'High Cholesterol' in Blood Test Results

by (181) Updated February 20, 2011 at 7:19 PM Created December 08, 2010 at 12:05 PM

I just got my blood tests back from the lab. My regular doctor is on vacation and the doctor filling in had to look at the results and comment on them before she would release them to me. She wants to but me on statins for 3 months and see how things go. I'm wondering if I should really be worried, though.

I'm 37yrs old, 135lbs (down from 150). I've been eating roughly 85-90% Paleo for the last year and take 7g of fish oil, 50mg zinc per day. I'll usually have 6 standard eggs for breakfast (5-6x per week) and 3 large cups of coffee daily. Standard grocery store fare is what I eat, but try to keep the meat at 90% lean or better.

The results:

  • C-Reactive Protein: .65mg/L (should be less than 1)
  • A1C: 5.2% (should be less than 7, or 5 according to Robb Wolf)
  • NMR Particle size test:
    • Total LDL: 1808 nmol/L (should be <1000)
    • Small LDL: <300 nmol/L (should be <600)
    • Total HDL: 29 nmol/L (<23 is low, >40 is optimal)
    • Large HDL: 10.7 mcmol/L (<4.0 is low, >9.0 is optimal)
    • Total Cholesterol is 359mg/dL (which is high)
    • Triglycerides: 101mg/dL
    • HDL Cholesterol is 61mg/DL
    • Calculated LDL is 278 (>190 is very high)

My father has had a heart attack and two heart bypass surgeries. I don't want to end up in the same boat. Am I really in trouble here or have I just been drinking the kool-aid for too long?

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9 Replies

3576 · February 20, 2011 at 7:19 PM

Bear in mind I'm not a doctor, I more have something of a Hermione complex. I've read a lot about this stuff and I pass on what seems interesting to me.

Your numbers are confusing. Would I be accurate in guessing you are not American? I don't usually see lab numbers for cholesterol presented as nmol/L. I'm seeing three different numbers there for your HDL. Here in the States, we don't even look at large HDL, ha ha, at least not on the lab results that the typical patient sees. That's not mentioned in the media, etc.

Here in the States we measure by mg/dl. I see you do have mg/dl numbers for both HDL and LDL. Your mg/dl HDL number is excellent by American standards. Current wisdom says that risk of heart disease is reduced if HDL is over 60 mg/dl. Low HDL at that measurement is 40 mg/dl for men and 50 mg/dl for women.

Looking at Wikipedia, which discusses the various measurement parameters, large HDL needs to be over 7.3 μmol/L and total HDL needs to be over 34.9 μmol/L for greatest heart disease protection. I am not well-versed enough in those teeny metric units of measure to say whether that's equivalent to the units you present in your list above. You'll want to ask your doctor.

Your LDL is calculated. There is no way you have any idea what your LDL is doing unless you have them do a direct count. Your triglycerides are just low enough that they might skew the Friedenwald equation. (Google that, it's very interesting.) Your small LDL is well below the danger threshold according to your laboratory. I'm going to guess that even if a direct count matched Friedenwald, you've got big and fluffy going on there. If it were me I would not worry about it.

There is a lot of debate about who exactly benefits from statin therapy. The general gist seems to be that if you're a guy and have already had a heart attack, you would probably benefit--but the benefit arises from reducing systemic inflammation. And the benefit translates to about one subsequent heart attack prevented out of 50 men. So you put yourself at risk for the side-effects--muscle pain, reduction in mental function, increased risk of metabolic syndrome and diabetes, and so on--on a gamble that you might be that one guy out of 50 who never has another heart attack.

If the one benefit from statins is a reduction in inflammation, you can take care of that on your own. Stop eating glutens if you're still eating them in that 10 percent not-Paleo thing you do. Cut your sugar intake--if you're going to cheat anyway, cheat with sugar-free treats. (Ignore anybody here who says you're killing yourself. When they find a hard link between non-aspartame artificial sweeteners and chronic disease, and that risk is greater than from the consumption of sugar, then maybe they'll have a case.) And watch your fatty acid intake. I'm afraid Cordain missed the boat on this one: you want more saturated fat than nonsaturated in your diet. And of the nonsaturated fatty acids you eat, you want to aim for as close to a 1:1 omega-3 to omega-6 ratio as possible. As you don't have time to sit around measuring, try these tricks:

  1. Choose wild-caught fish over farmed when you eat fish.
  2. Cut down on chicken intake. It's massively high in PUFAs. On days you eat it, consider supplementing with fish oil high in omega-3s. Some people just take cod liver oil every day (Green Pasture fermented is best, I get it in capsules) because that's omega-3s and vitamin A and D supplementation all in one fell swoop. Krill oil is supposedly good too.
  3. Get grass-finished beef if you can. The PUFA ratios are much, much better.

Your triglyceride level is actually better than much of the population. It may not be what the typical 100 compliant Paleo person gets but it's better than 300 or more, which is what a lot of people out there have.

