We’ve all heard about it for most of our lives. If you’re “middle aged” or older, your doctor has probably mentioned it to you at least once and probably suggested you need lower it. He or she may have also given some vague advice about how to do that, such as eating less fat or low fat foods, choosing leaner cuts of meat, and having fish once or twice a week instead of red meat. Not “bad advice” per se, but not really good advice either, since on average, in about eight years of schooling, doctors have very little education on nutrition. I intend to cover the basics about cholesterol and nutrition so that you can be armed with the knowledge to take the best care of your body. At my worst I have had an HDL of 35, an LDL of more than 170, and triglycerides over 400. Read on to see how I fixed those numbers.
HDL, or High-density Lipoproteins used to be called “good cholesterol”, but its only redeeming factor is that it helps remove oxidized LDL cholesterol.
LDL, or Low-density Lipoproteins are definitely the bad cholesterol. The lower the number on your labs, the better. High levels directly correlate to high instances of cardiovascular disease. LDL does have an important role in the body though, as it’s required for making cortisol, estrogen, progesterone, testosterone, and Vitamin D, as well as carrying nutrients to all of our cells, and playing a key role in brain health.
Triglycerides are the most common fat in the body. It mostly comes from eating processed and refined carbohydrates and added sugar or alcohol. High triglycerides increase a person’s risks for inflammation, atherosclerosis, and diabetes.
Trans- fats are not something you will see on your lipid panel (cholesterol test) but are worth a mention. It is a major contributor to LDL. It is naturally occurring in meat and dairy but much of it in our diets comes from processed foods. Food manufacturers found a way to artificially recreate them by hydrogenating or partially hydrogenating oils, so that the vegetable oils would be solid at room temperature, have an increased shelf life, and improve “mouth feel”.
The numbers on the lab results represent a range that the average American comes in at. Functional medicine uses a smaller range for what is actually healthy and should be the goals for optimum health or reduced risk for cardiovascular disease. Most doctors use the wider ranged average, which is the following:
HDL: Men should aim for greater than 40, women for greater than 50, but ideally either sex should be 70-100
LDL: The lower the better, but one should aim for less than 130. To minimize your risk of cardiovascular disease you should aim to never go over 100. If you are middle aged or over, and told to lower your cholesterol you should try to be at 75 or less. If you have ever had a heart attack, or have been diagnosed with cardiovascular disease, you should aim for 30 to 50. Don’t worry about the hormones and other functions I mentioned earlier. Single digit LDL has been observed with no effect on hormone production.
Triglycerides: Generally accepted that this needs to be 75 or lower for optimal health. It takes a bit of effort to get rid of processed carbs and added sugar, but it’s worth it to have better health, and have the doctor say your cholesterol is “excellent” and get a nice pat on the back for it.
Ratios: These may or may not show up on your cholesterol test. If not, they are simple to calculate.
Total Cholesterol to HDL- If it’s 5.0 or greater you are at high risk for cardiovascular disease and if it’s under 3.5 you are considered low risk. So aim to be under 3.5 but don’t panic if it’s between 3.5:1 and 5:1.
Triglycerides to HDL- High risk is anything over 3.0 the goal for this is to be below 2.0:1 but again the lower the better and 1:1 or lower is very achievable with a good diet.
So what all this means is that as time marches on, we as people learn more and more about what goes on in our bodies, how to prevent disease and how to stay healthy. For example scientists originally divided cholesterol into high and low density. They have since discovered there are several sub-types of each and some of the LDL sub-types aren’t so bad for us. Unfortunately most cholesterol tests done today are the same test designed in the 70’s and only show LDL and HDL without regard for the new sub-types. Doctors and scientists also used to believe that higher HDL could prevent heart disease. But studies following people who were born with high levels of HDL confirmed that those people were at just as high of a risk for heart disease as people born with lower HDL. Conversely, though, people born with low LDL levels were at a lower risk of developing associated diseases. So there is essentially no correlation between HDL and heart disease but there is a strong correlation between LDL and cardiovascular disease (higher LDL= higher risk of disease) In learning about the lack of correlation between HDL and cardio diseases, I discovered that was the case even when studies introduced drugs to significantly raise HDL levels, and since no discussion about cholesterol would be complete without mentioning statins, this seems like a good place to bring them up. In a word- AVOID. I am not a doctor and would never recommend you ignore your doctor’s advice or modify your treatment plan, but statins have a very bad reputation based on multiple scientific studies that have proven them to be effective for a very limited number of people : specifically, men over 60 who have already had a heart attack . If your doctor wants to discuss statins, I beg you to research them first and ask your doctor these two important questions. 1. what is the number needed to treat? (NNT) and 2. what percentage of people experience the significant side effects? For one of the most popular statins the NNT is 300 and 5% of people taking it experience significant side effects. Think about that for a minute: 300 people take the drug, one person out of 300 benefits from it and 15 have significant side effects. Does not sound like good odds to me.
How then do we sort through all of the antiquated test results, misinformation, and Big Pharma pushing to make money from us at any cost? How do we reduce our risk for cardiovascular disease, strokes, and high blood pressure associated with high cholesterol? Fortunately, scientists have been studying this for decades and they keep showing similar results that get refined over time. First there have been many different diets recommended for heart health that are now strongly cautioned against such as low fat or high carb diets. Registered dietician and nutritionist, Joann Ridout of the Dishing Up Nutrition podcast, states switching to eating “real foods” and cutting out breads and pasta lowered her cholesterol and triglycerides enough for her to get off a statin.
For me, switching to a whole food, plant based diet brought my numbers down to HDL=43, LDL=88, triglycerides = 74 and my general practitioner said it was excellent. One of the biggest reasons “Real Food” or a “whole food plant based” diet helps cholesterol is because “low fat” and processed foods generally have more refined sugars and processed or refined carbs which raise triglycerides and LDL, regardless of their fat content. To spell that out more, heart disease is still on the rise in the U.S. In 2000 people were eating an average the equivalent of 90 lbs. of sugar a year, every year. In 2003 the world health organization recommended that people get no more than 10% of their calories from sugar. Apparently no one listened because by 2011 the average was up to 156 lbs. per person per year, despite the Institute of Medicine stating in 2005 that sugar consumption could increase the risk of heart disease, Diabetes, and raise LDL cholesterol. Finally, the Harvard Nurses Study noted in 1993 that trans fats could increase the risk of cardiovascular disease by 50%, Denmark took note of this, did additional studies, and in 2003 banned manufacturers from adding trans fats to food. American food manufactures lobbied against that because, well profits. Hmm. They finally agreed to labeling requirements that essentially allow them to hide trans fats in plain sight, if one serving contains less than .5G of trans fat , the product can be labeled trans-fat free or “no trans-fats”. Unfortunately many snack size packages that a reasonable person would eat in one serving often have 2 or 2.5 or even 3 servings in one package. Buyer or consumer beware- and of note, The National Academy of Science has stated that the only safe amount of trans-fat is zero. Armed with all of this knowledge of what those cholesterol tests or lipid panel terms and numbers mean and the desire to be healthier or avoid cardiovascular diseases, heart attacks, strokes, and insulin resistance or diabetes, the path forward is simple and generally pretty easy. Eat whole real foods, significantly cut back on your food with added sugar, cut back on refined carbs like bread and pasta and when you “have to have it” go for whole grain versions with the highest fiber possible and replace as much of your beef, pork, and chicken with cold water, oily fish like salmon. In short if your food has ingredients lists, try to replace it with something you cook up from the produce section of your grocery store and put some salmon on the side.
Bon appetite & here’s to your health.
Written By: Doug Davis, CHC