub.com/2012/10/cholesterol-special-plus-free-report/) and this https://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.
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%.
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?
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!
Very best wishes – Zoe
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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.
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
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.
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.”
Oh, what a lovely piece of largely-incoherent pseudoscience. I appreciate that it’s relatively easy to spot a nutter from their consistently bizarre grammatical idiosyncracies.
For a real education, try reading this meta-analysis: http://www.ncbi.nlm.nih.gov/pubmed/22607822
Thanx for your reply Zoe. I will have a chat with my sister in law as she is a nurse and my parents in law are more likely to take notice of her than anyone else in the family. I’ve been thinking about what i read on your site all day. i shall look to get some of your suggested reading material in the near future. many thanks – Rebecca
Hi again Rebecca – I can tell you what a nurse will say with 99% certainty! The vast majority are so ignorant (through no fault of their own – poor and/or conflicted training) they think that LDL is bad cholesterol! I do agree that family members take more notice of white coats and especially white coats in the family – therein lies a big part of the problem. See if nursey can read The Great Cholesterol Con too – we can but hope!
Best wishes – Zoe
hallo zoe. what a thoughtful read this site is. I am 47 and type 2 diabetic since nov 2008. i was 14st 10lbs at the time lived for my carbs and had a very sedentric lifestyle with three young children. there is a family history of type 2 diabetes on my mothers side. my total cholesterol level at diagnosis was 3.9. it has been creeping up ever since and in feb 2012 was 4.5. Statins were first raised in the conversation as being a diabetic i have to achieve levels below 4! i refused and went away to research the subject. my levels were tested again in july and were raised further to 4.9. again statins were suggested to which i replied not at my age, not given i have no other risk factors and i am not going to spend half of my total life expectancy on them when there is no long term study into their heath effects. i also pointed out what was the value of making a suggestion on just a total cholesterol level when it is meaningless to not know the proportion of LDL, HDL and triglycerides?. Yesterday i had my 6 month diabetic review with a different nurse. My weight is now 12st8lbs, HBa1C is 6.7, total cholesterol is 5.1, LDL is 3.3 HDL is 1.4 and Triglycerides are 0.4. My Blood pressure is 116 over 70. The nurse suggested statins!!!! never never never am i going on them. I Hurt my shoulder in a cycling accident in sept 2011, i am approaching the menopause with early signs (my mother went through this aged 40-42) and my cholesterol test have gone from march and september to jan and july. maybe cholesterol levels are supposed to go up with age as our bodies start to need more help repairing themselves and maybe i shall start to believe in my own intelligence about my diabetic eating needs and let the cholesterol do its own thing. My Father in law has been prescribed statins since last summer and these have reduced his cholesterol from 8s to 3s. he is 73 in july should we be worried? he had been getting some chest pains last spring and has electrical problems with his heart rhythm as a result of a pneumonia induced heart attack when just 19 years old.
Wow! Many thanks for sharing this Rebecca. You’ve done very well looking after your own health. Sadly, the evidence for all 192 countries in the world (https://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/) suggests that your FIL now has higher risk of heart death and death from any other cause. At a cholesterol level of 3, I’m surprised his brain and muscles are functioning much at all!
Maybe he can check his drug patient leaflet? Lipitor’s patient leaflet is here (http://www.medicines.org.uk/emc/medicine/2498/PIL/) and cautions against the drug being taken by anyone over 70. Could it be because they know the relationship between low cholesterol and high mortality?!
I hope one day that the no win no fee lawyers stop worrying about council paving stones and go after a much bigger scandal.
Best wishes – Zoe
I have a cholesterol level of 8.6 (UK) I have been told I must go on Statins (Atorvastatin) and I haven’t taken them yet as don’t really believe in them. At the same time I am afraid as the doctor is always telling me I am not looking after myself. I am 58 yrs old and they say I could be shortening my life as my mother had her first heart attack at 48 yrs old and it was a big one. It didnt kill her but she was on statins untill she died of cancer. She thought the statins caused it. !!! Not sure about that but now i’m confused as to what to do. I would love your thoughts. My son has just been told he should be on statins as his level is 2.6 (Portugal) I said no way. He is also not going to take them. Thank you for your interesting web site. Lesley x
Wow!… no I did not know that !! how on earth did they prescribe them to her when clearly she was over 70 !??..
You know I think half the trouble is we are a nation that trusts our Doctor’s know what’s best for us, clearly this is not always the case!
Thank you for the information Zoë its much appreciated.
