I’m often asked about cholesterol and how to interpret the numbers on the blood form. If you are not sure what your numbers mean then you’re not alone.

Folks, here’s a great story about health and weight loss – along with some excellent examples of what to actually eat on the LCHF plan.  I’m often asked about cholesterol and how to interpret the numbers on the blood form. People get (rightly) concerned that their metabolic markers are heading in the right direction. So that’s answered here too.  Enjoy.

Hi Grant


  • Between Nov 12 and May 2013 I cut out sugar only
  • Nov 12 I was 92kgs and now range between 82-85kgs – have had to buy a size smaller clothes during this time.
  • Foods I eat:-
    • Breakfast (choice from one of these)
      • Greek Yoghurt .75 Cup, Raw Almonds .25 cup, Raspberries/Blue Berries .5 Cup, Cream  30ml
      • 2 Eggs and rasher bacon plus Baby Spinach 1 cup, maybe home made mayo 30ml
      • Coconut Cream Smoothie – Coconut Cream .75 Cup, Raspberries 0.5 Cup, Chia Seeds 2 tablespoons
      • Espresso Coffee no sugar, no milk, Cream 0.25 Cup (sometimes this alone can keep me going until lunch time)
    • Lunch (choice from one of these)
      • Big salad only lowcarb veggies and meat or cheese about 100 grams,Olive Oil and Cider Vinegar Dressing or Home Made Mayo
      • Paleo snack box – nuts, veggies, cheeses, smoked salmon whatever is around that is natural and has low carbs
      • Bought Chicken Satay without rice and extra vegetables
      • No sandwiches (ever)
      • Reheated last nights dinner mainly some fatty meat dish and low carb veggies
      • BBQ with Salad – no carbs
      • Pita Pita – Salad Bowl
    • Dinner (choice from one of the following)

      • BBQ with salad no carbs
      • Roast with veges but excluding potatoes, kumara, corn, carrots, onions
      • Stir fry meat and veges – no rice
      • Salmon and salad
      • Home made curry made with coconut milk served on baby spinach
      • Anything with meat and veges and no carbs
    • Drinks
      • Water
      • Soda Water and Fresh Lime/Lemon juice
      • Espresso Coffee & .25 cup cream – no sugar
      • >Maybe a glass of wine or Steiny Pure twice a week. Generally can’t drink alcohol that well these days – very quickly gives headaches
    • Snacks (rare maybe a handful 2 times a week from a mixup of the following)
      • Nuts
      • Cheese
      • Homemade Coconut Oil and Organic Cocoa Powder chocolates with a tiny flick of good quality honey
      • Olives
      • Small peppers spread with cream cheese
  • Pretty much I have excluded processed carbs from my diet and studiously read nutritional info on packaging before it goes in the trolley.
  • I don’t do a lot of exercise but do have a 6 and 8 year old son and do activities with them (mountain biking, cricket, kayaking, walks, nurf gun battles!)
  • How I feel on the diet?:-
    • Never hungry – sometimes think I eat out of habit – “Oh its lunchtime” and generally have a very big gap between Breakfast and Lunch
    • Have next to zero wish for sweet things any more, same goes for Bread, Rice, Potatoes, Chips and baking. Though the smell of fresh baked bread can test me 🙂
    • Walk into most cafes and look totally disheartened at the offerings
    • Notice around me everywhere how waistlines are increasing across all walks of life and all nationalities.
    •  I have sustained energy in my job and seem to need less sleep than I used to but have no trouble sleeping.

So hopefully that gives you a picture of me. My concern is, based on my situation, should I view my blood test results as a warning or carry on the LCHF lifestyle which I love?

I found this discussion on DietDoctor  http://www.dietdoctor.com/great-cholesterol-numbers-4-years-ultra-strict-lchf-diet/comment-page-1#comments Page 2 has a contributor who quotes an enormous amount of so called evidence to suggest that LCHF diets do increase Cholesterol in a bad way and you should consider Statins to put things right. That just feels wrong on many levels to me, we shouldn’t need drugs to maintain sustained health and surely aren’t designed that way.

