Clearing up the confusion between good and bad cholesterol

If you're wondering about good and bad cholesterol, you're not alone. Adults should get their cholesterol levels checked at least every five years and even more often with age.

If you’re wondering about good and bad cholesterol and what they mean for your health, you’re not alone. Even people with the highest risk of heart disease may have a hard time understanding the connection between high cholesterol levels and heart health and what they can do to lower their levels.

Here we’ll describe the differences between good and bad cholesterol to help you make the best decisions for your health going forward.

What is cholesterol?

Cholesterol is a waxy substance your body needs to make healthy cells, hormones and vitamins. However, too much cholesterol can raise your risk of heart disease, stroke and other health problems. Nearly one in three American adults has higher than the recommended cholesterol levels.

Cholesterol moves through the body on lipoproteins, which are a combination of fat and protein. What we refer to as “good” and “bad” cholesterol are actually different types of lipoproteins. High-density lipoproteins (HDLs), which are the good kind, help carry cholesterol out of the body.

Low-density lipoproteins (LDLs) enter the walls of the arteries (the tubes that carry blood), causing them to become hard and clogged with plaque. When that plaque builds up, the heart has to work harder to get blood to the rest of the body, including the brain. This increases the risk of heart attack and stroke, two of the major causes of death in the U.S. LDLs are what we call the “bad cholesterol.”

There’s also another type of bad cholesterol: very low density lipoprotein, which contributes to the buildup of plaque as well. Since HDL clears out cholesterol, raising your HDL numbers usually lowers your LDL numbers, which is a win-win for heart health.

Check your levels

When you get your cholesterol levels checked (which adults should do at least every five years and even more often with age), you’ll get a series of numbers:

• Total cholesterol: This should be under 200-240.
• HDL level: Recommended HDL levels are 40 mg/dL for men over 20 years old and 50 mg/dL for women.
• LDL level: Adults should have LDL levels of less than 100 mg/dL.
• VLDL level: This should be less than 30 mg/dL.

Your results will also show another important number: your triglyceride level. Triglycerides are another form of fat in your blood that raises your risk of heart disease. You want this number under 200 mg/dL, or better yet, under 150 mg/dL.

Diet and cholesterol

Your body makes all the cholesterol it needs, but many of the foods we eat also contain cholesterol. These include egg yolks, meat, cheese and other products that come from animals. So, is eating high-cholesterol foods the problem? This is where the issue of cholesterol becomes a bit more complex.

Eating cholesterol doesn’t necessarily raise your cholesterol levels, nor does eating foods from animals. Low-fat dairy products, eggs and lean meats are important parts of a healthy diet. Additionally, eating foods with unsaturated fats or monosaturated fats (sometimes known as “good fats”), such as nuts, olive oil and fish can actually help lower disease risk.

However, foods that are high in cholesterol also tend to be high in saturated fat, and saturated fat causes the body to make more LDL cholesterol. To add to the confusion, some plant-based foods also contain saturated fats, including coconuts, palm oil and cocoa butter. These can raise bad cholesterol levels as well.

Many processed foods, such as margarine and shortenings, may include “trans fats,” which are made by adding hydrogen to liquid oils to make them solid. These are even worse for your health, as eating trans fats not only raises LDL levels but can also lower HDL levels.

The American Heart Association recommends that saturated fats make up just 6% of total daily calories. If you are trying to lower your LDL level, you should avoid trans fats altogether.

The big picture

What does this all mean for your diet? There is no universal way everyone can lower cholesterol levels. It’s all about finding the right balance specific to your individual health profile.

High cholesterol occurs for many reasons. Your age, family history and weight can all affect your risk, and if you have diabetes or are obese, you are at higher risk. What you eat and how much exercise you get can also contribute to cholesterol levels.

While you can’t do anything about your age or your family or health history, there are steps you can take to decrease your bad cholesterol levels and your risk of heart disease, such as:

• Eating a healthy diet that includes some unsaturated fats, few saturated or trans fats, and a high amount of fiber. Good choices include fruits, vegetables, whole grains, beans and lean meats. You could try the DASH Eating plan or use the MyPlate website to get ideas for healthy meals your family will enjoy.
• Taking steps to increase your physical activity. This can be as simple as walking or taking time for any another exercise you enjoy, such as dancing, yoga or weight training. Aim for 75-150 minutes of exercise a week, depending on the intensity of the activity.
• Managing your stress. Long-term stress may raise LDL levels (that’s the bad one).
• Quitting smoking. Smoking can lower HDL levels (that’s the good one) and damage blood vessels, which can contribute to plaque buildup.

See your provider to check your cholesterol levels, and make sure you’re doing everything you can to maintain healthy cholesterol levels and reduce your risk of heart disease.