What do my cholesterol results mean?

What do my cholesterol results mean? What about LDL? HDL? Triglycerides? How do I improve my numbers?

Get answers from the physicians and other health professionals at the Pritikin Longevity Center in Miami. Pritikin has been helping people launch heart-healthy lifestyles since 1975.

What do the numbers on your cholesterol results really mean?

Did you know that our bodies manufacture all the cholesterol we need? We get more (often too much more) from the cholesterol we eat.

What do my cholesterol results mean? What should I aim for?

To understand your cholesterol numbers, it’s a good idea to understand, first of all, what cholesterol is.

Cholesterol is a complex molecule found in all animals, including humans. It’s vital for a number of reasons. It makes hormones and cell membranes and carries out numerous cell functions. We would not exist without cholesterol, but then again, neither would plaque build-up and heart disease.

Our body, particularly our liver, manufactures all the cholesterol we need. We do not need any more from the food we eat.

Eating foods high in cholesterol, saturated fat, and trans fats can very easily raise levels of cholesterol in our blood. It’s this extra cholesterol that can cause a world of hurt in our arteries.

How does cholesterol cause a heart attack?

Bad forms of cholesterol seep into the inner walls of the arteries, creating plaque. Like sores on your skin, plaques are raw, sensitive to infection, which means they make the inside skin of the arteries a breeding ground for inflammation.

High LDL cholesterol numbers leads to heart attacks.

High blood levels of bad cholesterol can lead to heart attacks.

The higher our blood levels of bad cholesterol, the more plaques tend to form, and the more inflamed the arterial skin becomes.

Plaque build-up is also known as atherosclerosis.

Plaque that ruptures

Most heart attacks occur because one of these plaques ruptures. Like boils, many plaques are soft and fragile, full of cholesterol-rich “pus.” When inflamed, they can burst and spew their contents into the bloodstream.

This eruption triggers chemical reactions that often culminate with a large blood clot, which can choke off blood flow to the heart, causing a heart attack.

Scientists call a plaque that has burst or ruptured the single most common lethal event of the industrialized world.

Plaque build-up can happen in arteries throughout the body, including those carrying blood to the brain, which means that plaque rupture causes not only heart attacks but also strokes and other circulatory problems.

Can I stabilize these plaques?

Yes. That’s the really good news. With a healthy lifestyle and, if needed, cholesterol-lowering medications, you can stabilize plaques and improve the entire health of the inner walls of your arteries.

Understanding your cholesterol numbers will help you stabilize the plaque in your bloodstream.

Lowering cholesterol levels will help you stabilize the plaque in your arteries’ walls.

Regular exercise and a diet like the Pritikin Eating Plan, very low in saturated fats, trans fats, and cholesterol, and very high in fruits, whole grains, beans, and vegetables, can dramatically lower the amount of cholesterol entering plaque.

More than 100 studies have documented that the Pritikin Program helps our arteries in many other ways as well. We lose excess weight, for example, and reduce insulin levels, normalize blood pressure, reduce inflammatory markers like C-reactive protein, and bring down blood sugar levels – all good things for our arteries.

Garbage trucks

One type of cholesterol – HDL cholesterol – has often been called the “good” cholesterol. Think of HDL as garbage trucks. When functioning properly, HDL tends to scoop up “trash” (bad cholesterol particles) from the blood and artery walls and transport them back to the liver for disposal. HDL garbage trucks, in effect, do a nice job of clearing cholesterol trash from the body.

But in recent years, scientists have discovered that HDL may not be as “good” as everyone thought, or certainly not good all the time. As garbage collectors, for example, they start falling down on the job. (We’ll talk more about this later.)

Your cholesterol numbers

A standard cholesterol panel gives you four key values:

  • LDL cholesterol
  • Non-HDL cholesterol
  • HDL cholesterol
  • Triglycerides

LDL and Non-HDL Cholesterol

For years, the scientific community believed that lowering LDL (the often so-called “bad” cholesterol) was the most important factor for reducing cardiovascular events like heart attacks and strokes.

But there is now growing consensus that non-HDL may be a better predictor of cardiovascular disease risk. That’s because non-HDL measures not just LDL but all forms of cholesterol that contribute to the build-up of plaque in the artery wall.

Bottom Line: LDL is still a “bad” cholesterol, but now we know that it’s not the only bad cholesterol. Our non-HDL number tells us virtually all the bad cholesterol in our blood.

How to compute non-HDL

Most standard lipid (cholesterol) panels nowadays include your non-HDL number, but if your panel does not, it’s easy to figure out.