My Mother was place on Sivastatin for about 18 months, she was at the time 76 year old, she had no other health issues other than slightly elevated cholesterol.
Within a year I noticed that she was complaining a lot about how her legs just ” did not have any strength” she had to push herself out of the chair with her arms and her shoulders and other joints were constantly hurting her. Now my Mum rarely complains about anything and has only been into hospital twice in her life one of them to give birth!..
She kept telling her doctors but it fell on deaf ears until she finally saw a stand in doctor who sent her for a blood test.. they called her a few days later and told her so stop taking the statin.. that just rang alarm bells with me and I was straight on the internet researching it and to my horror what I discovered really angered me.. it has 6.3 million results in google !!
The reports of how in some people Simvastatin can cause renal failure and death if not detected early enough.. symptoms included muscle fatigue and wastage, memory loss & confusion, weight gain Etc Etc.
The Telegraph newspaper even covered the warning on Statins on 20th March 2010
Anyway Mum came off it and within 6 months she was back to her old self , bowling again and pain free!..
We were lucky it was recognised early enough not to do permanent damage.
Why don’t the doctors just tell people about the most relevant side effects when they prescribe these drugs??
I know the list is long but is it so hard to let them know the most serious side effects? it could save lives..
I am sure its more about reducing the heart attack rates, that’s all surgeries are interested in.
Thankfully Mum does not take any more drugs and at 78 is healthy and mobile !
This Cholesterol war has a lot to answer for.
Hi Jeanne- thanks so much for sharing this. This has to be medical malpractice. Did you know even the statin leaflets caution against anyone over 70 (male or female) taking these drugs? Probably because the evidence for low cholesterol and high deaths rates (yes – you read that right) is so overwhelming in older people. I’m so glad your mum came off them and even more glad that she suffered no long term effects. Some people do find that their memory/muscle damage is not reversible. You are right on the cholesterol war having a lot to answer for!
Very best wishes – Zoe
Your Mum was lucky! My mum was put on Simvastatin at around 70 despite being perfectly healthy up until that point. Like your other she started to have breathing difficulties and joint pains, gained weight and became confused. I tried to persuade her to stop taking the statins but she was adamant that the doctor was right. By the time she was 85 she was on so many tablets for all the issues caused by the statins it was ridiculous! Sadly she died in hospital having gone in to be re-hydrated after a bout of diarrhoea. When they called to tell me she had died the nurse said she had had a massive asthma attack that had gone unnoticed and by the time someone did notice it was too late to save her life. On the death certificate it said “multiple organ failure due to old age”. Nothing about the asthma attack that went unnoticed! There is no doubt in my mind that statins killed her only one week before the Christening of her youngest grandchild.
My doctor is now trying to get me to take statins! You can guess my answer!
Hello, Zoe and everyone else who has posted on this page. One of my concerns over statins and cholesterol is that so many GPs appear to be totally ignorant of how this bit of us functions i.e what cholesterol actually is, what it does, and why, therefore, they should not prescribe statins. I almost laughed at Sara’s post, where she says how appalled her doctor was when she said she didn’t want to take statins, and then dared to question why she should be prescribed them anyway. It’s quite terrifying, I think. Jessica’s post is also frightening, considering her GP hadn’t actually found a reason why she should be taking statins, but was going to prescribe them anyway. I worry that “it can’t do any harm” is what is being thought by these GPs and other doctors. If my husband’s side effects were anything to go by, a great deal of harm is there to be done. I’m now going to have a look at THINCS – they sound like my kind of people!
Hi Catherine – here’s where it starts – the drug companies most efficient and effective way of controlling medical opinion is to get med students when they’re all together – at med school – before they disperse into practices. http://www.nytimes.com/2009/03/03/business/03medschool.html? This is how so many GPs are not only ignorant – they are completely unaware that they have been brainwashed. Good/bad cholesterol; taking cholesterol lowering as a necessary thing that must be done – all such harmful and erroneous concepts are taught early on.
This will one day go down in history as one of the greatest crimes ever committed, but we’re not there yet.
Keep fighting the fight!
Very best wishes – Zoe
It’s not just cholesterol. In this country GPs’ funding is dependant upon prescriptions creating a tendency to prescribe uneccessarily. This article in yesterday’s Telegraph really shocked me: http://www.telegraph.co.uk/health/elderhealth/9684407/The-tablets-that-do-more-harm-than-good.html Although you might want to challenge the comment about cholesterol in there! Keep up the good work Zoe.
