Cholesterol - Good, Bad Or Ugly?

Have you had your cholesterol levels checked lately?

The reason I ask this question is because cholesterol is one of the most commonly heard words in the medical field. When it comes to heart health, cholesterol is on the top of the list. I screen all of my patients for cholesterol levels, and I can tell you that explaining their test results can be difficult. I look at it this way, "When it comes to cholesterol levels, the news can be good, bad, or ugly". Let me explain what I mean.

First of all, cholesterol is not a bad thing. It is a waxy, fat-like substance made in the liver. As a matter of fact the body needs some cholesterol in order to function properly. Cell walls need cholesterol in order to produce hormones, vitamin D and the bile acids that help digest fat. Unfortunately, only a small amount is needed so when too much accumulates it forms a thick, hard deposit which eventually leads to hardening of the arteries and heart disease.

The important thing to comprehend when it comes to cholesterol levels is the amount of protein there is in relation to fat. This cholesterol-protein package is called lipoprotein and is classified as high density, low density, or very low density depending upon the ratio of protein to fat. This is where the "good, bad, or the ugly" come into play.

The Good Cholesterol

HDL or high density lipoproteins help the body get rid of bad cholesterol in the blood. The higher the level of HDL the better it is for fending off heart disease.

The Bad Cholesterol

LDL or low density lipoproteins can cause buildup of plaque on the walls of arteries and therefore puts you at greater risk for heart disease.

The Ugly Cholesterol

VLDL or very low density lipoproteins contain mostly fat and not much protein so it is the worst ratio of protein to fat and is a far greater threat to heart health.

How Much is Too Much?

I recommend that everyone over the age of 20 get their cholesterol levels measured at least once every 5 years. In general doctors like to see cholesterol stay below 200 but risk factors are always considered when determining the best method of treatment. The chart below gives you an overview of levels that go from desirable to high.


Total Cholesterol ----- Category

Less than 200 ----- Desirable

200 - 239 ----- Borderline High

240 and above ----- High

When the total level is too high both types of cholesterol (LDL and HDL) are important. The goal is to lower your LDL and raise your HDL.

How Can Cholesterol Levels Be Lowered?

There are two ways to lower cholesterol: therapeutic life style changes and taking cholesterol medication and/or supplements. Regular aerobic exercise and weight loss, along with a healthy diet will increase HDL levels. Medications that help to increase HDL include niacin, bile-acid resins, fibric acid derivatives, and statin drugs.

What Can You Do Now to Reduce the Risk of Heart Disease?

As a doctor who specializes in anti-aging, I advise my patients to start now to keep their cholesterol in check. A few simple changes can help lower cholesterol levels and reduce the risk of heart disease.

Eat foods low in cholesterol. The American Heart Association recommends you limit your average daily cholesterol intake to less than 300 milligrams. This means keeping your intake of saturated fats low and avoiding foods that are high in saturated fat.

Quit smoking. The lower levels of HDL resulting from smoking can be reversed if you stop.

Exercise. Moderate exercise, if done daily can help control weight, diabetes, and high blood pressure all of which contribute to heart disease.

Take medication as prescribed by your doctor. If diet and exercise are not enough to bring your cholesterol levels down, you may need to take a cholesterol lowering drug. Cholesterol-lowering medicine is most effective when combined with a low-cholesterol diet.

What Do You Order When Eating Out?

One of the most frequently asked questions from my patients is how to manage their cholesterol when eating out. It may be a little more difficult to choose the "right" foods but here are a few tips that might help.

Before you order:

Take time to study the menu or better still if you are already familiar with the menu, decide before hand what you will eat. This will help you resist tempting foods that might not be as healthy. Ask that the bread, butter, spreads, and other goodies be removed from the table. If you want bread the best choice is Melba toast or whole-grain rolls without butter or margarine. Drink two full glasses of water before your food arrives. Avoid the following - buttery, fried, pan-fried, creamed, escalloped, au gratin, or a la mode.

When you order:

Select foods that are steamed, broiled, grilled, stir-fried, or roasted. Ask the server to leave off the butter and sour cream...no loaded baked potatoes please! Don't be persuaded or influenced by another's choice. Order broth-based soups such as minestrone or gazpacho. Choose seafood, chicken, or lean meat rather that fatty meats and order broiled, baked, grilled, steamed or poached entrees. Substitute steamed vegetables instead of fries and order side dishes without sauces. For dessert order sorbet or fresh fruit without whipped cream

When you order salad:

Avoid grated cheese, prepared salads, cream dressings, chopped eggs, bacon bits, and croutons. Use rice vinegar, balsamic, or lemon juice instead of prepared dressing. Now is the time to make a few simple life style changes that could mean the difference in your health and reduce your risk of heart disease. Don't wait, start today!

Mark Rosenberg, M.D.
Institute For Healthy Aging

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