Cholesterol: Good vs. Bad

 You've gone to the doctor and had your cholesterol checked, but what do all those numbers mean? And is there anything you can do to lower your cholesterol without medications? I'm so glad you asked. 

I'm Dr.Vickie Petz Kasper. If you're ready to take control of your health, you're in the right  place. Whether you're focused on prevention or you're trying to manage a condition. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.

 This is episode 1 64. Cholesterol, the Good versus the Bad.

When I was about 26 years old, I had my cholesterol checked for the first time. Imagine my surprise when the number was 256.  Yikes. Now admittedly, the hospital where I was doing my residency had a fast food restaurant conveniently located right there in the cafeteria and my go-to: hamburgers and french fries.

But also I have a strong family history of significantly elevated cholesterol.  The doctor said I could lower it some and I should diet and exercise and blah, blah, blah, blah, blah, blah, blah. But guess what? I eventually lowered my cholesterol to 156 without medication, and I'm going to tell you how you can do it too.

But first, let's start at the beginning and go to mini medical school and learn exactly what is cholesterol. Technically we call it a lipid, which is sort of like a fat that circulates in your bloodstream. Structurally, these compounds make up parts of cell membranes and functionally they help regulate the transport across these membranes, so that's good. Right? Well, yes, we do need cholesterol to help move and store energy, produce hormones, and absorb vitamins. But you know, too much of a good thing. We'll get to that.

Lipids don't dissolve in water, so they have to hitch a ride on proteins to travel through the blood, and when they get hitched, they change their name to lipoproteins. Now this is gonna sound familiar if you've ever had a lipid panel drawn.  HDL stands for high density lipoproteins and LDL stands for low density lipoproteins.  Where does it come from? Well, your body actually makes it in both the liver and small intestines. Then it's stored in the liver where it's converted to bile acids, so you can get rid of it.

Is it bad or good? Well, that depends. HDL cholesterol reduces inflammation, prevents blood clots, and helps transport oxygen. And your body makes all of it that you need all of it. But here's the deal. Not only does your body make cholesterol, but we also eat it. Most of the cholesterol in the standard American diet comes from meat, eggs, cheese, and dairy products. Oh, well, who can afford eggs anyway?

But seriously, cholesterol is sneaky. Rather than announcing its presence, it just slips through your blood vessels undetected, but it leaves a calling card and we call it plaque. This buildup in the wall of the arteries can lead to hardening of the arteries and therefore cardiovascular disease.

Think about it. If a plaque gets big enough, it can compromise blood flow and cause a heart attack or stroke. And this can also happen with smaller plaques when a piece breaks off. I told you cholesterol is sneaky. Most people who have high cholesterol have no symptoms. We call it hyperlipidemia, and that's why you need to know your numbers and you need to know what they mean. 

I guess all those burgers weren't helping me have healthy blood vessels when I was in my twenties.  But that's not the whole story. We could go to mini medical school and learn the difference between HDL and LDL cholesterol, or we could just call them good cop, bad cop. Because that kind of sums it up. The reason LDL cholesterol is the bad cop is because it causes a fatty buildup inside the arteries and that impairs blood flow and puts you at increased risk of a heart attack or stroke.

You've seen those detective shows where they lock someone in an interrogation room and they just yell at 'em. No, it's not exactly the same, but I bet you'll remember now that LDL the bad cop cholesterol can make you have a heart attack. Now the good cop HDL cholesterol can actually lower your risk of heart disease and stroke.

You know, it's the reassuring I'll be your friend cop. Picture the scene, bad cop is giving the suspect a really hard time and good cop comes in and sends the bad cop away.   Stick with me here. HDL, good cholesterol carries at least a little bit of the LDL or bad cholesterol out of the arteries where it causes damage and into the liver where it can be broken down and eliminated.

So speaking in very general terms, you want your HDL cholesterol to be high and your LDL cholesterol to be low. We'll get to specific numbers in a sec. I do want to mention triglycerides. They are not the same thing as cholesterol, but they hang out together because you know, birds of a feather... When you have a lipid panel done, they often measure the whole flock, total cholesterol, HDL cholesterol, LDL, cholesterol and triglycerides.

You've also probably heard about the ratio and yes, it's very important, but whose side are these triglycerides on anyway? Well, they're the most common type of FAT in the body. And like all things in our bodies, they have a purpose and that is to store excess energy from your diet. And yeah, that's the problem.

Most of us have plenty of excess in our diet.  Hamburgers and french fries, or as Steve Martin said in the old Pink Panther movie, "Am barger." If you don't know that scene and that didn't make you laugh, please google it and watch a clip.

 The bottom line is that high triglycerides combined with high LDL means fatty buildup in the walls of the arteries, and that increases the risk of heart attack and stroke. Okay, I hope you're convinced that Steve Martin is hysterical and you need to see the clip from the Pink Panther, and you need to get your cholesterol checked. 

