Good vs. Bad Cholesterol from Dr. DeMeyere-Coursey
One of the most common phone calls I make to my patients is the dreaded “cholesterol results” phone call. Medicinal treatments for cholesterol have advanced greatly since I’ve been in medical school, and the guidelines have similarly changed. Whenever I receive a result, I find most often that the “good” cholesterol is low, and the “bad” cholesterol is high. The basic elements which make up a cholesterol panel include but are not limited to:
1.) Total cholesterol (aka, Tc) – This number takes into account both the good and the bad. The typical goal is to be below 200. However, it is important to take into account all the elements contributing to this. If the good cholesterol is so high that it is making total cholesterol read high, it may not be a problem at all!
2.) Triglycerides (aka TGs) – Triglycerides contribute to gallstones, pancreatitis, fatty liver, and various other unhealthy conditions. We know that triglycerides are closely linked with body fat, particularly around the midsection. I tell my patients that a good goal is for this number to be below 150.
3.) Low Density Lipoprotein (LDL) cholesterol – This is the baddy, the one which contributes to clogged arteries, heart attacks, strokes. I remember LDL as being the bad cholesterol by thinking “L is for Lousy”. A good goal for LDL is below 100-130.
4.) High Density Lipoprotein (HDL) cholesterol - “H is for Healthy”. This type of cholesterol actually helps to keep arteries clear and is protective against heart disease. Above 40 is normal, but above 60 has the most benefit, so this is my goal for my patients.
Whenever I look at a patient’s cholesterol panel, I take their numbers and plug them into a calculator (which you may also do for your own numbers here: http://www.cvriskcalculator.com/). This calculator not only accounts for cholesterol numbers, but also age, race, gender, and other risk factors such as smoking and high blood pressure. The number generated is one which I share with my patients: Their risk of having a heart event in the next 10 years. In general, if this number is over 5%, I begin the discussion of cholesterol lowering medication. However, I am always in favor of lifestyle changes before initiating medication.
So how does one lower bad cholesterol and raise good without taking a pill every day?
1.) Exercise! I recommend to my patients at least 150 minutes in a week, or 30 minutes, 5 times a week of dedicated exercise. Losing weight will lower triglycerides, and exercise itself helps to raise HDLs and lower LDLs.
2.) Replace bad cholesterol foods with good cholesterol foods. Some simple changes I suggest to my patients is to use olive oil instead of butter, switch out unhealthy snacks like chips and deep fried finger foods with almonds, walnuts, and hummus. Beans and legumes, whole grains, and high fiber fruit are also rich in HDLs. Additionally, fatty fish like tuna or salmon is a great alternative to a beefy steak. Avoid anything deep fried or greasy (sorry pizza and French fries).
In a later segment, I plan to discuss exercise in greater detail with tips on how to make it a less daunting accomplishment in day to day life. I should also note that even if a cholesterol lowering medication is taken, exercise and a healthy diet will always be recommended to pursue on top of it. Overall, it’s hugely important to find something which works for you. Be sure to ask your doctor if you have further questions!