Cholesterol : The Good, The Bad and the Ugly

It’s in every cell of our bodies. It can kill us or protect us. Roughly 1 in 8 Americans have too much of it. It is cholesterol!

Cholesterol has caused a lot of confusion over the years. Let’s first start with how our bodies use Cholesterol. Our bodies need cholesterol to make hormones (like estrogen, testosterone, progesterone and many others), Vitamin D, and bile acids which help with our digestion. Cholesterol is carried through our bloodstream by attaching to certain proteins. The combination of proteins and cholesterol is called a lipoprotein. There are different types of lipoproteins which make up the lipid panel and these include:

• Low-density lipoprotein (LDL). LDL, or “bad” cholesterol transports cholesterol particles throughout our bodies. Too much LDL cholesterol builds plaque in the walls of our arteries, making them hard and narrow (atherosclerosis).
• High-density lipoprotein (HDL). HDL, or “good” cholesterol picks up excess cholesterol and takes it back to the liver where it is broken down and removes it from the body.
• Very low density lipoprotein ( VLDL). Very small particles of LDL*
• Triglycerides (TG). Fats carried in blood*

*VLDL and Triglycerides will be covered in next week’s blog post

Recently, I had a patient come in for her follow-up lab check and she seemed disappointed. In my routine Well Woman panel, a fasting lipid panel is included. This measures the amount of total cholesterol, LDL cholesterol, HDL cholesterol and Triglycerides as mentioned above. When she looked at the copy of her lab results, she stately sadly, “I can’t believe it – I have high cholesterol”. I took a deep breath and reassured her, “Yes, but it depends on the numbers –specifically the HDL and LDL values. Your total cholesterol is 230, HDL 85, LDL 121, and VLDL = 24. Your total cholesterol is elevated because you have a high HDL level – that’s good news! You’re doing a great job!” Now she beamed with a wide smile, “So I get a gold star?” “Yes, you definitely do! “ I stated positively.

This clinical example shows how important it is to know your numbers and is key to understanding your cholesterol profile. That is why I always have my patients come in for consultation after their lab results return – so we can clear up any confusion and give kudos when you’re doing a great job!

Here is a graph showing the ranges for desirable, borderline high and high risk Cholesterol Levels. Note that the high risk cholesterol levels are when the LDL is greater than 160 and the HDL is less than 40. The desirable levels are to have LDL less than 130 and HDL greater than 50.

I always try to keep things simple and I use this mnemonic. “You want your LDL – low, and your HDL – high.”

Factors that contribute to the high risk Cholesterol guidelines (high LDL and low HDL cholesterol) include lack of exercise, obesity and an unhealthy diet. When it comes to diet and cholesterol, it is important to remember that foods high in cholesterol, like fatty meats and dairy, tend to be higher in saturated fats, which can increase LDL levels. There are some exceptions though, for example, egg yolks are high in cholesterol, but not saturated fats.

A dietary culprit to avoid is trans fat, or trans-fatty acids, found in many processed foods. Trans fat has a double-negative effect on your cholesterol – lowering HDL and increasing LDL (exactly the opposite of what we want for our bodies to do). Avoid eating processed foods and choose fresh fruits and vegetables instead of chips, cookies and crackers.

Yet, not all fats are bad and unhealthy. Certain fats can be good for us – like polyunsaturated and monounsaturated fats (olive, canola, and peanut oil, nuts, seeds and fatty fish).

Lifestyle changes to lower your LDL levels. (Remember you want LDL to be low, not high)

1. Make better dietary choices: avoid trans fats, or any processed foods.
2. Lose extra body fat: Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
3. Decrease the drinks: Alcoholic drinks, that is! Water is still good for you! In general, it is recommended that women have no more than 1 drink/day, and men 2 drinks/day.
4. Trim that waistline : For women, a waist circumference of 35 inches (89 centimeters) increases her risk. For her male counterpart, a waist circumference of 40 inches (102 centimeters) increases his risk.
5. Get your body moving: Doing cardiovascular exercise and weight training increases your body’s metabolism and boost your body’s HDL cholesterol production. Exercise also makes your bad LDL less harmful by making the size of the LDL particles smaller.
6. Stop the cigarettes and nip it in the bud: There are no beneficial effects of tobacco use. Cigarette smoking leads to atherosclerosis. Don’t smoke!
7. Diabetes: We know that by having high levels of sugar causes many problems in the body. ( Sugar – The White Death blog) including atherosclerosis and heart disease.

Another factor that affects your risk for high LDL cholesterol is your genetic makeup. Yes, your family may carry specific genes that put you at a higher risk. In general, about 1/400 cases of high cholesterol are due to family history (familial hypercholesterolemia- FH) and less than 20 percent are actually treated. This is because most people don’t get tested and why it’s so important to get your lipid panel checked.

If the above lifestyle changes aren’t enough or if you carry the gene for FH, your doctor may prescribe a medication or combination of medications to lower your cholesterol levels. The most common medication is called a statin. Some of my patients choose to not take a statin, but use a supplement called Red Rice Yeast Extract, which contains the same molecule as in statin medications. Always check with your doctor before starting any new supplement or medication.

In general, cholesterol levels, or your lipid panel, will be checked every 2-3 years depending on your risk and values. Once a new medication is started, these levels will be checked more frequently.

Many factors contribute to cholesterol levels, including diet, exercise and your genes. By working with your health care provider you can be proactive and decrease your risk for high cholesterol levels (that’s high LDL, not high HDL). Keep it simple- Want LDL to be low, and HDL to be high.

In Health & Wellness,

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