Experts: Is cholesterol calculated differently now ?

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Roxx

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I'm pretty frustrated gang.
So I have my upcoming annual Echo/Cardiologist appointment next week and I had to have bloodwork done leading up to it. I had it done Thursday, and received a copy of the results on Friday.
Not only am I not happy with the numbers as I have been watching my diet and working out almost daily and these are higher than last year, but unless there is a new guideline on how to calculate numbers, something seems off to me.

So the results have these numbers:
Total Cholesterol: 181
HDL Cholesterol: 51
Triglycerides: 41
LDL Cholesterol: 146

Now it's always been my understanding that Total Cholesterol is = HDL + LDL + Triglycerides divided by 5..... if that's the case, then my total should be 205, not 181.

Is there something I'm missing here? Is there another number I need to look at? Any help is appreciated.
 

pellicle

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Hi

I'm not highly in-tune with this subject (although we do have a member who fusses over this), however to my knowledge there are two predominate ways to measure:
  • millimoles per liter (mm/L)
  • milligrams per deciliter (mg/dL)
So in Australia we commonly use millimoles per Liter (you may wish to know what a mole is https://en.wikipedia.org/wiki/Mole_(unit) )

Your numbers look like mg/dL to me

Further they can sometimes be reported as individual "types" or one type and the remainder or even a whole count and one type

For example, myself I've had:
HDL = 1.52
LDL = 4.2
Total cholesterol = 6.2


and then other times just:
HDL = ??
LDL = ??
Total cholesterol 6.5

helpful isn't it

So from the wikipedia page https://en.wikipedia.org/wiki/Triglyceride#Guidelines

I'd say your numbers aren't bad with HDL being good IMO and LDL just borderline (again according to wikipedia, myself I don't give a rats arse about mine)
 

Paleowoman

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Roxx;n886482 said:
So the results have these numbers:
Total Cholesterol: 181
HDL Cholesterol: 51
Triglycerides: 41
LDL Cholesterol: 146

Now it's always been my understanding that Total Cholesterol is = HDL + LDL + Triglycerides divided by 5..... if that's the case, then my total should be 205, not 181.

Is there something I'm missing here? Is there another number I need to look at? Any help is appreciated.
In the test the lab measures Total Cholesterol, HDL and Triglycerides - those numbers are the ony accurate numbers - and from those numbers using the Friedewald formula the LDL is calculated. The Friedewald formula gives an inaccurate LDL if your Triglycerides are above or below a certain level. Your Triglcerides are low which is good and probably a reflection of your diet.

Have a read of this about the Freidwald formula: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226221/

However, looks like there is a number wrong there in your results because using Friedwald fomula your LDL would come out at 121 !

Here's a calculator which compares Friedewald formula with another formula for when Trirglycerides are out of range: https://www.thecalculator.co/health/...lator-683.html

Maybe your lab used a different formula ?
 
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Roxx

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That’s what I’m saying Paleo, either Total Cholesterol is 205 and ldl really is 146, Or LDL is 121 and TC is accurate at 181... or these numbers are just not right period.... or they are using a different equation than they used in the past. Who knows. It’s frustrating, and no one can answer my question at this place.
 

leadville

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Hi Roxx

so what are the numbers you're unhappy with if you dont mind me asking ?

Tris are low ?

HDL could do with being higher ?

I'm presuming it was a fasted blood draw & you're not on any of those statins ?
 
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Paleowoman

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Hi Roxx

You need to ask the doctor who ordered the test - or find out the contact details of the laboratory that did the analysis - to find out what was actually measured and what one was calculated, but as far as I know, as I said, it’s only Total Cholesterol, HDL and Triglycerides that are measured in the lipid panel aka cholesterol test. LDL is only calculated. To measure LDL is more expensive which is why they measure the others and just calculate the LDL.

Using the calculator results for when your triglycerides are under 100, as yours are, then your LDL actually comes out at 89 !

I think it’s important for you to find out.

PS - Triglycerides are usually a relfection of the amount of dietary carbohydrate. A triglyceride level of 41 would suggest you are having a low carb diet.
 
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Roxx

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leadville;n886487 said:
Hi Roxx

so what are the numbers you're unhappy with if you dont mind me asking ?

Tris are low ?

HDL could do with being higher ?