I’m hoping you could have a quick look at some lipid results and put some fears to rest. Please see attached blood test results covering three tests since Nov 12.

From my point of view….


  • Increasing HDL
  • Decreasing TOT CHOL / HDL ratio
  • Low Triglycerides


  • Rising LDL
  • Rising overall Total Cholesterol level.
Nov-12 Jun-13 Feb-14
Good Cholesterol HDL 1.37 1.63 1.87
Bad Cholesterol LDL 4.10 3.80 4.50
Total Cholesterol (TC) 6.47 6.23 6.70
Triglycerides (TG) 1.00 0.8 0.8
TC/HDL ratio 4.72 3.82 3.60
HbA1c 30.00
TG/HDL 0.72 0.49 0.42

Anyway, any feedback or advice you could provide would be much appreciated.


I have been watching your momentum build and doing my bit to get the word out there. If you ever want to bring a seminar to Queenstown please let me know I’d be happy to help anyway I could.


Many thanks,  Andrew

One of my doctoral students, Catherine Crofts, who is also a pharmacist, specialises in understanding these numbers and more specifically the role of hyperinsulinemia in health – so here’s Catherine’s excellent summary of cholesterol number interpretation.

Well done in taking such an interest in your health, including weight, energy, sleep and blood tests!  I think the first thing to set straight is that we shouldn’t think in terms of “good” or “bad” cholesterol.  (This science is about 20 years out of date.)

Cholesterol just “is” and it is needed in every cell in your body, especially in the nerves and brain.  One important job for cholesterol is to package up triglycerides and transport it around the body.

In simplified terms:

  • LDL, or low-density lipoproteins, take cholesterol from the liver to the body to be used as energy or for storage
  • HDL, or high-density lipoproteins, take cholesterol from the body back to the liver for reprocessing.

LDL can increase for many people after starting on LCHF, as you start mobilising your triglycerides more and shifting them around the body.  This is normal and these LDL levels may not return to baseline for up to a year according to some studies.  But quite frankly, LDL is not a useful measure of metabolic health.

The biggest catch to interpreting LDL cholesterol results is that is LDL is never actually measured….instead it is calculated.

The main formula used is LDL = TC – HDL – (TG/2.2)

Slight variations in formulae and rounding differences will explain why the numbers don’t totally add up when you apply this formula to your numbers.  But what is not always realised is that this formula is inaccurate when your triglyceride levels are above or below certain cut offs.

When your triglycerides are low, your LDL is artificially inflated.  So LDL falls just short of hopeless for assessing health, especially when eating low-carb tends to lower your triglyceride levels, as yours have done.

What we actually need to be looking at is LDL particle size and whether we have “large buoyant” LDL particles or “small dense” particles.  Small particles are unhealthy and are more likely to get stuck in the blood vessels causing blockages, whereas the large ones float around in the blood and just do their job. Small particles can more easily enter a damaged site.   By just measuring LDL, we can’t tell your particle size.  It’s a bit like measuring how many people are travelling down the motorway.  By counting heads, we miss out on measuring whether they are travelling in buses or cars…but which measure is more important to working out road congestion?   Head numbers or Vehicle size?

The easiest way to do this is to look at your TG/HDL ratio, which I added to the results you sent Grant.  Aim to get this number as low as possible…..and quite frankly, yours are fantastic.  Some studies suggest the TG/HDL ratio should be below 3.5.  That is way too high in my opinion, I think below 2 would be better, but we need more research in the area.

Your final marker of HbA1c is also great.  HbA1c is being suggested as the latest and greatest marker of metabolic health with levels below 37 (5.5%) indicating great metabolic health.

So overall, TG, HDL and HbA1c are the best markers for metabolic health.  There is a definite place for statins, they do save lives and people should not stop taking them before having a good chat with their doctor.  But maybe we’ll save that for another post.

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