By Ethan Ben-Sorek, M.D.
What is cholesterol, and what do the numbers that your doctor gives you mean? “Cholesterol” is a steroid alcohol present in animal cells and body fluids. It can be taken in by the diet [exogenous], or made by the liver [endogenous]. We use cholesterol to make bile acids which then is used to repair damaged cells throughout the body. It is also important in the production of steroid hormones. Cholesterol is linked to proteins — called lipoproteins — that allows it to be transported through the body. Lipoproteins are classified into several groups — chylomicrons, VLDL, IDL, LDL, and HDL. There are also other proteins, called apolipoproteins that are involved in assisting in lipoprotein metabolism.
Cholesterol is not just what you eat. The body itself makes a significant amount. Other than dietary sources, there are metabolic or endocrine issues that can affect cholesterol and these include diabetes, hypothyroidism, obesity, anorexia, renal disease and liver function. Finally, certain medications and excessive alcohol consumption also may have an effect on lipid levels.
An individual’s cholesterol goal also depends on other risk factors such as age, weight, family history, diabetes history and gender. To help guide you in determining what your cholesterol levels should be, here is a brief description of the different types of cholesterol and cholesterol goals:
Chylomicrons: Chylomicrons are proteins that transport dietary lipids from the intestines to other locations in the body. They help absorb fats from the small intestines and bring it to the liver for use.
– 200 mg/dl is a desirable level, decreases risks of heart disease
– 200 to 239mg/dl is borderline high
– Over 240 mg/dl is considered very high and can increase risk of CAD by two-fold when compared to those with cholesterol below 200.
HDL Cholesterol or Good Cholesterol – the higher, the better!
– HDL less than 40 mg/dl for men and 50 mg/dl for women has a higher risk of developing heart disease.
– HDL over 60 is considered protective against heart disease.
LDL Cholesterol or Bad Cholesterol – The lower your LDL cholesterol, the lower your risk of heart attack and stroke:
– Less than 100 mg/dl is ideal
– 100 to 129 near normal
– 130 to 159 is borderline high
– 160 to 189 is high
– 190 and above, very high
Triglycerides are used by the body for energy or may be stored for later use in fat cells:
– Less than 150 is optimal
– 150 to 199 is borderline high
– 200 – 300 is considered high
– Over 300 is very high
Not everyone has the same guidelines, your other risk factors for heart disease and stroke help determine what your LDL level should be, as well as the appropriate treatment for you. A healthy level for you may not be healthy for your friend or neighbor. For example, for those patients with a history of diabetes and/or existing heart disease, the desired level for LDL cholesterol is 70 mg/dl. Discuss your levels and your treatment options with your doctor to get the plan that works for you.
How do you get your numbers down? The first step is lifestyle modification with diet and exercise:
– Try to get a half hour of exercise at least 3 – 4 days a week.
– Cut down on saturated and “trans” fats in the diet and try to limit your total fat calories to < 20 percent of your daily caloric intake.
– Trim the fat off of red meats before you cook them and buy leaner cuts.
– Grill or use drip pans rather than frying.
– Don’t eat the skin of chicken or turkey.
– Use the minimal amount of oil in cooking. If you need to use it – olive and canola oil have the best ratios of monounsaturated fats. Instead of butter or margarine, try “smart balance”.
– Raise the good cholesterol by increasing dietary intake of nuts/ fish or fish oils.
– Increasing certain fibers like oat bran or psyllium in the diet helps bind bile salts so that they can’t be reabsorbed in the intestines. This in turn makes the liver process cholesterol to replace the lost bile salts.
The decision for medication is an individual choice and will be based on your numbers and risk factors. There are many options now, depending on what components of your cholesterol need treatment. All medications have risks as well as benefits, and some may have significant interactions with your other medications. Feel free to discuss any issues with your physician, and let him/her know immediately if you develop any adverse reactions or side effects.