I'm presuming it was a fasted blood draw & you're not on any of those statins ?
Hi there!
i don’t take any statins.

if 181 is my true total cholesterol, that’s fine.... I can live with the HDL, and the Triglycerides are great..... the LDL seems very high for the way that I eat. If anything, I’m probably too strict of an eater.... the Triglycerides show this, but if 146 LDL is to be believed, then my body must not be doing something it should be.

The difference between 181 or 205 being the correct total cholesterol may seem trivial, but I think I need to find out for sure how they arrived at these numbers, or possibly have the bloodwork done again before my Wednesday appointment, as my Cardio is one that always errors on the side of caution, and I know if 146 LDL is correct, the statin conversation will definitely come up. I’m not necessarily opposed to taking them, but they are very controversial. Some swear by them, some consider statins poison.
 

leadville

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I presume given that your triglycerides are so low you're low Carb / High fat diet ?

Your LDL given your TRI number will almost definitely be large,.... which is good.

The calculated LDL is made up of all sorts of stuff.

I am making a few presumptions ;

If you are new to a high fat diet then initially LDL can increase which usually settles lower after a while
https://www.youtube.com/watch?v=dCiRB29vkds

there are a subset of people on a high fat diet that have a high LDL

The LDL profile can be changed if the higher numbers Bother you, if you experiment by swapping out some
saturates and adding in lots more monosaturates that will alter the number and also increase the HDL

this may take 3 months .....

Best wishes
 

Paleowoman

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I do very low carb/high fat/moderate protein, I’ve been eating this way for the past 12 years. Prior to eating this way my cholesterol test results were always "medical text book normal". But soon after adopting this way of eating the cholesterol test results changed dramatically as many people find on low carb/high fat: my trigs are always low, average 0.5 (44), my HDL high 3.5 (135), my LDL high 4.2 (163) and Total Cholesterol high 8 (309) - it can freak doctors sometimes but due to the high HDL and low trigs this means that my LDL particles will be the protective kind and perhaps they know that. My cholesterol/lipid panel test has been done every six months for the past 12 years..

Last year I discovered Dave Feldman and his website. Feldman is a software engineer who does low carb/high fat way of eating and takes a great interest in lipid numbers and has done lots of experiments on himself - his website is well worth looking at, especially his video on how cholesterol numbers can be manipulated by a dietary change just a few days before the test. I was very sceptical at first because the premise is that for some days before a lipd test you eat really, really large amounts of fat and then your Total Cholesterol and LDL numbers will be much lower - this is only if you do very low carb mind you. I tried it last year and my blood test results after this experiment were trigs 0.3 (27), HDL 3.5 (135), LDL 1.8 (70) and Total Cholesterol 5.5 (212) - see the difference from my usual (above) ! I then reverted back to my normal low carb/high fat (eating massve amounts of fat is not easy, makes you feel nauseous) and my numbers at the next test went back to how they ususally are.

If the blood test results can be manipulated to give “good” results just by changing your diet to extreme high fat a few days before the test that says something about the cholesterol test doesn’t it ? It doesn’t mean though that it’s a good idea to eat that way always, that would be horrible and might be unsafe - it just shows how the test can be manipulated so easily. Here’s the link to Feldman’s website: https://cholesterolcode.com/about/ Lots of other interesting stuff there about the cholesterol test.

Anyway neither my cardiologist, nor endocrinologist, nor GP usually worry about my blood test results anymore, though they were surprised when they came down despite me eating even more fat than I usually do ! My endo always writes in his report that the LDL is only calculated just to stress it’s unimportance in the test. You can have a specific LDL test but they hardly ever do it due to cost.

Twice prior to aortic valve replacement and once since, I have had CT angiograms and never has there been any calcium in my coronary arteries, they are completely clear.
 

Roxx

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Mystery solved. Clarified by the lab manager at the hospital.
so on prior blood tests I had, the Friedwall ? Method was used.

on this test, done at a hospital, they use dLDL which is direct LDL... a much more expensive test.

so, my numbers are correct:

total cholesterol: 181
HDL: 51
Triglycerides: 41
direct LDL: 146

and honestly, I follow more of a high protein/average carbs/low fat diet.....

I am not extremely disappointed with my numbers given this is a more advanced blood panel then I have had done before, however, I would not be surprised if I don’t catch some crap over that LDL number, and he may even suggest a low dose statin.
 

