Your questions answered, 18th July, 2017

Hi everyone

This is part 2 of my cholesterol special, covering:

  1. Cholesterol tests can be inaccurate.
  2. Many things can impact cholesterol results, for example, stress, illness, inflammation.
  3. LDL is calculated, not tested directly, and can be inaccurate.
  4. The best markers to look at to assess heart disease risk.
  5. The fat we eat has little to do with our cholesterol levels.
  6. What is likely to happen to cholesterol levels if we go off cholesterol-lowering medication.
  7. Is there any such thing as “bad” cholesterol, or “good” cholesterol?

Oh, and check out my little friend in the bottom left corner of the picture on my video!! 🙂

Pick the format that works for you! You can either:

  • Watch the video
  • Download the audio, so you can listen with your phone, or in your car!
  • Read the answers

Talk soon


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Welcome to part 2 of my cholesterol special. Like I said last time, the most common question I get is about cholesterol, which is why I am doing this special.

One of the main things I want to discuss today is that cholesterol tests can actually be very inaccurate.  And many people end up making huge changes to their diet, and start medication based on one test that could have been completely incorrect.

Firstly, many things can impact our cholesterol readings. Remember last time I said that cholesterol heals and is likely to come up if it has something to heal. So what if we are coming down with a cold, or if we just fell over the night before and have some extra inflammation? Cholesterol is likely to rise in both instances. If we are stressed, angry, or running late, all these things can impact on our cholesterol levels. Intense exercise can raise cholesterol levels.

And, then there is the accuracy of the testing itself. No test is 100% accurate, and in fact, the accuracy increases the more tests we have done. So if we do have a result we are not expecting, it is always good to have a second test.

The other huge issue, especially with those who have been doing LCHF, is the LDL is not normally tested; it is calculated based on the other lipid markers, and the formula they use to calculate LDL does not work if triglycerides are low or high. The problem is, most people who are LCHF have low triglycerides, which is what we want. We want to see low trigs and good levels of HDL.

But this means that their LDL calculation will most likely be wrong (the reading will be higher than it should be). You can ask your doctor to have LDL tested directly, but many doctors don’t even know about this issue, so they may not do it. Also, some labs won’t test it directly even if has been specified on the form. So you can try to have it tested directly.

The other option is using an alternate formula that does work better when trigs are low. I actually have a cholesterol calculator on my website so you don’t need to know the formula, you can just enter your total cholesterol, your HDL and your triglycerides, and it will calculate it for you. If you would like to do that, just go to Resources — Cholesterol Calculator on the website.

The second thing I want to discuss is the fact that the fat we eat has little to do with our cholesterol levels! The majority of our cholesterol is made by our liver. And our liver makes what we need, despite what we eat (unless the liver isn’t able to function well). In fact, the liver generally produces four or five times as much cholesterol as we eat. And, this is why people like me can eat a ton of fat, and have “normal” cholesterol levels, and many people on a low-fat diet have extremely high cholesterol levels. In fact, a low-fat diet is very likely to cause high cholesterol because of all the extra inflammation and damage to the body. But, there will be some people on a very low-fat diet with extremely low cholesterol levels (4.0 and under, which is 155 if you are in the US), and this happens because the liver needs fat to function adequately, and if the diet is so low in fat that it can’t produce adequate cholesterol, then it will not produce what the body needs.

We see the same in those who get very sick to the point where the liver can’t function; total cholesterol can drop down to 2.0 or 3.0 (77 or 116). But, when the liver recovers, what is it likely to do? It is likely to produce more cholesterol than normal to catch up!

And this brings me to my next point. So what happens then if we have been taking cholesterol-lowering medication and suppressing our cholesterol level. I am sure you can guess. The liver will most likely play catch-up and produce more cholesterol than normal. This freaks a lot of people out because if they have done research on the negative side-effects of the medication, and have taken the decision to go off the medication, then had a blood test a few months later, their cholesterol is likely to be sky high. But, for most people, this is just temporary as the liver starts functioning again.

So, remembering everything I have said so far, that we need cholesterol, and that tests can be inaccurate, can we determine some level of heart disease risk by looking at our cholesterol results. Yes, we can, but health professionals that are just looking at total cholesterol are out-of-date with the latest science. We generally don’t look at the total cholesterol unless it is too low, then that is something that needs to be addressed. But if it is around 5.4 or higher, then we focus on the other markers. The main ones are triglycerides and HDL. If we have low triglycerides and high HDL, it is a generally a good indication of good heart health. We want to see our triglycerides under 1.0 (88), and most people on LCHF end up with triglycerides of around .4 or .5 (35 or 45), which is ideal.

But is there any such thing as “good” and “bad” cholesterol? Isn’t it all just cholesterol?

First of all, LDL is not even cholesterol, it is a lipoprotein, as is HDL.

The only difference between LDL and HDL is the direction it is traveling. LDL is a lipoprotein that carries cholesterol from the liver to the tissues. HDL is a lipoprotein that carries cholesterol the other way.

So how can one be “bad” and the other be “good?”

Cholesterol is cholesterol. Our liver makes it because we need it. Like Dr Zoe Harcombe says, “The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.”

And because most doctors still see LDL as a risk factor (even though there are many studies out there now showing that it isn’t), they can then put the fear of god into patients thinking they are about to have a massive cardiac event.

In my latest book, Bring Back the Fat, I analysed someone’s actual results, and it is a great example to look at if you would like to learn more about analysing your own results. The total cholesterol was 8.2, but the breakdown showed some very interesting things.

But the most interesting part was the fact that next to the Total Cholesterol, the doctor wrote “Too high, not chartered.” Next to the LDL she wrote “Bad/clogger.”

Next to the trigs she wrote, “Very good.” Next to HDL she wrote, “Good.” Next to the ratio she wrote, “Good/safe.”

How can half the results indicate low heart disease risk, while the other half indicate high heart disease risk? The answer is they can’t.


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