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?

A request

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.

Appendix 1

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?

  • Thanks for this very insightful article. I found it by searching on how to convert the US measuring of cholesterol to the Australian one. However I discovered a whole lot more useful information. I am currently taking statins (reluctantly), but am taking them every 2 days to reduce the side effects (lower CoQ10 etc.)

    • Hi Wendy
      You can get CoQ10 supplements from pharmacists or health shops. They were originally planned to be added to statins (early patents show), as it was known that blocking the mevalonate pathway impacts CoQ10 production and that’s the body’s energy sparkplug in effect. This didn’t go ahead but individuals can choose to do this at their own cost.
      Best wishes – Zoe

  • A few years ago I had my over 50s check up. I had elevated blood pressure and was put on Ramipril after the blood test my cholesterol was 5.4 and I was given Statins. After a week I felt worse and worse. Tired, in pain, my nose was runny etc and checking the leaflet I could tick the majority of side effects. I went back and I was given different Statins. This time it took 2 weeks but the side effects were even worse. I went back again and told my GP never again to mention Statins.
    It took a very long time for me to recover from this poison. To this day I believe I still feel the effects.
    What this experience did for me is to research cholesterol a bit further and have come to the conclusion that somehow our doctors are made to give out Statins without really knowing what they are doing. My hubby had even a lower cholesterol level than me and was told he should take Statins as a precaution. Because he knew the effects it had on me, he declined.
    My mother is now diabetic because of them. My mother in law can’t sleep because of them. I told them both to stop taking them. But I am not a doctor. How can I convince them?
    When will our doctors stop jumping when the pharma industry says jump???

    • Annie, thank you so much for your post! I was poisoned with Lipitor @ 80 mg which included memory loss, inflamed liver, muscle and joint pain, and rashes that got worse even after I tossed the poison. It took me 6 years to recover. The docs continued to catastropise about my LDL level and tried another 3 poisons on me. Each were tossed by me within a week – rashes, aches and pains all occurring with a vengeance within days. I believe these are dangerous drugs and gateways to serious illnesses, a marketing dream for Big Pharma whose business model is “Every human from cradle to grave reliant on at least one if our products. We are just commodities, guinea pigs and collateral to these greedy people.

  • It is very difficult to get a sane advice on medical help … in general, and more so in the matters of heart-related problems and diabetes! My belief that doctors are poorly exposed on nutrition, and biochemistry has gained more ground — they appear to have limited themselves to what the medical representative tells while selling/advt his/her drugs. They completely forget the human biochemistry and its physiology. And they steadfastly prescribe statins for high(er) cholesterol levels.
    The medicos of entire world appear to be behaving like a mindless group — they don’t appear to apply their mind.

  • Not sure if anyone has pointed this out, but TG is also measured (along with TotalC and HDLc, so 3 out of 4 numbers are measurable):

    TotalC = LDLc+ HDLc + VLDLc; Where VLDLc = TG/5; thus
    LDLc is calculated as TotalC – HDLc – TG/5;
    If TG >400mg/dL then LDLc cannot be calculated reliably (the friedewald approximation error becomes too big?)

    Still this is a great article, makes one think. Thank you!

  • Finally someone else saying exactly what I’ve been thinking! I am currently putting together an introductory course on nutrition and the deeper I delve the more questions I have. I have had this LDL/HDL/VLDL/IDL and triglyceride puzzle in my head for a while and it seemed clear to me but to no one else… what are they measuring exactly? .. I’m so glad I found your article, Thankyou thankyou thankyou!!! Another thing I have noticed so far is that the people who do the most in-depth research are the drug companies!… wonder why!!

    Jase :)

  • Dear Zoe.
    Just got my Lipid Profile and Total Ch is 6.2, HDL CH -1.1,Non HDL CH-5.1, LDL 4.4, TRI-1.6 and CH Ratio is 5.6 (all measurement in mm0L/L). I am a Malaysia of India Origin and though the results does not look good, I am actual comfortable with my life. I eat what i feel like eating and avoid very oily food. Have gone for by pass ope about 5 years back and still a mild smoker. I am on anti ch medication and blood thinner. What your advise on my situation. Quite smoking is no the card and don’t have any HBP/Sugar problem. I am with you on the CH which is all about $$$ and the medical world is just drumming along.You kind advise and comment please.

