I recently had blood work done. When I received the results and read through the report, my cholesterol values confused me. First some background: I have struggled with elevated cholesterol since my 20’s, although my weight has stayed around 115 pounds, so I am not overweight by any means. High cholesterol runs in my family, so I know at some point I may need medication to help control it. But I am continuously working on my lifestyle choices as long as possible before I get to that point. I work out regularly and eat pretty well, choose healthier fats, but I do love my sweet and salty snacks too.

Read this blog for a quick review about cholesterol, its role in the body, and values to aim for.

For those struggling with high cholesterol, their report may look like this: high total cholesterol, high triglycerides (trigs), low HDL, and high LDL. This essentially means that the person may have a diet high in unhealthier fats like saturated or trans fats, and is not regularly active. Of course, there can also be underlying health conditions, medications, and genetics that all factor in, but I am just generalizing with this explanation.

So why was my report confusing? I had high cholesterol (215), low trigs (70s), high HDL (80s), and high LDL (123). If low trigs protect against heart disease but high LDL increases the risk for it, what does this combination mean? Is this saying that i don’t eat a lot of fat, but the fat i do eat is the unhealthy fat? I found out that the answer is not so clear cut.

There are several explanations for low trigs and high LDL. There are two types of LDL particles: large particles that lower risk, and small particles that increase risk. One report shows that low trigs and high LDL can be an indication of a diet filled with healthy fats, which show up as larger and less dense particles.

Another reason may be the way that LDL is measured. Traditional cholesterol tests don’t measure LDL directly. It’s actually calculated using the Friedewald equation, which uses total cholesterol, HDL, and triglyceride (trig) values to make an estimation. A 2014 study of 14,600 adults found that the Friedewald equation overestimated LDL values when trigs were below 100, but also underestimated LDL values when trigs were over 200. The equation is not valid for those whose trigs are over 400. The researchers suggested having LDL directly tested for a more accurate reading.

Keeping this in mind, how do I proceed? Do I ignore my report and just continue eating what I eat? Not really. It’s good to know that my high LDL doesn’t automatically mean I’m at risk, since having low triglycerides and high HDL are both protective factors. But I also know that there are things I can change in my diet, like perhaps adding more healthy snacks, and not overthinking the types of fat that I do eat (it’s OK to have butter once in a while!). It’s good to know that there is more to this story than what meets the eye.

However, I also want to listen to my doctor and take her advice. Her recommendation is to re-test in three months. Since cholesterol values can change within a three month period, this is the best time to implement some changes to see if they help improve my numbers!

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