Your LDL cholesterol reading may be 40 points off

Boy does this tee me off

As you are probably aware, cholesterol is neither good nor bad. There is the "good" or high density lipoprotein (HDL) cholesterol, and the "bad" or low density lipoprotein (LDL) cholesterol. Given that one is considered good and one is considered bad, you wonder why their absolute values are added in the first place to obtain the total cholesterol (TC) as it is done in the US. Think about it! For a little math problem, let's suppose Johny has 90 red marbles and 10 black marbles, while Susie has 10 red marbles and 90 black ones. However we don't know that. We're only told black marbles are good and red marbles are bad and each person has 100 marbles. How would we know who has the better marbles? And if another person came along with 120 marbles, is that "worse" than 100? Only if the additional marbles are red. Do we assume that more marbles are necessarily bad marbles? Obviously, no mathematicians were consulted when this crazy system was developed. It has its basis in history.

In the early days, they didn't know about LDL and HDL. They only knew this "cholesterol" number. This was the Total Cholesterol that they measured. Then they began to study in more detail and they found out that the HD component actually was good. HDL is pretty easy to measure. LDL, apparently, is not. So when you subtract off the HDL, whatever is left must be LDL, right? Well pretty much. When you have a good thing and a bad thing (e.g. signal and noise), the ratio between them is more important. At a glacial pace, the USA medical establishment is finally getting their heads around this. Most doctors now are teling you that your HDL/LDL ratio should be above 1:4 or 0.25 (i.e. 25%)

So the LDL is just the TC minus the HDL, right? No not quite. There's a third factor called triglycerides, and for whatever reason, they don't exactly add up, but based on experiments they definitely affect it. Most of the time, the LDL reading you get when you have a cholesterol test is calculated using the formula LDL = TC - HDL - (TG/5). The reason for this? Actually measuring the LDL is a slightly more expensive test. The cheap test that is normally used for cholesterol screening measures the total cholesterol (TC), the HDL and some other plasma factors known as triglycerides.

The formula was made up by a doctor called Friedewald, and I mean it when I say "made up." It was based on empirical data, and the formula was developed to fit measured results. It is a heuristic (something that just sort of seems to work). It fits average data very well. Note that I am not saying normal. Normal is not the same thing as average. There are triglyceride readings within the realm of normal that are very unusual, and for these people, the formula is a very poor predictor of their actual measured LDL.

There was a medical report online that I used while researching this hub. I originally linked to it  but it has since gone away.  (Sorry, these things happen)  The report first refers to a previous report that found that if the TG is very high it will artificially lower the calculated LDL. Then it gives a case of a patient who had a very low TG and using this formula the calculated LDL was artificially high. They proved it by actually measuring the LDL and comparing it to the prediction. It was way way off for him -- so badly off that it completely changed how they viewed his cholesterol. When they measured it it was just below borderline. When they guessed at it, it was in the "needs drugs" category. It doesn't take a mathematical genius to see why the Friedewald formula fails for exceptionally high or low TG levels! If you subtract a very big number (even one divided by 5) you will have a smaller number left. Conversely if you subtract a very small number you will have a bigger number left. Freidewald was certainly no mathematician.

Here is where it starts to get scary. Doctors can mess with numbers like these til the cows come home as long as it's just interesting information about their patients. But when they use estimated LDL as a basis for prescribing statin drugs, that's where I draw the line.

The screening test is being used as a treatment determinant. I think that before anyone consents to take statin drugs (believe me, they're scary) they should insist that their LDL be measured, because as you see from the reference article, the calculated results can be way off. Doctors are giving out statin drugs to children these days based on the Friedewald heuristic. Doctors are using drugs as a first resort, instead of appropriately as a last resort. They assume that "diet and exercise" aren't going to really work. Drugs are the only things that really work so might as well just go straight to the drugs. And big pharma is standing on the sidelines, cheerleading and clapping them on the back. You Go Doc!!! Who doesn't like to be told how great they are. And meanwhile those cheerleaders are raking in the bucks.