  • hello ,
    My husband is 37 years old
    weight is 69 kgs
    height is 5 7″
    cholestrol ldl is 3.0
    bp is 120/80

    doctor asked him to eat oatmeal , fish and away from oil and exercise.
    no medicine is prescribed .

    does he have to decrease his weight ?
    how he can decrease his bad cholestrol ?

    how much salt he can consume?

  • hi mam, Im from Sri Lanka. i need to know about the lipid profil measurements and how many times per year we should do these measurements

  • Hi Zoe,

    I wrote to you earlier this year was regard to my cholesterol levels. I saw Dr M Khan at university hospital Coventry (UK) in the spring who wanted to prescribe statins for me as my cholesterol level was 7.8. He also wanted me to be screened for FH. I refused the statins at the time and i’m still waiting to be tested for FH. However i thought i would go and get checked again but at the pharmacy not at the doctors. My total cholesterol level now appears to be even higher at 11 even though i exercise regularly and my diet is very clean with plenty of fruit and veg. Could you possibly explain my results for me please. Total Cholesterol mmol/l 11.0, HDL Cholesterol 6.73, TC:HDL cholesterol ratio 0.61.


    Alex Chang.

    • Hi Garry
      I disagree – cholesterol isn’t important, the ratios aren’t important, LDL and HDL aren’t even cholesterol! It’s all just a fabrication to support the cholesterol hypothesis :-)
      Best wishes – Zoe

  • Hello Zoe, I have just finished reading your interesting piece on the perils of reducing cholesterol by the use of statins. I have been on 80mg of Lipitor for the last two years (my doctor doesn’t believe in half measures apparently)and I may be experiencing slight muscle pain because it (I don’t really know if this is because of Lipitor but I intend to find out by going off it; your advice on the dangers of doing this would be welcomed). I am interested in another approach to limiting plaque damage, and even reversing plaque, by consuming more antioxidants particularly the flavanols found in unprocessed cacao powder(raw cocoa), pomegranate juice, etc. Instead of unnaturally reducing cholesterol by reducing its uptake via the food we eat, the body needs less cholesterol because of less damage done to arteries etc. by more antioxidants in the blood. Your comments would be appreciated. By the way I am 71 years old. regards Tony mercer

    • Hi Tony
      You may find this interesting

      You’re right to be thinking – the body will make the cholesterol it needs, so it will make more to repair damage, so it makes sense to limit the damage. It obviously always makes sense to be as healthy as possible and that includes avoiding stress from unnecessary worry about cholesterol! I don’t think antioxidants would do much harm but I wouldn’t go out of my way to prioritise them – just eat real food – meat/fish/eggs/veg/dairy (pasture fed animals etc). Cocoa powder is awesome for nutrients – forget antioxidants. Juice is likely too sugary to be healthy. A couple of other thoughts: a) the antioxidant role in the body is best played by vitamin E and b) if we reduce our exposure to free radicals (processed food, pesticides, smoking, pollution etc), we need fewer antioxidants.

      Best wishes for 81 and 91!

  • SHHHH don’t tell. Why does the AHA say the the LDL target was made up out of thin air? Because IMO they made up the whole normal cholesterol target out of thin air. Why are they recommending statins to everyone in their 60’s and 70’s. You know why? because, Cholesterol doesn’t cause heart disease. The statin is doing something else other than lowering cholesterol. So don’t tell, but people with low cholesterol are at the same risk of heart disease as people with High cholesterol. (that’s why they are giving it out on basis of age)

    AHA still recommend them for people with LDL over 190? Why? Do they know for sure that over 190 is bad or are they just guessing(they did admit they made up the LDL numbers), or keeping people on it over 190, because if they say over 190, then everyone will know the lipid hypothesis is bunk. Or are they keeping them on it because they are unsure whether or not they will benefit. I think they are still clinging to the drug company delusion that there are no side effects to Statins. I do think Statins help, but I think the side effects aren’t worth it. (AHA still won’t admit)