I just received my Cholesterol today. The piece I don’t understand is why LDL is considered high (107)? My total is 174, Triglycerides 64, HDL is 54 and VLDL is 13. All of these are very good from what I have heard. I was told LDL is calculated by taking total cholesterol minus HDL minus (Triglycerides/5). Based on this formula is gives you 107.2 for LDL. Do you know why a formula would take everything in normal range and calculate an abnormal level for LDL?
Hi Steve – 107 isn’t high!
If you see my reply to Jessica on 2012/10/27 at 9.15am (above), you’ll see facts from an American study of LDL levels of people arriving at an American hospital having a heart attack (231,986 people across 541 hospitals – a big study!) The American average LDL levels were 123mg/dl and the average for those having heart attacks was 104.9mg/dl i.e. lower than the average.
None of your readings is abnormal – the problem is that the powers that be keep redefining normal so that they can put more people on statins (watch this brilliant video between about 40-48 mins to see who is setting these targets) Your cholesterol is on the low side to be honest, but your body makes what it needs so we can assume that your body doesn’t need lots at the moment.
This is a problem of profitability and a few evil money makers and a large number of ignorant followers of the doctrine set by those moneymakers. Your doc is more likely to be ignorant than evil but that’s not going to be any better for you
Hope this helps!
Best wishes – Zoe
I have now been told by my doctor that my statin is to be taken to ensure stability of my carotid plaque. At my blank look, he went on to say that when plaque breaks off and travels round the body, it causes strokes when it hits the brain. Asked why I need a cholesterol test to see if I need statins for carotid plaque stability, he was rather lost. He suggested that I talk to the diabetic expert as HE apparently has the study which will definitely show a causal link between high LDL levels and heart attacks. I am breathless with anticipation. Certainly,my doctor did not have this study. He did want to know about your credentials, and suggested that I should listen to medical experts rather than “someone off the internet” – which I agree with – but as he could not offer me any actual evidence to the contrary, it became a bit awkward. I do value evidence. I have tried highlighting the cause in Peter Hitchen’s column when he questioned the power that doctors have over us, but unfortunately did not show an interest in pursuing the train of thought.
Hi there – here’s a study doc may like (or not by the sounds of it):
A small study was published in 2001. (http://chestjournal.chestpubs.org/content/120/6/1953.full.pdf) It was clever in its simplicity of approach. The idea behind the study was to test the LDL levels of young adults who arrived at an American hospital having a heart attack. Put in scientific terms, the objective of the study was as follows:
“To define the clinical profile of young adults with optimal low-density lipoprotein (LDL) cholesterol levels who present with acute myocardial infarctions (MIs); to compare and contrast differences in the clinical profiles of young adults admitted to the hospital with MIs who have LDL cholesterol levels < 100 mg/dL and those with LDL cholesterol values > 160 mg/dL.”
The conclusion of the study was:
“Young adults experiencing acute MIs typically have acceptable cholesterol levels (i.e.< 130 mg/dL) or optimal values (i.e. < 100 mg/dL)”. (Kwame O. et al, Chest 2001;120;1953-1958) i.e. young people having heart attacks have normal or below normal levels of LDL. The initial study was quite small, but the goal was considered to be important to understand. Hence the net was cast more widely to gather far more data on cholesterol levels of people admitted to hospital with heart attacks. Data was subsequently gathered from 231,986 hospital admissions, across 541 hospitals. The lipid levels were documented in 136,905 cases. The average LDL levels were 104.9mg/dl for those arriving at hospital having a heart attack. (In UK speak this is 2.6mmol/l). (American Heart Journal 2009;157:111-7.e2) The average LDL levels for the whole population were 123mg/dl (3.1mmol/l) 70% of the people admitted to hospital having a heart attack had an LDL level below the average (the “mean”) for the whole population. Half of the people arriving at hospital with a heart attack (Myocardial Infarction) had an LDL level below 100mg/dl. Hence, people with so called ‘optimal/ideal’ LDL levels were arguably at higher risk of MI (heart attack) as people with higher LDL. You would think that, with such a magnitude of data and overwhelming evidence, the conclusion would be – one’s LDL appears to have nothing to do with one’s chance of having a heart attack, Except, perhaps, that low cholesterol may be riskier than high cholesterol. The conclusion from this study, incredibly, was that LDL goals should be set even lower! As Dr Kendrick says – we can lower LDL to the extreme (zero) and we’ll all be dead. I'll come back to you on the plaque when I've stopped banging my head against a wall! Best wishes - Zoe
Firstly many thanks for the work you do, I love reading your blog, and it’s great to a flow of rationality in my tweeter feed..