You are convinced, right? Don't believe me. The American Heart Association recommends that if you are over the age of 20, you should have your cholesterol checked and depending on your risk factors, every four to six years after that, until you get older and have an increased risk of. every dang thing.

So now you've had your blood drawn and the doctor calls you with your results.  No. Oh yeah. Your results are now on the portal and you want to know what they mean.  I do have to tell you that context matters and you really should discuss the results with your doctor, but if you don't hear from them, I'll give you some generalities for people who do not already have cardiovascular issues, and by the way, you should fast for at least 12 hours before you go to the lab and get this. You shouldn't have the test done if you're sick or stressed. Stress affects cholesterol too. It wreaks havoc on your body in so many ways. First of all, people who are stressed often smoke more, drink more, sleep less, exercise less socially isolate and eat more junk. So there's that, but also our old friend Cortisol, the stress hormone also plays a role. Cortisol is our body's way of preparing us to physically respond to a threat. So it triggers the release of glucose and fatty acids into the bloodstream and muscles. So energy is available for slaying dragons   threatening our safety, and that's a good thing when there are dragons pulling up in your driveway. Not so much if you live in a constant state of stress. Of course, if you have prolonged stress, you'll have to go ahead and surrender that vein in your arm and get your lipids checked anyway, because when it comes to your numbers, you need to know.

So let's get to those numbers. Total cholesterol should be below 200 milligrams per deciliter, and if it's between 201 and 239, that's considered borderline high cholesterol, and if it's above 240, that's just plain over the limit. Now, LDL cholesterol should be below 130 or even much lower than that if you are at risk of heart attack or stroke, HDL should ideally be above 60 and triglycerides below 150.

Any numbers outside of these parameters should be taken seriously because you have a higher risk of cardiovascular disease, especially if you continue to eat ham ba burgers.  Now, let's say you do hear from your doctor's office. You know, the nurse calls and says you either need to take a cholesterol lowering medication like a statin or that you need to eat a low cholesterol diet and exercise. Thank you very much. But shouldn't we have a more detailed conversation about this result?  You bet. Your cholesterol is just one group of numbers. It's not the whole picture. Your risk of heart disease is impacted by other factors like smoking, high blood pressure, your family history, your age, and yes, of course your diet.

And we are going to talk about a heart healthy diet in a bit. But first, let's discuss that conversation you're having with the nurse who calls from the doctor's office and said, we've sent in a prescription for a statin.  Hold up a minute. This literally happened to me last year. My total cholesterol was 202, a whopping two points above the normal range, and my ratio of good cholesterol to bad cholesterol was excellent.

So I questioned this recommendation,  but what are the recommendations? Remember, I am board certified in lifestyle medicine, which is a subspecialty of conventional medicine. So we're not opposed to treatment with medication when indicated, but before we go firing off prescriptions, we should at least examine the indications.

If your cholesterol is abnormal, and I would argue that mine is not thanks to some serious changes in my lifestyle and not my inherited tendencies, then you may need a cholesterol medication. Depending on your age and the likelihood of developing heart disease, but if you're not at risk for heart disease, then you might not need a medication, even if your cholesterol is high. At least not for now, because here's the deal, the number of your years only increases and age is a risk factor for heart disease, which by the way, is the number one killer of Americans. So let's say you are at risk and your cholesterol is high and your doctor wants you to take a medication quick pharmacology review.

These medications can help the body make less cholesterol, which is one source. They can block the absorption of cholesterol from food, which is another source, and on top of that, they can actually help your body get rid of cholesterol faster. Sounds great. Right, and it can be, you should probably take medication if you have known heart disease, especially if you've actually had a heart attack or stroke.

And because diabetes is such a big risk factor for cardiovascular disease, you may need to take a medication if you have type two diabetes, even if your cholesterol isn't high. And that's to prevent heart disease. Of course, you need to discuss all of this with your personal healthcare provider, and I recommend following their advice after you've had a conversation about options and risk. The most commonly prescribed class of medications are statins, but there are others.

But can you lower your cholesterol without medications? I'm living proof  exercise helps raise your good cholesterol and lower your bad cholesterol, but you gotta do it regularly. Ideally, 30 minutes, five days a week, or if you wanna step it up a notch, 20 minutes of vigorous exercise three times a week.

And remember, vigorous means you cannot have a conversation if you're talking, you are not exercising vigorously. You gotta be huffing and puffing to reach this level. So if you decide to stick with moderate, you can talk, but you can't sing. But here's the beauty of exercising - every little step in the right direction has immediate benefits, so you can start small and see results.

Resistance training is great to build muscle strength and burn energy. You know, bands, weights, pushups, things like that. Or maybe you could start walking briskly. Or go to the gym and join a class for built-in accountability and social connections.  

