Cholesterol: The Good, The Bad and the Ugly Part One

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*

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 stated 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!

Below 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.

Stay tuned for next week's blog post about how certain fats can be good for us! 

In Health & Wellness,

Dr. Diana