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.

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  • Kate

    Hi Jonny,
    This is great news. I’m a 22 year old female, regularly exercise, eat a diet high in good fats and watch my alcohol intake. Yet my Triglycerides have been consistently high in each test I’ve taken since I was 19. My mum is a GP and has been really concerned with my Triglyceride levels and is continually scolding me about my diet. My ratio, however, is 1.27 – seemingly I have no problem!! It’s a bit of a relief for me, and I’ll be sure to pass this article onto mum!

  • Liz

    So what if your Triglycerides DO happen to be higher than your HDL? Tri= 57, HDL=92??

  • John

    I would say you are wrong with the confidence you claim that Triglycerides will be higher than HDL. On my last physical, HDL was not only higher than Triglycerides, it was more than double (HDL was 69, Triglycerides were 30).

  • Anna

    My values are:
    TG’s– 54
    HDL– 83. Which makes my ratio .65.
    Is this ok, it sounds weird?
    I just want to be sure everything is ok.
    Oh, by the way I love your blog and all your books.

  • Bluebird

    Wow, my triglycerides are lower than my HDL (43 for triglycerides and 54 for HDL), so I guess that is good. Thank you for this information. I have your book, The Great Cholesteral Myth, and I have always had great “numbers,” but it hasn’t impressed me as much as it did my physician (I think because I am obese), but knowing that this ratio is important and that mine is good, helps.

  • Jim Hoeffel

    A month ago I read your book with Dr.Sinatra.

    From my recent blood test: Triglycerides=84

  • Barb

    Hi Johnny. I’m a Canadian too and as you know our values for cholesterol are completely different. Can you help with this

  • Salim Morgan

    So, why no mention of the “action” required? Eat a diet much higher in saturated fat.

  • Karl

    So what if my HDL is higher? Over the last few years my HDL has been in the 40s and triglycerides in the 60s. But about a year ago I gave up all sugar and most carbs. My test last month showed HDL of 66 and triglycerides at 60.

  • Tom

    I just had my bloodwork done on april 30 and here were the results….triglycerides 38
    HDL 75

    that puts me in the .000001 % who’s trig’s are actually lower than HDL !!!

    very interesting indeed !

  • Julie

    This was valuable information. Thank you!

  • Tom

    There is a recent study out, referenced by Chris Kressler’s blog, that shows a direct correlation between total cholesterol level and heart disease. Can you review this study and see if it is truly a contradiction to the findings in the HUNT2 study and to all the studies referenced in your book, The Great Cholesterol Myth?


    • Hi Tom

      I’m downloading the podcast now. I haven’t heard it, but i have listened to Chris Kresser and Chris Masterjohn discuss the subject for hours and doubt that either believes that cholesterol is the major– or even an important– factor in heart disease, at least cholesterol as it is commonly understood. I will listen eagerly to the podcast and let you know my thoughts.


  • Dear Jonny-
    I just finished The Great Cholesterol Myth and wanted to thank you for the great information. Could you say something about LDL-P? I just recently had mine done & the result was in the high range. I understand that my high TC and LDL-C (pattern a) should not be of concern, especially since I have a high HDL and low trigs, but should I be concerned about the LDL-P, and if so what can I do to improve it?
    I also wanted to mention how much I appreciated your acknowledgement of Werner in your book. I keep meeting people (now you!) whose lives were enriched as mine was by him and his work.

    • Hi Janet

      Thanks for the nice words. LDL-P is the NUMBER of particles and my co-author, Steve Sinatra, does think that’s very important. Usually when there’s a LOT of particles they tend to be the small (LDL-B) ones which are not so good. That’s a good indication that there’s some inflammation going on, so my best advice is to simply eat an anti-inflammatory diet, cut back on carbs (more like a Paleo diet), take your omega-3’s and check again. Sorry i can’t be more specific, but that’s what i would personally do.


  • Jorge Medeiros

    TRG= 127
    Ratio+ 2.15
    Seem good enough. Am I right? Should it be lower?
    I am, basically, vegetarian(greens, cruciferous, assorted leaves and sprouts. Very little grain and bread. Mostly , whenever available, organic. A green smoothie fan, started by V. Boutenko.
    Occasionally I eat some meat, or fish or chicken.
    I also, take supplements; among them Alpha Lipoic Acid, Krill oil, MSN, Astaxanthin, even DHEA and 7 Keto.
    My eyesight improved dramatically in these last few years.
    I am even reading, texting and gaming without glasses.
    Luckily, my woman is also a big fan of this diet. I live in a mountain, surrounded by forest and clean air.
    Absolute silence by night, except for the occasional owl, and unavoidable ckickets.
    And we are lean – I just bought a 32-32 jeans.
    I am 68, she 50. And,… very active.
    We are businesspeople though, and stress can be taxing ,specially in these lean times. One more reason to fight those damn free radicals.
    With health and love, it is so much easier to cope.
    Good health for you all.
    And keep learning with our guru, Dr. Mercola.

  • Cesar

    Hi Jonny, I heard about your book, and I made my Triglyceride to HDL Ratio calculation and it is 5.29 ¡¡¡¡¡
    My Triglyceride level 196 and my HDL is 37 ( according to my physician I have low genetic HDL ) .
    What can I do ?
    Because if I want to have it below 2 , I need to lower my Triglyceride under 74 , and I have never had it under 150¡¡¡

    What do You suggest I do?

    Regards from Mexico,


    • Hi cesar!

      it’s much easier to lower triglycerides than to raise HDL.. triglycerides drop like a rock on a low carb diet. I’d try that for a couple of weeks and then retest.


