More Important Than Cholesterol?

Readers of this newsletter know that I have long believed that the national obsession with cholesterol is ridiculous. Cholesterol is a relatively minor risk factor for heart disease compared with much more serious things like inflammation. And the emphasis on cholesterol to the exclusion of other more important risk factors has also led us to take our eye of the ball when it comes to a risk factor we can easily do something about without taking a single medication: triglycerides.

Triglycerides are the main form in which fat is found in the body, the diet and the bloodstream. (A triglyceride is simply three (“tri”) fatty acids bound to a glycerol backbone.) High triglycerides are an independent risk factor for both heart disease and stroke. An even more important number than your cholesterol level is the ratio of triglycerides to HDL cholesterol. According to research published in Circulation, the Journal of the American Heart Association, and in the journal Clinics, this ratio is a powerful predictor of heart disease.

It’s easy to figure your ratio. Look at any standard blood test that your doctor orders for you. It will contain a number for triglycerides and it will contain a number for HDL cholesterol. If your triglycerides are, for example, 150 and your HDL cholesterol is 50, your ratio is 150:50, or 3.

The triglyceride to HDL ratio is also an excellent low-tech surrogate measure for insulin resistance. Those with high ratios (over 4 or 5) are very likely to be insulin resistant, a condition in which the muscle cells stop “listening” to insulin. Insulin resistance increases the risk for diabetes, metabolic syndrome, obesity and heart disease, and many health professionals are beginning to get on board with the idea that insulin resistance is actually the underlying cause of all of these.

Triglycerides trigger the liver to produce more cholesterol, particularly the small dense particles known as LDLb which are particularly harmful.

Elevated triglycerides can be due to being overweight, being inactive, smoking, or eating a diet very high in carbohydrates. You can bring triglyceride levels down rather easily by reducing sugar in the diet. High sugar diets- or diets high in processed carbs- raise insulin, a hormone which not only causes you to store fat but also signals the liver to produce more triglycerides.

On a low-carb eating plan, triglycerides drop like a rock. This has been seen on virtually every low-carb diet study ever done. The more sugar and carbs you eat, the higher your triglycerides go. High carb diets raise triglycerides and low-carb diets lower them. It’s that simple.

Don’t eat products that list sugar, fructose, corn syrup, sucrose, dextrose or honey as one of the first ingredients, and try eating more nuts. According to a study in the Archives of Internal Medicine, people with elevated triglycerides were able to lower them by 10% by consuming approximately 2-3 ounces of nuts a day.

Fish oil has also been shown to lower triglycerides, another reason to take this important daily supplement. (3,4,5,6)

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  • Once again…the truth! The truth is so simple and elegant. Please keep shining it’s light.

  • Bob

    Hi Johnny,

    I purchased several of your books and have enjoyed reading them. In view of the above, has your thinking changed about oatmeal and quinoa?

  • As you mentioned, the formula to lower triglycerides and at the same time to get higher HDL cholesterol, the 2 main cardiovascular markers, is rather simple.

    -Diet. Eliminate processed foods (anything that comes from a factory), sugars and grain oils.
    -Exercise for 30 minutes a day at a level that makes you breath heavily.
    -Take 6.000 mg per day of fish oil (close to 900 mg of total omega 3 fats, EPA plus DHA, from the label).

    After 30 days, test you triglycerides and adjust the fish oil dosage accordingly.

    This formula is simple but most of the time is not easy for carbo addicts. They (we) have to change habits, one of the most difficult things to do in life.

    Best wishes,

    Alfredo E.

  • Joe

    What exactly do you consider “high carbs”? If I am a regular at the gym, lifting heavy weights and working my tail off, wouldn’t a diet consisting of 30-40% carbs (at least on training days) be perfectly healthy and more optimal for muscle building than a low carb approach, assuming that it doesn’t make me fat in the process?

  • Tom Krahel

    If a ratio of 4 or 5 is unhealthy, what is a normal ratio for normal people? I have type II diabetes and before treatment my total cholesterol was over 300. What should my ratio be?

