By: Roxanne B. Sukol, MD, MS
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Every once in a while, a friend thrusts their latest cholesterol lab results in front of me and asks a barrage of questions:
“What do you think of these results, and are they okay?”
“My doctor said the HDL is too low.”
“Why are my triglycerides so high?”
“What should the LDL be?”
“And why is the total so high if the individual numbers are good?”
No need to wonder anymore. Here’s what your cholesterol profile results mean, and how to make them better.
Doing the math
First, you should know how the total cholesterol is computed. Actually it’s pretty simple: just add the LDL plus HDL, and then add one-fifth of the triglycerides. That’s it.
So if your LDL = 100, HDL = 50, and triglycerides (TG) = 100, the total cholesterol will equal 100 (LDL) + 50 (HDL) + 100/5 (TG) = 100 + 50 + 20 = 170. Nice.
Here’s another example: If the LDL = 150, HDL = 50, and triglycerides = 500, the total cholesterol will equal 150 (LDL) + 50 (HDL) + 500/5 (TG) = 150 + 50 + 100 = 300. Not good. You want your total cholesterol below 200 or so, unless the HDL is high, in which case the total may be higher than 200, but that’s okay because high HDL levels lower your risk of coronary artery disease (heart attacks).
Understanding HDL cholesterol + triglycerides
When I check a cholesterol profile, my eyes always look to the HDL and triglycerides. These two numbers are highly affected by your intake of stripped carbs and ultra-processed oils. The more white flour, sugar, corn syrup, corn starch, white rice, corn oil, soybean oil, cottonseed oil and ‘vegetable’ oil you eat, the lower the HDL goes and the higher the triglycerides rise.
You want a triglyceride level below 150; higher triglyceride levels increase your risk of a heart attack. The HDL goal depends on your gender; the goal for women is at least 55 (or higher) and the goal for men is at least 45. HDL levels below 55 (women) or 45 (men) are an independent risk factor for heart disease. So, generally speaking, the higher the HDL, the better.
And if your cholesterol profile shows a low HDL and a high triglyceride level? It’s time to reassess your diet. Something is driving that HDL down and spiking the triglycerides, whether it’s an out-of-control sweet tooth or a regular fast-food habit. Or maybe it’s that daily soda, with the equivalent of 12 teaspoons of sugar in each can. However you look at it, too much stripped carb and ultra-processed oils are a problem. The numbers don’t usually lie, although I do occasionally see a low HDL in active people who are eating a nourishing diet. This appears to have, at least in part, some genetic component.
What else makes the HDL drop? Manufactured, ultraprocessed oils. That’s where fast food and processed items play a huge role. Whenever I see an extremely low HDL, like in the 20s, you can pretty much guarantee that it’s due to a daily lunch in the drive-thru, or a couple of donuts on the way to work every morning, or a serious potato chip habit. There are no two ways about it; any combination of deep-fried patties, corn syrup, processed cheese food, sugar, and white flour is a prescription for a heart attack.
How can you get your HDL up and triglycerides down? Eat more intact, whole, colorful carbs and nutritious fats like fish, olive oil, nuts, and peanut butter. Dark, green leafy vegetables, like bok choy, Swiss chard, collards, red leaf lettuce, kale or even dandelion greens are a powerhouse of important nutrients. And remember that exercise raises your HDL, too, so start walking, and your numbers will get even better.
What if your HDL looks great, but the triglycerides are still high? Look to the amount of alcohol being consumed, including beer. Alcohol in moderation happily raises your HDL, but beer, made from grain, is a type of stripped carb, and stripped carbs drive those triglycerides straight up. Everything in moderation: No more than one drink a day for women, two for men. [A drink is defined as 1 oz of liquor or 5 oz of wine or 12 oz of beer.] And use ‘em or lose ‘em because you can’t save up.
What is LDL cholesterol?
I also look carefully at the LDL, which is a different matter entirely. LDL is linked to your intake of animal-based foods, including dairy, eggs, chicken, turkey, beef, pork and lamb. If your LDL is around 130 or less, and you have no risk factors whatsoever for coronary artery disease, you’re doing great. But the more risk factors you have, the lower your LDL should be.
Risk factors that increase the likelihood of heart attacks include smoking, diabetes, hypertension, obesity, having a family or personal history of heart attacks, and/or being a couch potato. Being sedentary (inactive) is an important and reversible risk factor for heart disease.
Even if your only risk factor is that your father is a heart attack survivor, your doctor may choose to be more aggressive and decrease your LDL goal to 100. If you have diabetes, the LDL goal will likely drop closer to 70. Why? Diabetes is such a significant risk factor that it raises the risk of heart attack to equal that of someone who has already had a previous heart attack. Genetics can also be a factor in high LDL levels. For some people, it can be difficult to cut animal-based foods enough to lower LDL, which may be part of the reason that we use so much cholesterol-lowering medication to lower the risk of having a heart attack.
If you don’t like it, change it
If you don’t like the way your cholesterol profile looks, you’ve got a plan now, and it has no surprises. Eat more fruits and vegetables, whole grains, beans. Cut down on treats, and skip the soda, doughnuts, fast food. Be judicious about your intake of animal-based foods; save up to eat grass-fed or pastured, and not every day. Planning to make a pot of turkey chili? Add twice the amount of beans! Go for a walk because exercise raises your HDL. And get someone to help you figure out how to quit smoking.
Then have your cholesterol rechecked in a couple of months, and smile. Because you’re figuring it out.
— Adapted from Dr. Roxanne Sukol’s blog, Your Health Is on Your Plate, May 27, 2018.