Let me give you a startling fact.  People who have a heart attack are four times more likely to die within three years if they don't have social connections. The older you get, the stronger the association. And if you're wondering how in the world that could be, it turns out the key is caring about others. When you value people in your life and you know they value you, you are more likely to make healthier choices like not smoking and positive relationships help manage stress and lower inflammation, and that damages blood vessels and also contributes to heart disease. 

Sleep matters too. As part of an overall healthy lifestyle, you should aim for seven to nine hours per night and less than six hours a night is associated with higher cholesterol levels.  In the past, medical literature reported a positive association between drinking a glass of red wine and heart health. Turns out that's probably not true and moderate to heavy drinking  unquestionably raises your risk for heart disease. You know, if your liver's working overtime to get rid of alcohol, it's much less effective in dealing with cholesterol.

Now, your Dr. may not have mentioned any of this except diet and exercise. So let's park there for a minute. A healthy weight is often associated with better numbers, but that isn't always true. Genetics also plays a big role, but whether you're at an ideal weight or overweight, changing your diet can have a huge impact on your cholesterol.

In fact, depending on how much change you're willing to make, I would say that you can lower your cholesterol to a healthy level. And if you're interested in making healthy habit changes, you might want to go to my website Healthy Looks Great on you.com and sign up for Kickstart to Better Health. And for sure, you're going to want to stay tuned for an upcoming interview I have on Habit Change. Subscribe to this podcast. There's a link in the show notes or go to the website Healthy looks great on you.com.

Either way, you should listen to your doctor. And make sure they listen to you as well. You may need medication to lower your cholesterol, and you may need to make lifestyle changes, especially if your numbers are going up in the wrong direction, even a little.

But if you're motivated to do it without medications, let me harp on your diet. Hear me when I say this. When it comes to cholesterol or weight loss, diet matters more than exercise. Of course you should do both, but if you don't change your diet, exercise may not have the impact you're looking for. If you want to reduce the intake of cholesterol, stay away from trans fats, sometimes referred to as partially hydrogenated oils. They've basically been outlawed and banned anyway, but sometimes these transitions take some time to implement. Just make sure packaged pastries and things like margarine, which you shouldn't be eating anyway, don't have them. Avoid foods that are high in any kind of saturated fat.  

Here's my top five list of foods that are high in cholesterol. Maybe we can find some hints about why my cholesterol was high eating in that fast food restaurant every day.

Number one is red meat, beef, pork,  and especially processed meats like bacon, sausage, and hot dogs. Ah, remember what those hamburgers did to my cholesterol numbers.

Number two is fried foods, and yes, I ordered french fries with my burgers. And fried foods are particularly bad when certain oils are used.

Number three is sugar sweetened beverages and good grief. I drank a Coke with my burger and fries. No wonder my numbers were bad.

Number four is sweets, pastries, pies, cakes, cookies, and ice cream. Yep. I probably ate that too.

Number five is dairy, especially whole milk, cream, butter, and unfortunately cheese, which I also put on my burger. Good grief. I was daring my cholesterol to be high with all the foods from the naughty list.

So what am I doing now? Well, I'm glad you asked. Here's a fun fact.  You really don't find cholesterol in plants. So eat plants, eat a lot of plants, eat different plants, eat plants that have different colors. Usually the darker, brighter the color, the more nutrients it has.

Cholesterol's only found in processed foods, meat and dairy. But you wanna know what's only found in plants. Fiber and a high fiber diet is so important in lowering your cholesterol. It creates a healthy gut microbiome. Think of it like a sponge too, that soaks up cholesterol out of your bloodstream and helps remove it.

Things like unprocessed oatmeal, whole wheat bread, whole grain brown rice, and popcorn. Also, beans, broccoli, sweet potatoes, apples, pears, oranges, grapes, all kinds of berries and nuts are on the good list. You didn't just ask me about eggs, did you? Goodness, that's a whole other conversation. And so is the other player in this conversation, triglycerides. But I will tell you that if you have high LDL cholesterol, you should at least limit your consumption of eggs.

And the bottom line is that HDL cholesterol is your friend. It can help protect you from cardiovascular disease. And LDL Cholesterol levels should be low for heart health. That's easy to remember. H stands for high. L stands for low, and in some cases your doctor will want it really, really low. Below 70. So is cholesterol good or bad? The answer is yes. Cholesterol helps with cell membrane transport, absorption of vitamins, brain function, hormone production. But don't get the wrong idea. LDL cholesterol causes fatty buildup in the arteries, and that can be a huge threat to your health. So lower your bad cholesterol with medications if you need it, but definitely lower it with lifestyle changes because lower LDL is better for your health and healthy. Looks great on you.   

The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change