Secondly, I recently had a somewhat surprising lipid panel. My total cholesterol increased 100% to 9 mmol/L from previous panels around the 4.5 – 5 mark. As background 18 months ago I had an LAD stent inserted. 15 months ago I went paleo, lost 30 kg, increased strength and energy beyond measure and at 42 have the best body I ever had.
I should say as well that since the previous lipid panel I am undergoing investigations with a GI specialist to treat various symptoms around my lower right quadrant; liver / gall bladder area. I suspect that the rise in serum chol. is no coincidence and my carers and I will come to realise that… eventually.
But the dramatic increase in Chol. is a concern especially for my doctor. My heart fell as she starting telling me how to reduce cholesterol with a diet of egg whites, PUFA s, and wholemeal bread and crumpets. You can imagine what that means for a paleo boy. In the coming months there will be increasing pressure on me to take statins again (which I kicked into touch when I went paleo), eventually I expect to have somewhat passively aggressive intimidating conversation with my cardiologist.
So my question to you (sorry for the ramble, got there in the end though), is there an easy to swallow publication / pamphlet or something that I could give to my GP that has enough credibility to keep her interested, doesn’t abuse her for following established clinical guidelines, but neatly summarises our position here.
Would be grateful for any pointers.
Hi there – I have a few thoughts:
1) The cholesterol test is about as reliable as GCSE English exam marking! Dr Malcolm Kendrick runs through the many things that can impact the result from running late for the test to what time of day/year it is.
2) As you know – you have undergone a lot of invasion recently and your body is trying to repair you – LDL carries the repair kit – cholesterol, triglyceride, protein and phospholipids. Your body seems to be responding pretty marvelously by all accounts and I share your concern that your ‘carers’ want to interfere with this DIY!
3) I believe that a healthy body (your food and lifestyle seem very good) will make the right amount of cholesterol that it needs. Yours is making lots at the moment because it needs lots. “Cholesterol in food makes no difference to cholesterol in the blood and we’ve known that all along” (Ancel Keys) so your egg white carer is ignorant. Interestingly, the one substance that can likely unnaturally raise cholesterol levels is carbohydrate. The starting process from which cholesterol is made involves Acetyl-CoA – which is an early by product in the Krebs cycle (as the body turns carbs into energy). Hence carbs can raise triglyceride (VLDL) and LDL is a residue of IDL which is a residue of VLDL. Hence I can see how carbs can impact the blood cholesterol test, but not real fat/real food.
Here’s an extract from my book The Obesity Epidemic: What caused it? How can we stop it?
“…we should pause here to note a study done by Elizabeth Parks in 2001 entitled “Effect of dietary carbohydrate on triglyceride metabolism in humans”. The study concluded: “When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise. This phenomenon, known as carbohydrate-induced hypertriglyceridemia, is paradoxical because the increase in dietary carbohydrate usually comes at the expense of dietary fat. Thus, when the content of the carbohydrate in the diet is increased, fat in the diet is reduced, but the content of fat (triglycerides) in the blood rises.”
In answer to your question ( a great one!) – I am sadly not aware of such a simple booklet which can interest someone without undermining their clinical guidelines – not least because the opposing views really are diametrically opposed. The clinical guidelines say that there is good and bad cholesterol (puh-lease!) and that cholesterol should be lowered to a magic number of 5 because the drug companies have decreed this to be the case. (You’ll enjoy all of this but the cholesterol target bit for the USA is at c. 40 mins in: http://www.youtube.com/watch?v=3vr-c8GeT34) The UK is no less conflicted.
This may help, but it will offend everything your docs hold true so they will need to be open minded: http://theharcombedietclub.co.uk/proplan/reports/Cholesterol-and-heart-disease.pdf
This will also be of interest in terms of the stent they have already inflicted upon you – read the essay especially in the link at the end: http://drmalcolmkendrick.org/2012/04/13/the-joy-of-coronary-arteries-the-body-aint-that-simple/
I would love every GP to be given a copy of Dr Malcolm’s The Great Cholesterol Con, but that’s unlikely to happen! The other thing you should treat yourself to (and an extra copy for doc) is “How statin drugs really lower cholesterol and kill you one cell at a time.” by Yoseph and Yoseph.
I do believe that if the medical profession knew precisely how statins ‘work’ they could not prescribe them and if they don’t know precisely how they ‘work’ they should not prescribe them.
