Triglycerides – not cholesterol – is the bona fide risk factor for coronary heart disease

| June 19, 2013
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When your doctor is visiting you about your blood work, she normally will immediately zero in on your total cholesterol (TC). If it’s over 200 mg/dl, your doctor will likely recommend a statin cholesterol-lowering drug. If you decline, expect repeated attempts to educate you about the danger of ‘high cholesterol.’

In these circumstances, it’s best to change the subject to Fasting Glucose, Triglycerides, and HDL. As was known as early as the 1950s, total cholesterol is a poor, unreliable predictor of risk of heart disease.

Instead, have your doctor focus on the following four numbers:

                  Lipid                                                 Goal______________________

  • Fasting Glucose (FG)                about 87 or lower
  • Triglycerides (TG)                      below 100
  • HDL                                            over 60 for men; over 70 for women
  • Ratio of TG:HDL                        1 = low risk; 2 = increased risk; 4 = high risk

You want Fasting Glucose (FG) – blood sugar – to be about 87. According to Dr. Atkins’ 40 years of clinical experience as a cardiologist and family physician, your risk of heart disease increases in linear manner as fasting glucose goes over 100.

If your doctor doesn’t warn you at 95, you will be diagnosed “pre-diabetic” at 110 and diabetic at 125. Elevated blood sugar is also a marker for Metabolic Syndrome – a cluster of risk factors that includes elevated blood sugar, chronically high insulin levels, elevated triglycerides and low HDL.

Your doctor may say TG up to 150 is normal; Dr. Atkins believed 100 was top limit of normal

Your doctor may say TG up to 150 is normal; Dr. Atkins believed 100 was top limit of normal

In Metabolic Syndrome, elevated fasting glucose is associated with elevated triglycerides. Triglycerides are blood fats made in the liver from excess energy, especially excess fructose (white sugar and high fructose corn syrup). As TG goes over 100, your risk of a heart attack increases in linear manner. (The medical profession is still currently at 150 before they alert you.)

In part, elevated triglycerides are a measure of “blood stickiness.” At 175, there is the danger of clot-prone blood and a greater risk of a heart attack or sudden death. In teeter totter fashion, as triglycerides go up, HDL (so called ‘good cholesterol’) goes down.   HDL over 60 in men (over 70 in women) is associated with protection from heart disease.

The fourth and final number: All important ratio of TG:HDL, ideally 1, representing low risk of heart disease. If your Triglycerides are 80 and your HDL is 80, you’re at low risk of heart disease (80:80 = 1). If your TG is 160 and your HDL is 40, you are at high risk of heart disease (160:40 = 4).

According to Gary Taubes (Good Calories Bad Calories), in five major studies:

“The inverse relationship between HDL and heart disease held true for every age group from forty-five year olds to octogenarians, in both men and women, and in every ethnic group from Framingham, Massachusetts to Honolulu.”

Years ago, in several newsletters, Dr. Atkins warned about the danger of elevated triglycerides:

“The higher the triglyceride reading, the greater the risks of a heart attack.

“Men with the highest triglycerides were 2.5 times more likely to have a heart attack than those with the lowest measurements.”

Atkins quoted from the Journal of the American Medical Association, vol. 276, p. 882, 1996.

Back to Total Cholesterol

Now, your doctor may still want to discuss TC, but unless it’s below 160 or above 350, it’s not worth talking about. (Cross out with a black marker.) Writing in the 1950s, Dr. John Gofman, a medical physicist at the University of California, who discovered the various lipoproteins (such as VLDL and LDL), wrote, “Total cholesterol is a false and highly dangerous guide to the effect of diet on heart disease…” Gofman added:

Neglect of the carbohydrate factor can lead to rather serious consequences.”

By 1955, Peter Ahrens of Rockefeller University had reached the same conclusion. Ahrens referred to triglyceride buildup in the blood as carbohydrate-induced-lipemia; the promotion of sticky, clot-prone blood, a consequence of consuming excess dietary carbohydrates – not excess fat or cholesterol.

As Gofman, Ahrens and other credible scientists made these startling discoveries – pointing to excess carbs as the heart disease culprit, Key’s “cholesterol bandwagon” had already gathered too much steam. If the American Heart Association and the National Institutes of Health had seriously considered the solid science of Gofman, Ahrens and many other credible scientists from the 1950s, they would have reached these conclusions about the dietary effects contributing to heart disease:

  1. Dietary fat, whether saturated or not, is not a cause of obesity, heart disease or any other chronic disease.
  2. The problem is the carbohydrates in the diet, especially excess sugars – sucrose and high fructose corn syrup specifically.
  3. Through their effects on blood fat abnormalities – elevated Triglycerides and low HDL – refined carbohydrates, sugars and starches are the dietary cause of diabetes and coronary heart disease.
  4. Total cholesterol is not a reliable predictor of heart disease risk. The majority of people who have a heart attack have low or normal cholesterol.




Category: Diabetes/Heart Disease

Comments (39)

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  1. Nicholas says:

    Please can you provide studies to show that trigs are the key marker? I would love to look at them.


  2. Carol says:

    It would be helpful if the values and units are also given in SI. Does anyone have a link to find them easily?

  3. Alan Watson says:

    For your own research, I recommend Taubes’ important book, GOOD CALORIES, BAD CALORIES, containing hundreds of references thoroughly discussing the history of all “Diet Heart” studies going back to the 1950s.

    In my article, I reference the study Atkins quoted: JAMA, vol. 276, p. 882, 1996; also, if you google Dr. J.M. Gaziano’s Harvard study: Circulation 1997; 96:2520-25, you can learn more about the definitive study showing that elevated triglycerides and low HDL is the best predictor of heart disease risk.

    The medical establishment has totally ignored the dietary implications of Gaziano’s Harvard study. Why, because the best way to lower triglycerides and boost HDL is eating a high natural fat diet. As an example, daily eggs – not cereal – is the best way to keep triglycerides below 100 and HDL over 60.

  4. Nicholas says:

    Thanks Alan!

  5. Nicholas says:

    “The ratio TG/HDL-c, initially proposed by Gaziano et al,17 is an atherogenic index that has proven to be a highly significant independent predictor of myocardial infarction, even stronger than TC/HDL-c and LDL-c/HDL-c. The Copenhagen Male Study showed triglycerides on their own to be another strong risk factor, but it found that stratifying triglyceride levels by HDL-c levels led to more accurate detection of increased risk of coronary disease.”

    From this study:

    High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease


  6. Alan Watson says:

    Thanks for your suggestion; will provide European values going forward; please copy/go below for conversion values. thanks

  7. Kirk Bloomer says:

    Hi Alan. You say fasting glucose of 87.1 mg/dl (= 4.83889 mmol/l). Mine is below, so I’m happy but it varies daily between 2.9 and 4.0mmol/l. Is that normal?

  8. Alan Watson says:

    I need to correct to say: 87.1 is at the end of optimal range. Chris Kresser had this to say: “While most doctors will tell you that anything under 100 mg/dL is normal, it may not be. In this study, people with FBG levels above 95 had more than 3x the risk of developing future diabetes than people with FBG levels below 90.” To see his more in depth article, click here:

  9. John Davis says:

    I heard about a pure triglyceride lowering drug that doesn’t raise your cholesterol, Vascepa

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  11. Nsharra says:

    Comparisons of my cholesterol levels from fall 2013 and then february 2014
    2013 – HDL 93, LDL 158, TRG 50, AND TC 227.
    2014 – HDL 36, LDL 108, TRG 7, AND TC 160.

    I first read the numbers and was happy that for once in my adult life (43 years old now), my total cholesterol was below 200. But after reading this article, I am now NOT resting easy. I was proud of the fact that the doctor and I opted against cholesterol reducing meds until I made a true attempt at changing my diet and lifestyle. I’m made great strides and worked hard, but am baffled as to why my HDL went down so low and my TRG’s have raised so much. Can someone please explain? If I am reading your article correctly, I calculate that I am at a greater risk for heart disease now than I was before.

  12. Alice says:

    Nsharra you may have made a typo as TRG is showing as going down not up.
    I changed my diet to higher fat, lower carb (although not too strict due to festive/holiday season) I didn’t have a blood test beforehand but results are:
    Jan 2014 – HDL 104, LDL 163 (do not know density type), TRG 43, TC 277 and fasting glucose 88.
    As a 58 yr old female I think its heading in the healthier direction. I will see if I can get LDL high density and low density tested for.

  13. Susannah says:

    had a lipid panel done today. results were TC 313, HDL over 100 (they didn’t give the number which I thought was weird), LDL 194 ( very high but no VAP.. I was hoping they’d break it out since I know this is high but my HDL’s are so high ).. triglycerides 96 and blood glucose 78. no body better try pushing statins on me. despite the high TC, I think I am doing pretty well for a 49 year old woman. should I be concerned?

    Like Alice I want to get the breakdown on m LDL’s

  14. Alan Watson says:

    Your Triglycerides (96) are in optimum range (under 100), indicating that your LDL is predominantly the large fluffy (benign) variety. While your TG:HDL ratio is apparently 1:1 indicating low risk of heart disease, I would ask them to clarify what your HDL number actually is. (Very high HDL would require some further research on your part.) Women live longer with higher total cholesterol in the context of a favorable 1:1 TG:HDL ratio. Your fastng glucose (78) is optimum. Your only concern: learn what your HDL is and do some further research into “elevated HDL.” Yes, a goal for women is HDL over 70 mg/dl – over 60 mg/dl for men – but HDL over 100 may indicate or signal something you need to be aware of. A final note: not being a “health practitioner – I base any lipid analysis on the decades-long experience of Dr. Robert Atkins.

  15. susan levy says:

    tIf my TG/HDL is 98/100 almost 1:1, still are the numbers too high in and of themselves? My Triglycerides are 64. LDL is at 149, TC 249 really doesn’t bother me.

    The big difference in the last year for me is that I went back to eating eggs almost daily in the morning. My HDL went up several points.

  16. Michael says:

    Hi Everyone,

    It is important to note that the authour of this article is not an MD nor does he hold a graduate degree in any biology/chemistry related field – he admits this himself. Please listen to your doctors and not what you read online. This is not a personal attack on the authour, but it is extremely easy to find literature to support your point as there are constantly conflicting reports regarding the efficacy of using certain biomarkers to predict heart disease. Everyone is different, and as such, the treatment/pre-treatments must be tailored towards the individual. The reason why looking at levels of cholesterol are so important (especially LDL) is because this is what facilitates the progression of atherosclerosis (the clogging of the artery). Higher levels of circulating LDL cholesterol are directly proportionate to increased levels of atherosclerosis (leading to heart attacks). LDL becomes oxidized and “activates” your arteries. Your “activated” arteries begin to attract circulating white blood cells which adhere to the arterial wall. Over time (15-20+ years) these white blood cells become necrotic and further perpetuate the disease (more white blood cells become attracted to the site and are unable to emigrate). Eventually your arteries become clogged leading to potential heart attacks.

    All in all, it is important to look at the WHOLE picture and not just focus on one biomarker and disregard others. Please listen to your doctors and become fully educated on the subject matter. As hard as it is to believe sometimes, they are here to help you.

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  21. Gabriele says:

    Hi, thanks for the interesting informations. During a recent blood donation the doctor warned me about my total cholesterol level, so I was just looking for infos like these. My levels were (I’m 41):

    tot.col. 259 mg/dl
    HDL 86 mg/dl
    trigl 52 mg/dl
    Glucose 88 mg/dl

    So I suppose I don’t have to be so worry about the total chol, though so high?

    Thnak you
    Gabriele (from Italy)

  22. Alan Watson says:

    your lipid profile reveals optimum cardiovascular health!

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  27. Lee says:

    Hi, great info here and really good information sharing. I have recently had problems with TC reaching in the 300 range but with a diet change managed to bring it down to 245. Here’s some values from my latest blood work:

    TC 245 mg/dl
    HDL 62 mg/dl
    LDL 168 mg/dl
    Trigl 160 mg/dl
    Glucose 72 mg/dl

    My LDL and Trigl/s seem too high. I generally have an ok diet where everything is made from freash ingredients (more vegetarian than meat) but I do drink a lot of German wheat beer (too much infact). Can it be the beer? I also smoke.