  • Hi!
    My Dr just told me that I have high cholesterol and he wants to put me on a statin drug. He said that it has been shown to reduce heart attacks and stroke by 12 to 13%. He said that is a lot. He told me that it can damage my liver but that it’s okay because the liver is a regenerate organ. . .huh? He also said it can cause Diabetes II but it doesn’t matter because I already have Diabetes II…even though my overall blood sugar levels were perfectly normal. So huh? Again! He told me that I need to make sure and have good health insurance because I’m at high risk for a heart attack and stroke because of high cholesterol and Diabetes II and elevated blood pressure. Even with the ridiculous stuff he said, he really scared me! Made me feel like I’m a walking time bomb. My total cholesterol was 343. I don’t know the breakdown and it sounds like it doesn’t matter. One thing that really upsets me is that I was told before that I would need to start taking insulin because my blood sugar was uncontrolled. I started exercising much more, I eat no sugar that is not natural and I’ve lost over 60 lbs. I worked hard to get my blood sugar normal and now he suggests that I take a drug that will raise my blood sugar. I understand that high blood sugar is damaging because its sugar that your body is not getting rid of adequately and sugar is damaging. So . ..all in all, I feel the best thing I can do for myself is to keep my blood sugar level in a good range via a healthy lifestyle.

  • Hi Zoe….like so many people I am very confused about cholesterol levels and in my case particularly high triglycerides.
    I was given Simvastatin which upset my stomach, and also had back pains. After that I was put on Tricor (Fenofibrate) which I have tolerated …or have I? The reason I say this is because my hair has thinned something awful and I have terrible aches and pains…..I currently have a frozen shoulder. These are my no’s serum total cholesterol 5.4. Triglyceride level 1.7. Serum Hdl 1.7. Serum Hdl ratio 3.2. Serum Ldl 2.9. Every Dr. I have seen insists I take medication. I eat healthy and walk 30 mins. aday. I will mention that I am hypothyroid and every article I have read states that having hypothyroidism also means you probably will have high blood pressure (which I do) and high cholesterol levels. Trying to get the Dr’s to understand the connection is ignored. What do I know ?

  • Hi Zoe,
    I’m a pro drummer travel, still playing everyday got chol. results today, I’m 74.6 years old, basically healthy, but … readings are 244 and 162 they want to put me on Atro … lowering chol. drug, I do eat quite a lot of butter, cream, milk and white Italian bread, and a baked potatoe with of course butter, I feel concerned now, I have some high blood pressure 160/ 105 -= sometimes, take lycinapril … But more concerned about chol. what should I do, Thanks, Saint

  • Hi Zoe.

    I am Filipina 25 yrs old had a cholesterol of 7 and was given atorvastatin lipitor for two weeks now. I have checked my cholesterol on the 12th day and it was 170 then after two days it became 133 is it still okay and should stop taking lipitor?
    Thanks! Hoping for your reply. :)

    • Hi Pau – I cannot advise you.

      I can share that the cholesterol test is about 20% inaccurate ( and therefore the difference in your readings could be due to accuracy.

      I can tell you that a cholesterol level of 170 (4.3) is frighteningly low for a young woman and 133 (3.4) is even worse. This may be of interest:

      I can also say that I am utterly horrified that any woman of child bearing age is on statins. I hope that you have been given massive cautions not to get pregnant now or any time you are on statins or any time afterwards when you could still have traces of them in your body. You cannot make a healthy baby without cholesterol. I would be taking legal action against my doctor if this were me, but then I would never let a statin pass my lips, so I would never be in this situation.

      This may also be of interest – you’re LOW cholesterol levels are associated with HIGHER deaths rates – read that carefully

      Seriously – I am almost speechless that a young woman, with such low cholesterol is on statins – there will be law suits. Maybe you’ll be first?!

      Best wishes – Zoe

  • Zoe:

    Thanks for all your work and for spreading the work about cholesterol and statins.