Very best wishes – Zoe
I am finding this whole subject so frustrating as I am a doctor working in Health Screening in Scotland (land of the deep fried Mars Bar) and expected to follow the government guidelines on cholesterol. I know the guidelines are total rubbish ( though NICE doesn’t cover us) but am scared to deviate too far (to the truth) without reprisal. I have followed the Harcombe Diet myself for the last 2 years and feel fantastic. I am quite evangelical about advising my patients on the principals but have to state that they are my opinion only. I would be very grateful for some robust research evidence refuting the nonsense supporting the government guidelines that I could quote to my patients. Please don’t tar all doctors with the same brush. We don’t all think the same.
Many thanks for your lovely comment. I know it’s not all docs, not least because the international network of cholesterol skeptics is full of brilliant docs. There are too many who just accept the advice handed down though. I’ll email you direct and send you something
Very best wishes – Zoe
Hi Sara, you might try a few diabetic forums. People there are usually aware of alternative treatments because they very often have to use them. I would do a lot of research however, it’s good to get a balanced view before taking a decision about treatment.
So far, no real change in my condition except I seem to stopped losing words now. I live in hope.
I had a 48hr trace done, nothing was found amiss and it was decided I had ectopic beats and palpitations. I then read that statins can cause ectopics and palpitations ! I stopped immediately and after 6weeks have had nothing.
That should give cause for thought !
Hey Zoe…. I recently went to my doctor for a checkup. I had not been for several years as I had quit taking the statins for high cholesterol. Needless to say, when I told her that I had quit taking them both she and her nurse were apalled. I had the bloodwork done and yes, my cholesterol level was at 300 mg/dl and LDL was at 100 mg/dl. She told me that she had never seen a reading this high before and was adamandt that I go back on to the statin drugs again. I have not done so at this time. I have been reading about cholesterol and other “cures”. One is to take Niacin. What do you know about that or do I even need to worry. My mother died from a massive stroke but she smoked most of her life which I do not. Thanks for all you do.
Just to let you know that I have been looking at the side effects of taking statins and apart from the muscle pains, I appear to have all of them. I have started experiencing a mild form of aphasia (well, mild in the sense that I’m just having trouble remembering words, but major in the sense that I ‘lose’ words whilst having conversations), I’ve had some cognitive disfunction for a while now (I find myself unable to connect pieces of information together – if I have five bits, I can usually fit four togther and then sort of ignore the fifth which is really embarrasing at times), neuropathy despite my BG levels being good and chronic fatigue. I’m going to stop taking them to see if it helps. I will be furious if my doctor has been keeping me on them to make money whilst ignoring things like, “My tiredness is so bad I feel like declaring myself handicapped” and “My thighs have gone numb – is this usual?”. I feel so….adrift. It’s so hard to explain how frightning it is to be unable to recall simple, every day words and have to cover up. I hope this is reversible.
But in looking at side effects, I note that a number of people can’t understand why they are still on them after having had a heart attack/stroke. Obviously the statins didn’t help them. So why are the doctors still prescribing them?
I am reading your book, stop counting calories, which has lead me to this blog which I find very interesting and concerning. I had a triple bypass at 35yrs in 1998; diagnosed with hyperlipidemia, Cholesterol 12. I have been on numerous statins since, including one which was subsequently taken off the market. After 3 yrs of 80mg simvastatin daily, last year I was put on Resuvostatin 20 mg, and it seems to be effective. My cholesterol is mow 3.9.
I am concerned because my fight has always been to lower my cholesterol to avoid future heart attacks or strokes. I understand weight and waist measurement are also important so have always been food and nutrition conscious. I am going to try your diet, because I want to optimise my chances. I just would like your opinion on people with exceptionally raised cholesterol levels and whether they should be treated with statins.
I should mention that I am on 12 other drugs for Systemic Lupus Erythamtosis, probably another cause of heart disease.
Best wishes, I hope you can reply, Marina
My reply to Elsie on this post (and the post itself) https://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/ may help and I really do recommend Uffe’s book – Ignore the Awkward – Chapter 3.
Your cholesterol is the best protection tool that you have in fighting any arterial wall damage – that’s the ultimate irony! My personal view is that no human should ingest a statin/block their mevalonate pathway. The consequences are way too serious.
Hope this helps
Best wishes – Zoe
June 15, 2012 at 2:42 pm
Hi Elsie – it’s a blog in itself probably! Too many blogs to do, too little time. I highly recommend getting hold of Uffe’s books – especially the latest one “Ignore the Awkward”. There’s a chapter about FH and he’s the expert on it.
