Too high and they shout you need statins.

The problem is when you are on a low carb diet like Atkins or Protein Power, after a while your triglycerides will be low while your high-density lipoprotein cholesterol (HDL) is high. The problem is LDL is expensive to measure in a laboratory, hence they generally calculate out this value using the Friedewald estimation.

ie, LDL-C (calc.) = CH − HDL − (TG/5)^2.

However this formula only works for triglycerides under 400mg/dl (4.52 mmol/l) and more importantly above 100mg/dl ( 1.13 mmol/l). When triglycerides are  above 400mg/dl, the labs generally warn in the report that it cannot be calculated. But then don’t warn if its below 100mg/dl.

The problem is that if you are on low carb diet for a while, your triglycerides will naturally fall below 100mg/dl. Then then abnormal LDL will be inflated by as much as 58%.

Hence the Cholesterol Confusion

For better estimates you would use the Iranian formula from this medical paper.

Or better ask for a direct LDL measurement

Do note that you can only use this formula if TG < 100mg/dl (1.13 mmol/l) AND TC > 250mg/dl (6.46mmol/L)

For mmol/L you would use

LDL (mmol/L) = TC/1.19 + TG/0.81 – HDL/1.1 – 0.98

For mg/dL

LDL (mg/dl) = TC/1.19 + TG/1.9 – HDL/1.1 – 38

If a doctor tries to press you to use Statins, please ask him to refer to the following articles

For the doctor:

Low Triglyceride Levels Affect Calculation of Low-Density Lipoprotein Cholesterol Values

The impact of low serum triglyceride on LDL-cholesterol estimation

The accuracy in using modified Friedewald equation to calculate LDL from non-fast triglyceride: a pilot study

For us layman:

Low-carbohydrate diets increase LDL: debunking the myth

Making Dr Friedewald an honest man

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