Paleowoman

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Roxx;n886495 said:
Mystery solved. Clarified by the lab manager at the hospital.
so on prior blood tests I had, the Friedwall ? Method was used.

on this test, done at a hospital, they use dLDL which is direct LDL... a much more expensive test.

so, my numbers are correct:

total cholesterol: 181
HDL: 51
Triglycerides: 41
direct LDL: 146
Glad you cleared this up Roxx. But doesn't it also show how inaccurate the usual way of measuring LDL - Friedewald - is ! Under Freidewald your LDL would have been reported as 121 which you might have been happier with but which wouldn't have been correct.
 

Roxx

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Paleowoman;n886496 said:
Glad you cleared this up Roxx. But doesn't it also show how inaccurate the usual way of measuring LDL - Friedewald - is ! Under Freidewald your LDL would have been reported as 121 which you might have been happier with but which wouldn't have been correct.
Exactly what I was thinking.
Yes, using the more common equation... 121 would be the LDL.... on this "direct" test, they are saying 146 is the "dLDL"

I guess what I have to figure out is if I will take a statin if offered.
My parents are 65(mother) 68(father) and my dad takes a low dose statin, my mom has been offered by her primary physician, but always refuses as she is of the belief statins are poison.

I already eat very healthy (boring) and deprive myself of many things most guys my age enjoy....pizza? hamburgers? fries? ice cream? cookies? I honestly can't even remember what those things taste like. So I don't think there is much else I can do with my diet.

I will have to research this a little. Thanks for all the help guys.
 

Paleowoman

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Roxx;n886497 said:
I guess what I have to figure out is if I will take a statin if offered.
My parents are 65(mother) 68(father) and my dad takes a low dose statin, my mom has been offered by her primary physician, but always refuses as she is of the belief statins are poison.
I’ve just ordered Dr Malcom Kendrick’s latest book ‘A Statin Nation’. I don’t take a statin but I have a “high" cholesterol (see my last but one post) and I always enjoy reading Dr Kendrick’s books, especially his clear, and sometimes amusing, way of explaining things: www.amazon.com/Statin-Nation-Damaging-Millions-Post-health/dp/1786068257/ref=sr_1_2?ie=UTF8&qid=1549300696&sr=8-2&keywords=a+statin+nation Maybe your cardiologist will be like mine and not be interested in pushing a statin on you.
 
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Roxx

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Paleowoman;n886498 said:
I’ve just ordered Dr Malcom Kendrick’s latest book ‘A Statin Nation’. I don’t take a statin but I have a “high" cholesterol (see my last but one post) and I always enjoy reading Dr Kendrick’s books, especially his clear, and sometimes amusing, way of explaining things: www.amazon.com/Statin-Nation-Damaging-Millions-Post-health/dp/1786068257/ref=sr_1_2?ie=UTF8&qid=1549300696&sr=8-2&keywords=a+statin+nation Maybe your cardiologist will be like mine and not be interested in pushing a statin on you.
I was just looking at his books!
I will be honest with you Paleo, I have never really been impressed with my current cardiologist.
He is pretty negative, loves to talk doom and gloom, has a reputation of being over vigilant on EVVVERYTHING (ie: 1 BP reading over 140/80 will get you a moderate strength beta blocker with this guy)... but even worse, he turns what would be 1 visit with most doctors into 4. You have an Echo, then leave. Come back a different day for a 20 second EK, then leave. Have blood drawn, then leave. Then... if you are a good boy or girl, sometime over the next month, the office will "try" to get you in to go over your results.

While my LDL was in the "borderline" area... my risk ratios (as author Kendrick talks about) are all low.
Total Chol/HDL = 3.5
LDL/HDL = 2.8
VLDL = 8
And Total = 181

So, if he insists I take a statin, or else get his "tude"... there is a good chance I'm going Dr. shopping.
 

Keithl

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One thing to ask your doc for is an Advanced Lipid Profile vs. the standard test. Primary doc and I discuss things all the time and she turned me onto research that shows that LDL and HDL is only part of the numbers, the size of the different particles is Turing out to be as if not more important. I have been getting this test for years and and it been very enlightening. Interestingly my last 2 cardiologists have now asked for this test. Unfortunately some insurance may not cover it fully, but I don’t care as it helped me get me get my numbers better. My HDL was always slightly low and my LDL and triglycerides were fine, but the particle sizes were out of whack. Some diet changes and supplements with exercise have gotten my particle sizes in line.
 


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