The book that I’ve just finished reading would also help – “How statins drugs really lower cholesterol and kill you one cell at a time.” (Yoseph & Yoseph) One of the most shocking books you’ll ever read on conflict of interest and the scandal that is statin drugs. In short – statins block the mevalonate pathway in the body, which is just about as serious as anything we could do to another human. This stops cell rejuvenation, production of isoprenoids – including the one responsible for DNA replication and cell replication and also CoQ10 – vital for energy. The body responds to this life threatening situation by increasing production of reductase. (Statins are called reductase inhibitors – and they are – but they are also reductase stimulators, as the body will try to make more reductase to reboot the mevalonate pathway. This doesn’t work, by the way. Nothing can reboot the mevalonate pathway – this is why we will be killed one cell at a time.) At the same time as reductase tries to rescue the body, the LDL receptors also try to take more LDL from the blood stream into cells to protect those cells. This is because the cell recognises that it can no longer make its own cholesterol properly, as this has been impaired by statins (statins don’t stop the body making cholesterol entirely or they would kill us instantly). Hence statins increase LDL receptor activity, as the body tries to get the LDL needed by the cell from the blood stream. This is how LDL in the bloodstream is lowered – it has been taken by the cells in response to the attack the body has experienced and to replace the cholesterol that the cell would have happily made if left alone.
FH is characterised by a gene defect on chromosome 19. In some types of FH, the LDL receptors barely work at all and statins won’t help with this type at all because, even with the LDL receptors being stimulated to take more LDL from the blood stream, the receptors are just not working well enough to do this. (The early supporters of statins know this by the way – they know exactly how statins do their worst and they know that they won’t help the most serious type of FH. Statins, ironically, were only originally approved for FH, but the money is in being able to prescribe them for anyone with a pulse.) In other types of FH, the LDL receptors work to an extent and the stimulation of the LDL receptors can help to get more LDL into the cells. This might be a good thing but for the fact that the statin has stopped the cell producing its own cholesterol and but for the fact that the statin has blocked the mevalonate pathway and thus shut off cell rejuvenation and the cycle of life itself.
I know that I will never, ever, ever take a statin and I wonder if any doctor would prescribe them ever again if they read everything that we know about these drugs.
Ignorance is not bliss when it comes to the mevalonate pathway!
Best wishes – Zoe
p.s. since writing the cholesterol and heart disease blog, I thought of another bit of logic – high cholesterol is not a problem in itself – the problem with FH is that the LDL (the lipoprotein carrying cholesterol and protein and phospholipids and triglyceride) cannot get into the cell effectively, as the LDL receptor is not working properly (or at all). This means that the damage done to the body is because the vital LDL – our body’s repair kit – doesn’t get to where it should. This can include not getting to the heart and other vital organs – as every cell needs cholesterol and the other substances in a lipoprotein. Hence the heart can be damaged by not getting the repair kit. The repair kit being in the blood stream is not a problem per se – it’s a symptom of the thing that didn’t happen being a problem!
Things can be seen very differently when you don’t start from the assumption that cholesterol is evil!
Zoe, thanks for the reply. I’ll look into those books. I’ve just started reading “Fantastic Voyage” by Ray Kurzweil & Dr Terry Grossman, an interesting book that claims we are on the brink of uncovering the secrets that will allow us to live forever (not that I particularly want to!)
But already, in chapter one, they mention the role of fats and cholesterol in atherosclerosis, and go on to question current cholesterol targets, and suggest that they might not be low enough. But I haven’t let it put me off though. I’m just hoping they make a ‘discovery’ a bit further into the book. (The book was written in 2005 so perhaps they’re a little behind the times!)
Zoe, I noticed a quote from you, a very profound quote, one that made me sit up and take notice: “We think that people who try to lower the blood-cholesterol levels of their fellow human beings are guilty of what will go down in history as one of the greatest crimes against humankind.” Heavy stuff!
So I hope you don’t mind me asking, but who exactly is “we”? Are you part of an organisation or are you referring to your co-conspirators, as it were? Dr Kendrick etc.
All the best
Hi Richard – I am a member of thincs – the international network of cholesterol skeptics. We come from all over the world and most are professors, doctors, academics etc who have come from different approaches, but all with the same conclusion – that the demonisation of fat and cholesterol and subsequent lowering is a crime against humanity. The consequences of this campaign are not yet fully known – do read that Yoseph book and you are likely to concur!
Most people in our on-line eat real food support club have also come to agree with that quotation. Many have been on statins or told that their cholesterol is ‘high’ by doctors who haven’t read as widely as they have and they are starting to challenge from a position of evidence and knowledge. Just like you!