    I am a Caucasian male and I am 55 years old. My BP is 130/80. I have been on a LCHF diet for about 8.5 months (Jan. 6, 2014). I just had a physical exam by my new PCP, which included blood work. All my blood lab numbers are in the standard ranges, EXCEPT cholesterol. My Lipid Panel looks like: TC = 313; TG = 109; NMR LP HDL-C = 67; LDL Calculated = 224. I feel fantastic and have never had any type of cardiovascular events nor have I been diagnosed with any type of heard disease.

    Do I need to worry about my LDL number? I will be meeting with my PCP again next week. I am going to ask him to perform a CT calcium scan, a LDL-P, CRP, plus possibly some additional thyroid tests. I repeat, I FEEL GREAT! Are there any other tests I should consider or am I doing okay?

    Also, I consume a couple glasses of wine (mostly red) several nights a week. What do you predict my Lipid Panel would do if I were to quit drinking alcohol for a few months prior to repeating my Lipid Panel?

    • Hi Jeff – it sounds like you’re doing really well and this is one of the reasons why I get so angry at the cholesterol scam that is making billions for drug companies, while subjecting individuals to stress about things that they shouldn’t even know – let alone worry about. Are you old enough to remember a world when we didn’t even know our cholesterol numbers let alone care? I don’t know mine and I don’t care. You may be doing more harm from stress caring about any of this than from anything else you’re doing!

      This may help:

      I don’t know what impact red wine can have on cholesterol, let alone does. This is the process by which the body makes cholesterol (
      Q1) What impact can alcohol have on total cholesterol and/or LDL (good to see you know this is guessed, not measured by the standard blood test).
      A) I don’t know – see if you can find a doc that can explain precisely which part of the cholesterol metabolic pathway alcohol impacts.

      Q2) Dr Malcolm Kendrick asked in his 2007 book – how can saturated fat impact LDL? Maybe if doc can answer Q1) they can try Q2.

      We talk about dietary factors impacting cholesterol without even explaining HOW this can happen, let alone that it does.

      Red wine is a very enjoyable, relaxing, sociable thing to partake of. What would happen to your stress and well being if you gave it up? Stress, unlike cholesterol, IS a significant factor in heart disease.

      Not sure if this helps but I’m not the person to care one iota about cholesterol! Cheers to red wine – Zoe :-)

  • Hi Zoe. thanks for all the useful information. Is there a chart somewhere to show the conversion between the US and UK measurements of statins?

    • Hi Barbara
      The USA uses mg/dl for cholesterol measurement. Europe and Australia use mmol/L. To convert mmol/L to mg/dl, multiply by 38.67. To convert mg/dl to mmol/L, divide by 38.67. e.g. the current ridiculous UK target of 5mmol/L converts to 193mg/dl.

      You can plug either number into this convertor and it will give you the other number:

      Best wishes – Zoe

  • just had my(fasting) blood work done again after quitting 1500mg Niacin nightly.Chol. 279,Trig.138, HDL 80, LDL 171,chol/hdl ratio 3.49, chol. non-HDL 199.
    Previous fasting bloodwork while taking Niacin was Chol.246, LDL 141, Tri.67, Chol/HDL 2.67
    I am 5’5, 115lbs. Blood pressure is low and I eat very healthy,no fast food, no meat,chicken or fish(other than canned sardines or herrings), although I smoke and drink.

    After reading your extremely interesting and informative article I am wondering if it’s even worth worrying about it at all. I have absolutely refused to take Statins.
    I would really appreciate your comments !


    • Hi Christa – I think your pondering is right. I don’t know what my cholesterol level is and I don’t care. I trust my body to do its job and make more if I need it and to turn it into vitamin D when I get out in the sun and to keep me alive and to keep every cell in my body as healthy as can be. We’ve got enough to do in modern life without worrying about stuff we shouldn’t even know.

      You’ll know that smoking is genuinely bad for you so you’ll also know that a) if you want to improve your health stop smoking (a heck of a lot easier said than done – I know having seen quit evidence) and b) there is absolutely no point worrying about anything else while you smoke! It would be like worrying about a cut finger when you’ve just severed an artery.

