The range your lab uses
Start with the answer to the question as it is usually asked. A standard lipid panel in North America reports total cholesterol, LDL, HDL and triglycerides, and the reference ranges printed beside them do not change once you pass 60. Total cholesterol under 200 mg/dL is called desirable, 200 to 239 borderline, 240 and over high. LDL is wanted under 100. HDL is wanted over 50 for a woman. Triglycerides are wanted under 150.
So the technical answer to what is normal for a woman over 60 is the same as it is for a woman of 40. That is the whole problem, in his view, and not because the numbers are too strict. It is because of which numbers get the attention.
Why the number moves after 60
Plenty of women get to their sixties with a lipid panel that never moved, and then one year it does. Total cholesterol comes back at 230 where it used to be 190, and nothing about the way she eats has changed.
What changed is estrogen. Through the menopause transition estrogen falls away, and with it goes some of the effect it had on how the liver handles fats. Total cholesterol and LDL tend to drift up. HDL often drifts down. None of that is a new disease. It is what the panel does when the hormone that was shaping it leaves.
This is the moment a great many women are first offered a cholesterol lowering medication. His question, asked on this episode more than once, is why that line is the one being treated.
Why he says those are the wrong numbers
Dr. Martin on what doctors are looking at:
Dr. Martin, The Doctor Is In, Episode 1546If you go to 99.9% of doctors, they still are obsessed with your numbers. You're lipid and they're looking at the wrong numbers.
He then gives the reason he thinks the panel gets read the way it does, and it is not a claim about anyone's intentions.
Dr. Martin, The Doctor Is In, Episode 1546And why is it cholesterol and not triglycerides? Why is it cholesterol and not triglycerides that they're looking at? Because they don't have a medication to lower triglycerides.
Behind that sits the argument he has made for years, and it is an argument about results rather than about theory.
Dr. Martin, The Doctor Is In, Episode 1546And the overarching principle is if lowering cholesterol would get rid of heart disease, we would've done it already.
Heart disease is still the number one killer in North America, he says, after fifty years of lowering cholesterol as the main strategy. That is the whole of his case in one line. He covers the history of how cholesterol got the blame, going back to Ancel Keys and a 1965 magazine cover, in the whole cholesterol thing is a hoax.
"Every cell in your body needs cholesterol."
Dr. Martin, The Doctor Is In, Episode 1546The two lines he reads instead
Ask him what a good result looks like for a woman over 60 and he does not answer with a total cholesterol figure at all.
Dr. Martin, The Doctor Is In, Episode 1546And I'm obsessed. Okay? I'm obsessed with your triglycerides and your HDL. To me. It's not even close. What causes heart disease? You're much better off to know your triglycerides and your HDL.
Both of those lines are already on the panel you were handed. Triglycerides are the fats circulating in your blood, and he ties them to carbohydrate and to the liver rather than to the fat on your plate. HDL is the particle that carries cholesterol back to the liver. He wants the first one low and the second one high, and he wants them read against each other rather than one at a time. The arithmetic of that, and what counts as a good result, is in the triglyceride to HDL ratio after 60.
The part that runs backwards
This is the section that surprises most women, and it is the reason he says an LDL number on its own tells you very little about how you are living.
Dr. Martin, The Doctor Is In, Episode 1546Here's what lowers it, obviously, statin drugs, Lipitor, Crestor, Zocor, they lower your cholesterol. Is that good? Okay. Now listen, what else lowers your cholesterol? Your LDL. I mean, okay, snacking lowers it.
Processed carbohydrate does the same thing, he says. Then he turns it around. What raises your LDL, in the same stretch of that episode, is eating less frequently, the way you do on an intermittent fast, and cutting your carbohydrate intake down. Which is the opposite of what the number is meant to reward.
Steak lands in the same place. He says it raises your cholesterol and lowers your triglycerides at the same time, which is exactly the trade he would take. If eating more often and eating more processed carbohydrate brings a number down, he argues, that number was never a good measure of how well a woman over 60 is doing.
What to do with your own result
He is careful about this, and it is worth quoting rather than paraphrasing.
Dr. Martin, The Doctor Is In, Episode 1546And I really don't want you to fight with your doctor, okay? I don't want people to fight with their doctor.
What he asks for instead is that you read the whole page rather than the top line of it. Find your triglycerides. Find your HDL. Look at them next to each other. Then look at the things that actually move them, which on his list are sugar, processed carbohydrate and how often you are eating, not the eggs and the butter.
Common questions
What is a normal cholesterol level for a woman over 60?
A lab calls total cholesterol under 200 mg/dL desirable, LDL under 100, HDL over 50 and triglycerides under 150, and those targets do not change with age. Dr. Martin does not read the total or the LDL as the measure that matters. He reads triglycerides and HDL.
Why did my cholesterol go up after menopause?
Estrogen falls away through the menopause transition, and the lipid panel usually drifts with it. Total cholesterol and LDL go up, HDL often goes down. A higher number in your sixties is frequently that, rather than anything you changed.
Does a high total cholesterol mean I will have a heart attack?
Not in his reading of it. His argument is results based: if lowering cholesterol got rid of heart disease, he says, it would have happened already, and heart disease is still the number one killer in North America.
Which numbers on my blood work does Dr. Martin want?
Triglycerides and HDL, read against each other. He wants triglycerides low and HDL high. Both are already printed on a standard lipid panel.
The line he actually reads
Triglycerides follow sugar and processed carbohydrate more than they follow anything else on your plate. Martin Clinic's Blood Sugar Support Formula is the one he built for that side of the panel.
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