Back to holiday! Best wishes – Zoe
First of all I’d like to say thank you. How refreshing it is to see somebody looking at the evidence and coming to their own conclusions rather than ignorantly towing the line.
I’m a 42 year-old type 1 diabetic, and have been for 14 years now. Four years ago when my cholesterol level reached 6, I was prescribed simvastatin and aspirin. I’ve been taking them ever since. Until, that is, I heard you on the Steve Wright radio show and subsequently discovered your fascinating website. I’ve been statin-free for about ten days now!
I’ve long since suspected that all was not as it should be in this murky world of cholesterol and statins. And looking back now I can see that my personality has changed significantly in, what I estimate to be, about four years. I’m more irratable, angry, short tempered and somewhat lazier and apathetical than I ever used to be. A coincidence? I don’t yet know. I’m hoping that that will all change though. But I’m not holding my breath.
Keep up the good work, Zoe. I’ve begun to spread the word.
P.S. An interesting anecdote I have discovered since doing my own research. Don’t know whether it is in fact true. But if it is you might want to include it in your text: Human breast milk is high in cholesterol. Do we think our breasts are out to get our newborns?
Hi Richard – thanks so much for your lovely note. I am aware of the cholesterol content of breast milk and don’t think that we’re trying to kill our off spring! ;-) Delighted to hear that some of the side effects are going away.
If you fancy any further reading – Dr Malcolm Kendricks The Great Cholesterol Con is the funniest book you will ever read about this serious topic. Anything by Uffe Ravnskov (fat and cholesterol are good for you or Ignore the Awkward) is well worth a read. The one that might make you angry is “How statin drugs really lower cholesterol and kill you one cell at a time” by Yoseph & Yoseph. Just read that recently and it’s dynamite!
Keep up the rebellion!
Best wishes – Zoe
Well, Peter Attia is on the low carb side with Gary Taubes, but says things like “Statins are a tool” and I don’t know what to make of it yet (Dr. Davis and Dr. Carlson also have their exceptions about them). I don’t buy the hypothesis that all that matters is the number of LDL particles yet though, but at least it seems clear that he is going to focus on a low carb solution on his cholesterol series. Personally, my cholesterol is 332mg/dl —8.59mmol/l— (281mg/dl —7.27mmol/l— a year ago) and I couldn’t care less. Actually, I like to check it (company annual checkup) to see my high saturated fat diet at work: my triglycerides dumped from 140 —1.58— to 79mg/dl —0.89mmol/l— and my HDL skyrocketed from 68 —1.76— to 110mg/dl —2.84mmol/l—. I simply don’t comply to the advice the doctor gives me to lower saturated fats and go to my family doctor, though.
About the cholesterol skeptics… are there cholesterol believers around here? ;-).
…because pharma OWNS the medical profession.
I’ve given up. I will not ever recover from Statin damage, of the years it cost me, and yet still deal with hostility and coldness (no eye-contact etc because I refuse to take Statins anymore. So here I am, 70yrs old, no cardiovascular disease, a TC of 9.7 to 11, T always well under 100, LDL 7.19. Have no idea of the rest and do not care. They do not know what they are doing, and prescribe only to protect themselves.
I think Dr. Davis’ book has a typo in the sidebar on Friedewald.
”For this equation to work and yield reliable LDL cholesterol values, for instance, HDL must be 40 mg/dl or greater, triglycerides 100 mg/dl or less. Any deviation from these values and the calculated LDL value will be thrown off.”
Because a low triglyceride level would overestimate LDL, shouldn’t the sentence read “…triglycerides 100 mg/dl or greater”?
Mike Eades’ blog (www.proteinpower.com) has a good analysis of Friedewald. But just because we can measure something, it doesn’t mean we should or that the measurement is meaningful. The sad thing is that by concentrating on lab values and pushing pills, medicine misses the point(s)–good health, vitality, quality of life, etc.
Hi Zoe-Maybe you will remember where you saw that challenge of small vs large particles,and post it.I would love to read that.
Hi Mike – my ‘sparring partner’ spotted it. Just emailed him – watch this space!
Best wishes – Zoe
Hi again Zoe — thanks for the link, I will read it. You might be interested in this link, beginning a short series of blog posts about the role of blood lipids in the body (I only thought of it after your response!). See especially the diagram showing the relationship of morbidity of all causes to particular levels of cholesterol worldwide (not just USA) —
Hi Kathy – thanks so much for this – great link! “Mortality goes up as cholesterol goes down” Of course it does – cholesterol is one of our main repair tools. Low cholesterol = low repair ability.