  • Deja Vu…was just having this conversation with a coaching client a few weeks ago after her results from nutrition coaching with us. She was wrongly interpreting, as was her Dr as well, her post nutrition coaching program cholesterol results as negative, when in fact they were positive, and her triglycerides showed significant improvement in just weeks with our support! What frustrates me as a holistic health practitioner, is people are misfed info at the Dr’s office both on how these tests should be interpreted and prioritized. Cholesterol is still sadly demonized improperly & misinterpreted, when it’s triglycerides that are the best indicator. Great blog, Johnny. Mercola has an excellent article taking you through how to actually read the tests properly in a way that your Dr will not.

  • Ken

    This is very interesting. My doc keeps telling me my cholesterol is high, and i need to get it lower. Per your ratio, my .5 to .6 is off the charts! My HDL is consistently at or over 100 and Triglycerides in the 50’s. BUT, my LDL is 149, so apparently i will keel over soon from a heart attack if i dont fix that. I excersize regularly and have a low body fat ratio. How can i get the doc to back off?

  • vijay singh de simone

    How absolutely refreshing to see this in print from one who is skilled in how cholesterol affects our heart, and in general our health.
    My total chol was 265′ ldl above 160, hdl 80 and tri 115. My dr. recommended (he knew my answer would be a blunt NO) statins, but respected my input because he knows I take care myself and treat my body with respect. I practice intermed. yoga 3times a wk; 3days of intermed. aerobics and light weight bearing exercises. 95% of our meals are veget. with fish 2times a wk. How and why my #s were a bit high is a complete mystery to me, but I take RYR, coq10, plant sterols, omega3s and niacin and have been doing so for over 15yrs.
    I am also a ovarian cancer survivor for 16yrs….surviving the treatment and ending up with osteoporosis due to the removal of my ovaries,refused to take fosamax as well.

  • SC1

    Excellent article! I wish I’d known this 12 years ago…but am happy to know it now.

    “take our eye of the ball” should be “take our eye off the ball”

  • Most of us informed about the bad effects of the cholesterol but don’t forget also about the good side of cholesterol which is it is essential for synthesizing a number of critical hormones, including the sex hormones testosterone, progesterone and estrogen and many good effects also in our body.

  • Checkyourmetrics

    Take bio-identical estrogen and progesterone transdermally until serum levels reach age appropriate physiological levels and supplement nutrients/cofactors with high impact training to build bone and address osteoporosis. Iodine, selenium, and other thyroid support may help use some of that built up cholesterol. My hypothesis is that high levels of cholesterol indicate poor functioning of the endocrine system. Cholesterol build up could be an indication that the body, for whatever reason, is failing in steroid production and a correlation of this biomarker (which may in fact have a protective effect/be an adaptive response) has been mistaken for causation. Remember, similar pathologies have multiple or many competing origins. Holistic perspective of the organism for the win!

  • For my 64th birthday, I just did my annual checkup. Height 6’1″, Weight 182 lbs. BMI 24.0. Waist 32″. TG 39 mg/dL. HDL 88; TG/HDL 0.44; LDL/HDL 1.2; Total cholesterol/HDL 2.3.

    I ran a marathon last summer, about 7 months ago. Still train.

    I don’t particularly avoid carbs, but I don’t necessarily sit around munching donuts all morning either. I try for 1:1:1 on carbs, fats, proteins. Take great supplements including fish oils.

    But carbs are necessary for metabolism, and trying to train up for a marathon on a low carb – high fat or high protein (Atkins and its derivatives) would be death to one’s kidneys, IMHO. Don’t get me wrong; I’m not arguing that reducing carbs in the standard America diet (SAD) wouldn’t help drop TG, per your statements here. It surely would.

    I’m just pointing out that when you get to a balance point of proper diet and exercise, a low carb diet is not necessarily a clever step. The glycemic index of your carb intake is very pertinent. But you can have your cake and eat it too. Well, you can if it’s a low glycemic cake anyway.

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