A doctor might say to a patient with a dismissive tone of voice, "well you could try the diet ad exercise (eye rolling says yeah and we know how well THAT works) but come back after it fails and I'll give you something that will knock that cholesterol on its ass. Ignoring that the doctor didn't really give any specific recommendations for diet and exercise, we also note that people are very responsive to unspoken messages. They are being set up to fail at taking responsibility for their own health and just take the easy way and let drugs do it for them. For both doctor and patient, drugs are easy. Just remember to pop this pill every day.

Another scientific beef I have: It's pretty clear that statins drive the cholesterol numbers down, but there has never been a solid proof that cholesterol CAUSES atherosclerosis, only correlations between the two. It is possible that a third factor causes both! Here's a wikipedia example. Is it not conceivable that in the same way HRT was not actually causing lower heart disease risk, so cholesterol isn't causing atherosclerosis. If you lower the cholesterol, but the cholesterol was a result rather than a cause, you haven't affected the atherosclerosis at all because you have not removed whatever third factor is causing it.

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Aya Katz profile image

Aya Katz 7 years ago from The Ozarks

Hot Dorkage, yes! You made a lot of valid points. Correlation with heart disease isn't the same as causing it. The best thing to do? If you are healthy, don't let some test result from a lab convince you otherwise.

hot dorkage profile image

hot dorkage 7 years ago from Oregon, USA Author

Thank you Aya Katz. Probably no one else will read this hub because it has math in it :D

hot dorkage profile image

hot dorkage 7 years ago from Oregon, USA Author

They scare healthy people. "Oh you may think you're healthy now... look at so and so perfect BMI out for a 10 mile jog and dropped dead of a heart attack..... High choley is symptomless bla bla bla" you get my drift.

bala99 profile image

bala99 7 years ago from Hyderabad, Telangana, India.

Back in good old days, there was physical work connected to everything you wanted. If you wanted ice, either you had to crank the ice maker or walk to the grocer. Now you call!

Automated comfort is, I think, a leading cause.

bala99 profile image

bala99 7 years ago from Hyderabad, Telangana, India.


I Seem to be a compulsive clicker.

Chris Telden profile image

Chris Telden 7 years ago from Pacific Northwest, U.S.A.

Great hub!

In the West, a statistic is like an accessory--you've got to have one or no one will take you seriously. But medical statistics are like clay. They're startlingly malleable and can be anything from powder--which can blow away at a whiff--to the dried, hard, baked-on stuff that feels akin to stone. People take conclusions drawn from statistical data far more seriously than they should.

But the common medical practice of using statistics--which apply only to a broad sample of the population and say nothing about any one member of that population--to treat specific individuals is, well, lunacy. "You have a 75% chance of contracting such-and-such disease" is meaningless. No one event can be predicted from a probability distribution...including disease.

hot dorkage profile image

hot dorkage 7 years ago from Oregon, USA Author

Thanks Chris. Yes indeed, we attach way too much significance to numbers. I was told my blood sugar was low once in hospital and so they fed me a popsicle to make the number go up. that is lunacy. I know what sugar actually does to your body. I only ate the damn thing so they would let me go home. And Bala, while I'm a HUGE fan of exercise, I have to point out that an ancestor of mine several generations back who worked hard physical labor every single day still died of a heart attack.

Tootsy 6 years ago

Thanks Chris! This makes sense to me. Thanks for pointing out about the difference between average and norma, etc.... Yes, my total was recently 273, my LDL 133, and my HDL was 92. My doctor said that he puts everyone my age (70) who has an elevated total cholesterol on medicine. I told him to forget it with me...that I would change my nutrition and exercise. I knew exactly what I had been doing to raise it...and reduce stressors on me. Also, I didn't fast before the test. So, thanksl

hot dorkage profile image

hot dorkage 6 years ago from Oregon, USA Author

Tootsy you are right to refuse statins. Your HDL number seems totally awesome and if you believe those numbers your ratio is very very good. In the 2nd place 133 and 92 only add up to 225 not 273. I know there's triglycerides in there somewhere but they wouldn't account for that big a difference. Plus your age (70) sort of puts you in the group of "gee if they were gonna have a heart attack they probably would have had it by now." And your doctor sounds like a total jackass. How dare he prescribe statins for you if you didn't even fast for the test. Even by their own reckoning that completely invalidates the test so he shouldn't be basing ANY treatment on it! It just proves my point: they just want to push these dangerous drugs off on everyone. I'd get another doctor if I were you! You go girl.