There may also be a causation the other way round – someone is fighting cancer, for example, and cholesterol in the blood stream is low because it’s being dispatched to cancerous cells to try to repair them. If the host keeps eating sugar & fake food/smoking/being exposed to pollutants & chemicals etc – the body may not be able to produce enough cholesterol to try to help.
I need a “Hands off our cholesterol” T Shirt!
Best wishes – Zoe
Hi Zoe — I thought, from the title of your post, you would be discussing the roles of the various fractions of cholesterol, and perhaps the meaning of “high” or “low” values in one’s metabolism. Or have you already posted on that sort of thing?
Hi Kathy – I’ll leave that to the majority who believe that cholesterol is something in need of measuring! I am not one of them. There is no such thing as high or low cholesterol or any part of various fractions as far as I’m concerned. The body makes the cholesterol that it needs and we mess with that at our peril. The concepts of high and low are subjective views introduced by people who stand to gain billions from lowering a life vital substance! – as the members of the NCEP illustrate.
Not sure if this helps but don’t worry about cholesterol and don’t ever try to lower it!
Very best wishes – Zoe
p.s. this may be of interest: https://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/
I look forward to it Zoe. As an aside, I do chuckle when Michael Mosley is constantly surprised by the ‘new research’ (e.g. intermittent fasting, high intensity training) out there. He should read a few very well written blogs to keep up. When it comes to nutrition Horizon seems behind the curve.
Zoe I don’t know if you watched the Horizon (BBC) programme on calorie restriction and intermittent fasting but I would love your feedback. I was confused that IGF-1 was linked to eating too much protein. Apparently eating too much protein puts our body in “go, go, go” mode, i.e; cell turnover (inhibiting cell repair). From my limited reading it is excess insulin and glucose which is the problem, so it was a surprise to hear the opposite.
Hi M – I’ve taped it – not sure when I’ll get to watch it. Will no doubt tweet or blog if there’s enough to say!
Bye for now – Zoe
The “Friedewald equation” according to DR.William Davis,Author of,”Wheat Belly”
” For this equation to work and yield reliable LDL cholesterol values, for instance, HDL must be 40 mg/dl or greater, triglycerides 100 mg/dl or less. Any deviation from these values and the calculated LDL value will be thrown off.”
“Another problem: If LDL particles are small, calculated LDL will underestimate real LDL. Conversely, if LDL particles are large, calculated LDL will overestimate real LDL. To make the situation even more confusing, if you shift LDL particles from undesirably small to healthier large by some change in diet—a good thing—the calculated LDL value will often appear to go up, while the real value is actually going down”.
Hi Mike – I love that book! Nice reminder of this quote from it. I remember seeing something recently challenging the small dense vs large fluffy LDL theory. I think the whole cholesterol scam is nonsense but it still doesn’t hurt to see component parts highlighted for their deficiencies – many thanks for this!
Best wishes – Zoe
I had all the same doubts until reading Dr. Peter Attia explaining all of it in his series about cholesterol: measuring is covered in The straight dope on cholesterol – Part III.
Thanks so much Andrés – these look interesting – another one to put on the todo list! (Just seen one link on this link goes off to Daniel Steinberg however – he gets his just desserts in the brilliant Joseph & Joseph book “How statin drugs really lower cholesterol and kill you one cell at a time”. If there is a smoking gun in this whole cholesterol crime, many believe that Steinberg is the guy holding it, so I’ll reserve judgement)
p.s. for all replies – I’m getting the impression that the best replies are coming from cholesterol skeptics – those don’t buy the simple nonsense we have been given and who have therefore looked into the topic a lot more thoroughly. I’d be interested to see what people who believe that LDL is bad cholesterol and HDL is good cholesterol think this is all about!
Many thanks Jay – will listen tomorrow.
p.s. Update – I heard Chris M saying the bit you mentioned – in LDL and HDL it is cholesterol in the lipoproteins measured. This doesn’t cover the triglyceride bit or the fact that the standard blood test does only ‘measure’ total cholesterol and HDL and estimates the rest. I love the podcast though – going to set aside 90 mins to listen to the whole lot properly! Thanks again – Zoe
Chris Masterjohn talked about this in his first appearance on Chris Kresser’s podcast. He stated that the test measured the amount of cholesterol in the lipoproteins, not the amount of lipoproteins.
If like me you’re on a primal low carb diet, with fairly high total cholesterol and low trigs, the Friedewald equation usually overstates LDL (for what it’s worth).
Try the Iranian formula instead and you might be better armed to fend off the statinators: