Trig/HDL ratio is 1.8...but tons of sdLDL? Is Total/HDL ratio a better predictor?

#1

Just saw the latest video of A/Prof. Ken Sikaris:

And there was an example he used in there that has me stumped. Below are the snapshots of the issue.

Here is a 41 y/o man who has a family history of palpitations and was reporting palpitations. As you can see in this picture between both labs (6 months apart) he cholesterol jumped significantly. He started a LCHF diet and turns out he is a hyper responder.

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Now, his ratio here is 1.84 in terms of mg/dl (if I did the math right: 1.6/2.0=0.8*2.3=1.84) Which is below 2, which should be ideal. Turns out though (because he is a hyper-responder) he has TONS of small dense LDL (pattern B). So maybe the trig/hdl ratio should be cavated with, “trig/hdl ratio is a good predictor of sdLDL so long as your trigs aren’t high and total cholesterol l isn’t through the roof”?

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Also, He makes the case that total cholesterol to HDL ratio is a better predictor for sdLDL than trig to HDL:

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Cholesterol is fuuuunnnnnnnnn.

(Bacon is a many-splendoured thing) #2

I believe that when the measure is in mmol/L, the trig/HDL ratio is supposed to be under 0.9. Under 2.0 is the goal when the measurement is in mg/dL.

I’m confused a bit by your statement that the readings in this man’s bloodwork are six months apart. I have trouble with Commonwealth dates, so I may be wrong, but I’m reading the earlier measurements as having been taken on June 16, 2010 (“16/06/10”), and the second as having been taken on April 1, 2017 (“01/04/17”), which is about a seven-year gap. Dr. Sikaris doesn’t say in the lecture how long the fellow had been in ketosis when the more recent bloodwork was done, so I wonder if the picture improved any after he’d been keto for, say, about six months.

#3

Ah, apologies, it wasn’t very clear what I did and my math was compact. I converted it from mmol/L to mg/dL. So I’ll do it here again in both scales:

I took the trigs (1.6 mmol/L) and divided it by the HDL (2.00 mmol/L) and came up with 0.84 mmol/L. This is below the 0.87 threshold for “ideal” in mmol/L.

Then I multiplied 0.84 mmol/L by 2.3 to convert it to mg/dL, resulting in 1.84 mg/dL. This is below the 2.0 threshold for “ideal” in mg/dL. I got this math from this website: https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/

As to the other point, In the video, Dr. Sikaris says that the labs were a couple months apart, so I took it as June 10th 2016 and then January 14th 2017. Seems like the first lab wrote it in Commonwealth and the second in US…which is suuuuper confusing, or Dr. Sikaris wrote it incorrectly.

(Darag Rennie) #4

I wonder if you missed the main point of Ken’s update? Which was that TC/HDL ratio is a much better predictor of heart disease than the TG/HDL ratio. Mine has been stubbornly high despite being on LCHF-keto for a few years