The question Laura asked
This one came in on a question and answer episode. Laura asked him to explain the numbers to divide for the triglyceride to HDL ratio on her blood work. His first move was to take the pressure off.
Dr. Martin, The Doctor Is In, Episode 1528Laura, listen, let me make it really crystal clear and simple, okay? Don't get into the weeds, okay? Don't get into the weeds with your blood work.
For a woman over 60 holding a page with a dozen lines on it, that is the useful part. He is not asking you to interpret all of it. He is asking you to find two lines.
How to work it out
The arithmetic is one division. Take your triglycerides. Divide by your HDL. That is the ratio.
- Triglycerides 150, HDL 50. That is 3.0, and it is the shape he sees most.
- Triglycerides 100, HDL 60. That is 1.7.
- Triglycerides 70, HDL 70. That is 1.0, which he calls not bad.
- Triglycerides 60, HDL 75. That is 0.8, and HDL is now the bigger of the two.
Lower is better, because a lower result means the triglycerides came down or the HDL went up, and both of those are the direction he wants.
What a good result looks like
He does not give the answer as a decimal. He gives it as a comparison, which is easier to hold in your head.
Dr. Martin, The Doctor Is In, Episode 1528You want those to be low and you want your HDL to be high, at least equal. But if your HDL is higher than your triglycerides, you're in good shape.
So the target in plain words is HDL at least matching your triglycerides, and better if it beats them. Then he says how much weight he puts on it.
Dr. Martin, The Doctor Is In, Episode 1528When it comes to your heart, that is a much better indication than any other test for your heart.
He also says where most people actually land, and it is not close to the target. The large majority come in with high triglycerides and low HDL, which is the ratio running the wrong way.
"I love looking at blood work, but I look at blood work differently."
Dr. Martin, The Doctor Is In, Episode 1528The units trap
One practical note he does not cover, and it catches people who compare results with a friend or read an article from elsewhere. In the United States a lipid panel reports both triglycerides and HDL in mg/dL. In Canada, the United Kingdom and much of Europe, both are reported in mmol/L, and the numbers look much smaller.
The ratio survives that, as long as you divide like with like. Both of your numbers come off the same page in the same units, so the units cancel and the answer means the same thing either way. Do not mix a triglyceride number from one page with an HDL number from another.
Why it reads your liver too
He adds something to the same answer that is easy to miss.
Dr. Martin, The Doctor Is In, Episode 1528I want your triglycerides to be lower than your HDL, and that'll tell you the condition of your liver pretty well too.
His reason is where triglycerides are made. They come out of the liver, and what drives them up is sugar and processed carbohydrate rather than the fat on your plate. When the liver has more than it can store, he says, it ships the excess out into the bloodstream as triglycerides. A high triglyceride line, on his reading, is a message about the liver and about how much sugar is going through it.
That is why the thing he changes first is not the fat in the diet. It is the carbohydrate.
What about my LDL
Someone on the same episode asked the obvious follow up. If the triglycerides and the HDL are good, how high can the LDL go? He did not hedge.
Dr. Martin, The Doctor Is In, Episode 1528Okay, check your triglycerides and check your HDL. I don't care about total cholesterol.
His position on LDL on this episode is that it is not the cause of heart disease, and that fifty years of driving it down has not moved heart disease. That argument, and where it came from, is in the whole cholesterol thing is a hoax, and what the standard lab ranges mean for a woman your age is in what is a normal cholesterol level for a woman over 60. If you are already on a cholesterol lowering medication, should a woman over 60 take a statin covers what he asked patients on one to do.
Common questions
How do you calculate the triglyceride to HDL ratio?
Divide your triglycerides by your HDL, both taken off the same lipid panel in the same units. Triglycerides of 100 and HDL of 60 give 1.7.
What ratio does Dr. Martin want to see?
He puts it as a comparison rather than a decimal. He wants HDL at least equal to your triglycerides, and says that if your HDL is higher than your triglycerides you are in good shape.
Does it matter if my results are in mmol/L instead of mg/dL?
Not for the ratio, as long as both numbers come off the same panel in the same units. The units cancel in the division. The individual numbers will look very different between countries.
What lowers triglycerides?
On his reading, cutting sugar and processed carbohydrate, because triglycerides are made in the liver out of excess sugar rather than out of the fat on your plate.
The side of the panel he works on
Triglycerides follow sugar and insulin. Martin Clinic's Blood Sugar Support Formula is the one he built for that.
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