    Do you see any risk with my numbers and if so what can I do to improve? Any information greatly appreciated.

  28. Alan Watson says:

    Your TG:HDL ratio = 2.5 indicates a bit of increased risk of heart issues. HDL > 60 is good & Fasting Glucose of 72 good too. Triglycerides over 150 represents tendency for more sluggish blood. I would quit smoking – (biggest risk) and reduce your carb intake in favor of more natural fat (to lower triglycerides). Thank you for sharing your story

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  31. Vinny says:

    age: 57
    Glucose: 89
    Total Cholesterol: 229
    Triglycerides: 50
    HDL: 77
    VLDL: 10
    LDL: 142
    TG:HDL: .64

    So, I guess I am ok. BTW, I stopped all forms of added sugar two years ago.

  32. Jane says:

    “Michael” on August 13, 2014 wrote that higher levels of circulating LDL oxidizes, attracts circulating white blood cells which become attached to the arterial wall. I have not had an MI. I have been diagnosed with peripheral artery disease, and probable left descending artery obstruction. I am a female in her 60s. I have been prescribed statins which I have refused to take because I was concerned about their effects on other health concerns.

    No physician has referenced the correlation between higher LDL and increased white blood cells. No physician has indicated any concern regarding consistently high Lymphocytes at 3.7 (1.0-3.3 K/ul).

    Recent fasting test results: the lymphocytes at 3.5
    Glucose 103 (70-100 mg/dl)
    Cholesterol 274 (112-199 mg/dl)
    Triglycerides 158
    HDL 50 (40-200 mg/dl)
    LDL Direct 197 (57-99 mg/dl)
    C-Reactive Protein 1.3 (0.0 – 8.0 mg/L)
    Sedimentation Rate 5 (0-30 mm/hr)

    Severely poor maternal family history of heart disease, even with non-smokers. I smoke. Only medication 12.5 mg atenolol once a day, and 325 mg aspirin daily.

    Are the low/high lymphocyte counts, those of which “Michael” speaks? Wouldn’t a cardiologist or primary care physician remark about the consistent, slightly above normal high lymphocyte count, combined with hyperlipidemia, being indicative of heart disease? (And, wouldn’t I be far more inclined to attempt statins?)

    For females, is there a “safer” statin?

  33. Alan Watson says:

    No women should take a statin drug. (And 325 mg daily aspirin may be overkill!) Glucose over 100 and Triglycerides over 150 indicate excess carbohydrate intake. Consider restricting carbs, especially sugar and grains.

  34. jagan says:

    Hi, my TC is 169; TG is 163; HDL is 38; fasting sugar is 106; LDL is 98.4. I am 55 and feel active and healthy. By your article, my cardiohealth seems to be bad. How can i reduce TG and FBS? and increase LDL

  35. Alan Watson says:

    I would suggest a two week meal log – as specific as practical. After two weeks, look at the carbohydrate component. Carbohydrates constitute the greatest percentage of elevated triglycerides. Also, your fasting glucose – Over 100 – suggests that you are eating excess carbs. If you reduce carbs, your TG should come down and your HDL will increase. It may be important to start your day with zero carbs n the AM and restrict carbs to 60 grams per day for two weeks.

  36. Another Jane says:

    Alan- Here’s the real question: If carbohydrates are terrible for you, why do they taste so damn good? ( and, btw, I am an M.D. )

  37. Alan Watson says:

    I don’t say “Carbohydrates are terrible.” I say restrict sugar, grain, cereal – carbs that raise blood sugar fast – to a level appropriate for your metabolism. Fats do not raise blood sugar; carbohydrates do. Since type II diabetes is clearly epidemic, at least 25% of the population must be careful about blood sugar elevation – leading to chronically high insulin levels. For me, excellently prepared liver and onions taste damn good too; and, of course, berries in season taste great. Much of this is habit and what our families served us, isn’t it? Thanks for your question! Al W