Your CRP's normal. Your A1C is almost there. If you cut your sugar intake and eat more veggies than fruits and up your sat-fat intake you might tackle that one without drug intervention. You might consider buying a glucose meter and testing yourself one hour after you finish a meal to see if any foods you eat get you up over 140 mg/dl (or the equivalent where you live). That's the danger zone. If any food puts you up over that upper limit, drop it.

I would say you are on the right track even if you're not all the way there yet. Way to go.

505 · December 08, 2010 at 12:57 PM

This is one of the best links concerning cholesterol that I've read. Hopefully you'll find it just as enlightening as I did.


1724 · December 09, 2010 at 11:09 AM

Don't take statins! Improve your diet. Go to 100% paleo, first. Second, seriously, Damiro, you don't need 6 eggs a day at breakfast. That is excessive. There are lots of other protein sources that taste great at breakfast (ground bison, smoked or broiled salmon, etc.) You need to exercise more and eat more good fats, like coconut oil. Your HDL should be much higher. Also, I'm looking particularly at your high Triglicerides and I'm going to guess that you eat way too many calories per day as carbohydrates. Where are they coming from? You need to eat more greens (e.g. Kale, Collards, Broccoli, Salads, etc.) and less fruit, brother. Good luck. Also, I think you should fast 24 hours 1x per week and take a B vitamin supplement that includes Niacin. Finally, I suggest you read Robb Wolf's book, and send a fuller account of your diet along with these numbers and your questions to Robb Wolf's paleo solution podcast and get a more professional opinion on your situation.

3591 · December 08, 2010 at 2:37 PM

So you are paleo 85% to 90%. Does that mean 10% of the food you eat on a daily basis is not paleo? Like you eat a jelly sandwich for a snack or something or did you just take a vacation from dieting last year?

If you are in the habit of having a daily 10% cheat like a beer, candy bar or some sort of bready thing you might be sabotaging yourself.

Your trigs are a little high I think for someone on Paleo. Maybe the rest of the club here could confirm that.

High trigs usually mean there some high carb/sugar things going on... If that's the case and you are strict perhaps curbing your fruit/starch intake? Are you overweight? Have metabolic syndrome?

20 · December 08, 2010 at 12:56 PM

Read The Cholesterol Myths by Ravnskov before you go on statins or buy in to the great pharma conspiracy about cholesterol.

18383 · December 08, 2010 at 6:31 PM

Your total LDL doesn't seem concerning considering your small LDL (the "bad" one) is low.
Calculated LDL might not apply.

Your triglycerides seem high. If you are at risk genetically for heart disease, lowering your carbohydrates is prudent. This should lower your triglycerides.

My biggest question, though, is why are you striving to eat lean meat? Eating lots of good (and by good I mean sturated) fat does not increase heart disease. In fact, it should raise your HDL. Your HDL/total is .170, which is quite low, but this is partly because total is very high, obviously.

I would definitely avoid statins, as they are usually harmful, and rarely helpful. Instead I would drastically lower carbs and retest in a couple of months.

20469 · December 08, 2010 at 5:32 PM

This is a good question though. Should we care at all about overall cholesterol levels and LDL? My mother's is quite high, not just a bit high. She eats healthy mostly paleo. I don't want her on statins as I believe the research does not show benefits, especially for elderly and women, for which no statin study has ever shown a benefit. But is there an issue if LDL and cholesterol are just really really high? Or is this one of those things that in reality is just not so important. My mother is 74 with no health problems nor heart probs, and thus, so far, we've decided to let nature take its course, but this is something I really would like to know more on. But perhaps the research is just not there yet as to what this kind of thing really means or does not mean.

8848 · December 08, 2010 at 3:07 PM

Over at the PaNu forum, there is a thread on this that you might enjoy reading.


In Good Calories, Bad Calories, Taubes points out that high LDL levels generally do not correlate with cardiovascular disease. Low HDL levels do, however; so I place more importance on that number.

In the results of the "Get With The Program" (GWTP) study, they found the following [the study looked at over 100,000 coronary artery disease (CAD) hospitalizations and tried to correlate them to, among other things, blood lipid levels]:

  • Three quarters of the patients had LDL < 130 mg/DL
  • HDL > 60 mg/DL was observed in only 7.8% of patients.

This to me is consistent with Taubes's analysis. Your reference ranges in nmol/L are not familiar to me, so I can't speak to your LDL and Total Cholesterol. But your HDL levels are very good. Triglycerides look good. To lower your risk, I would suggest going even more toward 100% paleo.

The importance of the LDL level is hotly debated. It seems that not all LDL particles are created equal. Total cholesterol is not particularly meaningful. Don't drink the Kool-Aid!

9983 · December 08, 2010 at 12:59 PM

Watch the following from The Healthy Skeptic. "I have high cholesterol and I don't care."


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