      Hope this helps!
      Best wishes – Zoe

      • haha, thank you very much. Of course you are right. I forgot to mention that I am 71 yrs. old and have smoked for about 40. At this point I am not giving up anything ! Bears to mention both my grandmother and mother smoked and both died in their 90’s ! I don’t even want to get that old !
        Kindest regards

        • Ha ha back ;-)
          You’ve just also shared a vital piece of info – age! Even the patient leaflet for statins essentially says don’t take them past 70 (,+20mg,+40mg,+80mg+Tablets/) and not many docs can ever have read this!

          Plus the evidence for living longer and cholesterol in the more mature person is that the last thing you want is lower cholesterol. Here are a few snippets from my obesity book.

          Cholesterol and mortality
          The Honolulu Study was a 20 year study of cholesterol levels and mortality in 3,572 Japanese American men. The study concluded that “Only the group with low cholesterol concentration at both examinations had a significant association with mortality”. The authors went on “We have been unable to explain our results”. (I.e. we were expecting lower cholesterol to equal lower mortality, not the other way round). All credit to the team for their honest reporting of these unexpected results and their final statement in the abstract: “These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4•65 mmol/L) in elderly people.”

          Framingham similarly concluded that “There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels).” Kendrick does a clever calculation on this quotation and translates this into – a reduction in cholesterol from 5 to 4 mmol/L would increase your risk of dying by 400%.
          Elaine Meilahn reported in Circulation (2005) “In 1990, an NIH (National Institutes of Health) conference concluded from a meta-analysis of 19 studies that men and, to a lesser extent, women with a total serum cholesterol level below 4.2 mmol/L exhibited about a 10% to 20% excess total mortality compared with those with a cholesterol level between 4.2 and 5.2 mmol/L. Specifically, excess causes of death included cancer (primarily lung and hematopoietic), respiratory and digestive disease, violent death (suicide and trauma), and hemorrhagic stroke.”

          If you want more evidence for the connection between low cholesterol levels and increased mortality, I recommend Kendrick’s comprehensive sample of references and Dr. Natasha Campbell Mc-Bride’s Put your heart in your mouth. Just reading the list in Chapter Eight of this book, detailing the vital importance of cholesterol to the entire functioning of the human body, is enough for me for this to be common sense.

          Sounds like you’re doing well so don’t worry about cholesterol!
          Best wishes – Zoe

  • Hi Zoe, great blogs, articles and books –
    I was wondering if you had read the latest JBS3 which provides extensive info on how to reduce CVD…. it is pretty long but I was interested to note that they are now only recommending monitoring of HDL plus non-HDL cholesterol – (still begs too many questions but…) it looks like they finally recognise that TAGs may be just as (or more) important than LDL… and of course VLDL aka TAG is of course primarily liver-production of CHO (as far as I can gather) not normally from high fat intake.

    Is this the sleight of hand that normally accompanies not wanting to admit a mistake?

    Eventually, I am wondering if they will admit that it is not about lowering cholesterol… but persist because statins effect is on reducing inflammation -shame that it also reduces cholesterol… I’d like an intervention that just does the inflammation – oh, we have one… is it that it just doesn’t make pharma companies any money?

  • Zoe,

    Thank you for sharing your knowledge in plain language. I stop taking any medicine for cholesterol since its side effects were “killing me”. I am feeling better and keep doing what I was doing; exercising and improving my food in-take.I am very lucky as many readers of this site; my wife is a nurse and the doctor of the family.


  • Zoe hi thankyou so much for your answering so quickly a sign of relief,

    you are an angel helping people with their results
    lots of love Elie xx

  • hi zoe
    i am female age 67 ,68 in june 2014 i have just move to live in portugal i had a full blood test done bit confused with my colestrol total its says 245 mg dl my hdl reads 73 mg dl my triglicerides 107mgdl these no reading for ldl so the 2 come to 180 so how come the toatal is 245 mg dl when they have not given me a reading for my ldl

    Elie xx

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