  • Hey Dr. JB,

    Thanks for the helpful info. Your method is a pretty simple and I bet it’s already helped a lot of people. I’ve been having problems with high cholesterol for a few months now and I’m looking for a better way to manage it. I’ll definitely read your book “The Great Cholesterol Myth”.


  • Pam

    Hi Jonny!

    I just did your calculation on my last cholesterol test, and my ratio is 1. Sounds good to me! But on the test results, the ratio is listed as 4. My HDL and triglycerides are exactly the same, so I’m scratching my head. Then I realized they were dividing triglycerides by total cholesterol, not HDL. Do you think they just made a mistake, or is that some other calculation that is typically done? I’m betting on mistake, since the value is labeled TC/HDL ratio. So apparently I should not only question the value of the numbers, but the numbers themselves!

  • Mark

    I have HDL-C 61 and Triglycerides 76 for a ratio of 1.24.
    Total LDL-C 200
    Real LDL size particle B
    So in my case the ratio is not an indicator of particle size.
    Any thoughts on this condition? Is this unusual? What about trying to increase particle size? I thought in the YouTube video you said eating saturated fat increases the amount of large particles but I don’t recall whether the implication was that small particles would also decrease.
    Hope to hear from you.
    Mark M.

  • karen smith

    My HDL is 63 and my Triglyceride is 59. Is there something wrong that my HDL number is higher than the Triglyceride number? When I do the division, the result is 0.936508.

  • Dana Mills

    Dr. Bowden,

    My mother has been taking Crestor for 15+ years. She’s been told by her doctor(s) that her cholesterol is hereditary and she must remain on statin drugs for the rest of her life. Recently, while taking this statin her cholesterol increased. Her doctor increased the statin to 80mg/day. Her cholestoral continued to rise. She currectly suffers from muscle and joint ache, weakness and slight memory loss…. I’ve read your book, “The Cholesterol Myth”. My mother is keen to stop taking this statin but fully understands the recommeded tested must be completed first. Once we have the results, are we able to send them to you for your review?

    Dana Mills

  • Hi Dr. Bowden,

    I read your book at the exact right time. As soon as I heard on the news that they were suggesting statins for all! (or so it seemed), my doc sent me a list of drugs she wanted to put me on. I have RA and type 2 currently. As I already have to be concerned about joint pain, I did not want to be on a regimen that would increase this for me. She has been resistant to me losing weight, and seems more focused on the meds. I told her I did not want to take these, especially after reading your book. As we could not agree on a course of treatment, I have found a new doc. I’m only 43 and active and do not like the side effects attached to a lot of these drugs, especially when diet and exercise can improve my health.

    Thanks, again, for a very informative read!


  • Hi Jonny, I live in the UK and just wanted to know where I could get the particle test done? I am not sure if our NHS service provides it. Do you know of any services that provide it in the UK?


  • soyab

    Hi Dr Bowden
    I just did home cholesterol test here are my results-

    Total Cholesterol = 271mg/dL
    HDL= 62mg/dL
    Trig= 45mg/dL
    which gives me a result of 0.72 is this correct?


  • Victor

    Not sure when this article was published but it was great and I have forwarded it to my friends. Just read the book Living Low Carb and sent a copy to my DAD. Best diet book ever.
    I’m in the exclusive club with HDl/TRI of 87/59 but my calculated LDL was 171 and my doctor gave me the conventional diet recommendations.

    I wish that someone would create a national directory of physicians that are open minded are not hard wired to practice medicine according to the orthodox dogma. They are very few and far between.

      • koullis

        Hi Dr Bowden,

        I am following ketogenic diet for the last four months. I am 48 years old, 173 cm, 69 Kg, 13,8% body fat. I dropped to 69 kg from 75 kg and to 13,7% from 16,5% body fat the last four months following the keto diet. I exercise in the gym 4 times/week. I am lean enough and fit for my age.

        My Total cholesterol surge from 250 to 350, my LDL from 207 to 280 and my HDL from 41 to 51. My triglycerides dropped from 100 to 90.

        I would like to have your opinion on my blood results.
        Do you think I shall try to reduce my total cholesterol to 250 mg/dl? How can I do this? Do you advice me to stop keto diet? Or reduce a little the saturated fat and increase fat from olive oil, avocado and nuts.

        Note that in order not to become very skinny, I actually do Cyclic Ketogenic Diet with a re-feed once a week every Friday for 16 hours eating more Carbs (75% carbs, 15% protein, 15% fat). My weight now is stable at 69-69,5 kg.

        Many thanks in advance for your answer.

  • Nice post on conventional cholesterol test. Follow proper diet and be health……

  • Khan


    As you said -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. Let us assume any individual has normal total cholesterol.

    1) Does an LDL & VLDL number also play any role with particle sizes? I mean do LDL & VLDL numbers can be related atherogenic and non- atherogenic particle present in any individuals?

    2) What could be the alarming ratio of TRI/HDL that should be treated and what could be the way (Statin drugs?)?

    Thanks for listening!

  • Chris


    I have a high cholesterol reading but my ratios are generally good. Like a number of other people my triglycerides are consistently lower that my HDL; 0.99/1.86, 0.51/2.01 (mmol/L). Is there an issue with low triglycerides? Thanks

  • Azbkey

    Love your book, love this article! There’s heart disease on my father’s side of the family. I am 56 and my last labs I had “high” values for total cholesterol at 284 and LDLs at 132. However, my HDL was 140 and my doc said that’s what folks who live to 100 have. Trigs were 60, so my ratio is 0.43. Thanks for this reassurance!

  • Marlon

    My triglycerides are very low 1.30 mmol/l but my HDl is very low 1.03 mmol , what ratio does That give me and am I at risk

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