Conventional Cholesterol Tests are Obsolete

As many of you know, I’ve been traveling around a bit, speaking about our best-selling book “The Great Cholesterol Myth”, and one of the things I’ve been saying is that conventional cholesterol tests are obsolete, a message I repeated recently on the Dr. Oz show as well as The Doctors.

And one of the questions I’m frequently asked is this: What tests should I pay attention to?

The Cholesterol Particle Test

That’s the more modern version of a cholesterol test that takes into account the fact that there are different types of LDL cholesterol and that they behave differently in the body. LDL-a, for example, is a big fluffy molecule that does little if any harm, while LDL-b is a nasty little oxidized particle that causes inflammation and is of great concern. (If your doctor is “treating” you for high cholesterol based only on your total LDL number, he or she is missing the boat and treating a number, not a patient. You need to know what kind of LDL you have: pattern A (harmless) or pattern B (inflammatory). Without the particle test, there’s no way to know.)

Actually, I lied.

There is a way to know what kind of LDL you have even without taking the particle test. Best of all, you can do it at home and even better, it doesn’t cost  a dime. It’s a test you can perform yourself if you’ve had a standard blood test in the last six to twelve months and if you can do third grade level math. It’s easy, low-tech, and it provides extremely valuable information—way more than a conventional cholesterol test.

Triglyceride to HDL Ratio

Here’s how you do it. Look at any standard blood test you’ve had recently and pick out two numbers: Triglycerides and HDL cholesterol. Both of them will be on the test, guaranteed. The triglyceride number will always be higher (OK, 99.999999% of the time). To find the ratio, simply divide triglycerides by HDL. Bam. You’ve got your ratio. And in a minute, I’ll tell you what it means.

In case the very thought of math makes your eyes glaze over even if it’s simple division, let’s do a few examples:

  • Let’s say your triglycerides are 100 and your HDL is 50. Your ratio is thus 100: 50, which you can streamline by simply dividing triglycerides (100) by HDL (50) giving you a ratio of 2.
  • Say your triglycerides are 150 and your HDL is still 50. The ratio is now 150: 50, or 150 divided by 50, or 3.

The triglyceride to HDL ratio is an excellent indicator of heart health. It’s also an excellent marker for insulin resistance (or it’s opposite, insulin sensitivity). You want your triglyceride to HDL ratio to be low—2 or under is wonderful. When it’s high, it’s cause for concern, or, even better, action.

The triglyceride to HDL ratio—something integrative physicians and health professionals have been talking about for years—recently got a big boost in public awareness. Just this week, the Wall Street Journal published a full page article (“Children on Track for a Heart Attack”) reporting on a study from the Cincinnati Children’s Hospital Medical Center that looked at nearly 900 children and young adults. The study, published in the journal Pediatrics found that higher the ratio of triglycerides to HDL, the greater the likelihood that a child would have stiff and damaged arteries.

“Stiff vessels make your heart work harder. It isn’t good for you.”

– Elaine Urbina, head of preventive cardiology at Cincinatti Children’s, and lead author of the study

Indeed. The triglycerides to HDL ratio is also a great indicator of insulin resistance. In one study, a ratio of three or greater predicted insulin resistance with great reliability, while in another classic study from Harvard researchers, those with a high ratio were 16 times more likely to develop heart disease than those with a low ratio.

If you’ve read my book, The Great Cholesterol Myth, you know that when it comes to LDL cholesterol measurement, the metrics that matter are not total cholesterol or even total LDL, but the number and size of your LDL particles.

The triglyceride to HDL ratio is an excellent stand-in for the particle size test. (Your insurance company may not cover the particle test, and you may not feel like springing for the 60 bucks or so it costs to get it, though I highly recommend that if you’re “worried” about your cholesterol you do exactly that. But your triglyceride to HDL ratio is a terrific—and no cost—substitute.)

Those with high ratios of triglycerides to HDL tend to have much more of the atherogenic LDL-B particles, while those with low ratios tend to have the much healthier LDL-A particles. We would certainly not recommend treatment of “high cholesterol” with a statin drug just based on total LDL, and especially not for a person with a very low (2 or under) triglyceride to HDL ratio.

The triglyceride to HDL ratio got a lot of attention at the recent conference of the Nutrition and Metabolism Society in San Diego, and—if that recent Wall Street Journal article is any indication– you’ll be hearing about it more and more once the media gets the message from doctors about how important it really is.

The information it gives you is invaluable, and you can’t beat the cost.




  1. Richard A. Fletcher

    Dr. Bowden has once again provided some very interesting and important issues regarding heart health.

  2. Roland Scott

    Dr. Jonny,
    I am from Canada, and we measure Cholesterol by different measurements. Is there an equivalency that I can use to understand where my test results fall into the range that you use in the United States. I have enjoyed two of your books that I purchased, the first being ” The Great Cholesterol Myth ” which I brought to find out why my doctor is so persistent in trying to lower my cholesterol with the use of statin medication and the second ” The 150 Healthiest Foods on Earth “, I have followed the directions of these books for over two years and fully enjoy the benefits as my good to better health. I look forward to your answer.

  3. Jonny Bowden

    Honestly I just did a search online and found many cholesterol converters. Try it, and you’ll be able to get the answers you’re looking for. Good luck!