lm 6 years ago

Try checking out the relationship between alzheimer's and statins. There's good evidence they help, and if you've lived with two cases of dementia, doing daily care as basic toilet skills are forgotten and the people you love don't even know you, you'll try anything that has a hope in hell of working. This isn't just about heart attacks and other nice (yes, very damn nice) ways to die. I've lived with a total of 16 years of familial dementia, and if you aren't scared you should be.

hot dorkage profile image

hot dorkage 6 years ago from Oregon, USA Author

We are dealing with a parent who is not demented but had a stroke, and pretty much lost physical abilities. He still recognizes us but he can't do much. If he were a total zombie it would be much much worse. By that stage of life, try the drugs by all means what have you got to lose.

I googled as you suggested, and the results are mixed. If anything they suggest a correlation, and the best science was the one suggesting that it's a wash. Mistaking correlation for cause is a serious fallacy. And none of the studies currently dares to suggest statins as a preventive for Alzheimers.

I'm talking about feeding statins wholesale to mass numbers of people in their 40's or younger -- even as young as children and think of how many years they would be on it-- because of some number which may very well be WRONG in the first place, and in the second place may only be an effect, not a cause.

taulandi 6 years ago

Good Hub

Keep it up.

john000 profile image

john000 6 years ago from Superior, Arizona

I'm impressed by the reasoning. Gives pause for thought. Thank you. John000

Marianne618 6 years ago

I had a non-fasting cholesterol check by needle prick at the blood center with a reading of 174. About 3 wks. prior to this I had a 15 hr fasting blood check at my dr.'s and it was 231. Any idea why such a large discrepency?

hot dorkage profile image

hot dorkage 6 years ago from Oregon, USA Author

I'm not a doctor but it appears you are just giving the total numbers in the USA measurements, and not the breakdown. A lot can influence choley readings, the most important being the skill of the lab technician who performs tne test. Also: how much exercise and what kind, your mental/emotional state, and your diet around the time, (some nurses swear that consuming a big mac the day before your test even if you fast correctly causes a big gob of yellow goo in your blood sample when they put it in the centrifuge.) You don't say your age either so I really can't even speculate.

Wendy 5 years ago

Dose it make a big difference in a cholesterol reading rather you fast or not? My numbers fasting first where 225-155ldl. Then not fasting they where much higher 259 total cholesterol why would they have you take a cholesterol test with out fasting? If it makes that much of a difference ? I'm a 50 year old lady and will be getting long term life insurance so should I fast before my next test? I've also been eating lots more fruits and vegetables .I'm very fit work out six days a week.

hot dorkage profile image

hot dorkage 5 years ago from Oregon, USA Author

Wendy, I am not a doctor but everything I know says you need to fast before the test because they want base readings and if you eat it causes them to fluctuate. But I think you should consult with the doctor who is ordering the test.

hot dorkage profile image

hot dorkage 5 years ago from Oregon, USA Author

The latest and greatest on this: There are two kinds of LDL, low density and high density. Only the high density kind is bad. The high density kind is correlated with high carb intake. You can tell which kind you have by looking at your triglycerides. High triglycerides are correlated with high levels of high density LDL

KoffeeKlatch Gals profile image

KoffeeKlatch Gals 4 years ago from Sunny Florida

I agree, they are putting way too many people on cholesterol medicine. Wonderful article. You brought up a great number of valid points.

Pharmk565 2 years ago

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