Here’s the formula:

Non-HDL cholesterol is: Total cholesterol minus HDL cholesterol. So if your total cholesterol is 190 and your HDL cholesterol is 40, your non-HDL cholesterol is 150.

Recommended non-HDL levels

How low should you go?  To some extent, it depends on your risk factors.  If you have minimal risk (no heart disease, no family history of it, no hypertension, no cigarette smoking, no diabetes, and the remainder of your lipid profile is in the normal range), chances are your non-HDL can be higher than those who have risk factors.

For healthy people…

Generally, for healthy people wanting to prevent the development of cardiovascular disease, a good goal for non-HDL is less than 100.

For people with heart disease…

For people who have advanced atherosclerosis (they have suffered a heart attack, they need heart surgery or angioplasty, they have diabetes, or testing has identified plaque formation), the goal for non-HDL is lower.

Evidence-based research, for example, a trial that followed 18,144 heart patients as well as another study that treated 202 heart patients, indicate that a non-HDL less than 80 is optimal for those with clear evidence of coronary artery disease.

For those at highest risk of a cardiovascular event, a non-HDL target of 70 might provide even more protection.

How to improve non-HDL numbers

For essentially everyone, any significant improvement in non-HDL likely means significant reductions in heart attack risks. Non-HDL levels improve, and rapidly so, among guests at the Pritikin Longevity Center.

Following 4,587 men at women at Pritikin, research found that non-HDL levels fell on average 24% within three weeks.

Some factors that tend to raise cholesterol in the blood are unalterable.  They include family history, age, and gender.

The good news is that many factors are in fact alterable.  Hearteningly, there is much we can do to lower our non-HDL and LDL cholesterol levels.

Recommended Values For Non-HDL Cholesterol:

Less than 100 if you’re healthy.

Less than 80 if you have coronary artery disease.

Key lifestyle actions to lower non-HDL and LDL cholesterol:

  • Eat far fewer saturated fats (such as butter, palm oil, coconut oil, meat fats, and milk fats); trans fats (any foods that have partially hydrogenated oils in their ingredient lists); and dietary cholesterol. Food high in dietary cholesterol include egg yolks and organ meats.
  • Eat far more fiber-rich foods (especially soluble fiber from beans, yams, oats, barley, and berries, or BYOBB).
  • Eat vegetable proteins (such as tofu and beans) in place of meat and poultry.
  • Eat fewer refined sugars (especially fructose) and refined grains (such as white flour).
  • Exercise regularly: 1) Aerobic exercise daily, a minimum of 30 minutes and optimally 60 to 90 minutes, alternating moderate-intensity days with vigorous-intensity days; 2) Full-body resistance routine two to three times weekly; and 3) Stretching exercises daily to greatly enhance your overall flexibility and ability to exercise more freely.
  • Lose excess weight, especially weight around the middle.*
  • If the above are insufficient, try plant sterols (such as CholestOff)
  • If necessary, talk to your doctor about medications.

* Excess body weight is defined as a BMI (Body Mass Index) greater than 25. More important is improving your body composition  (muscle-to-fat ratio) and reducing abdominal girth. Of particular concern are men who are more than 40″ around the waist and women who are more than 35.”  Belly fat and a poor body composition are key contributing factors for not only elevated cholesterol but also diabetes, hypertension, and other cardiovascular-related diseases.

How Long Does It Take To Lower Cholesterol?

You may be surprised how quickly you can improve your cholesterol results. How long will it take you to lower cholesterol?

HDL Cholesterol

Is HDL still thought of as the “good” cholesterol?

Yes and no.

We once thought HDL was always “good,” and the more HDL in the blood, the better.

Dysfunctional HDL

But we now know that HDLs can lose their ability to reduce inflammation and act as good “garbage trucks,” removing cholesterol from the artery wall.

Bottom Line: There is HDL that is functioning well and doing good things for our arteries, but there is also HDL that is dysfunctional.

How to repair HDL

The good news: Research is now finding that a healthy lifestyle can help repair HDL. Scientists at UCLA, for example, followed men attending the Pritikin Longevity Center and found that at entry, the men tended to have dysfunctional HDL. But after three weeks at Pritikin, blood tests showed that their HDL had converted from pro-inflammatory to anti-inflammatory. Dysfunctional HDL, in other words, had returned to well-functioning HDL.

Lowest heart disease rates in the world

Moreover, don’t be overly concerned if you’re following a heart-healthy lifestyle like Pritikin but your HDL is lower than traditionally recommended ranges (greater than 50 or 60). Over the last four decades, studies have consistently found that populations with some of the lowest heart disease rates in the world, such as the people of Okinawa, Japan, had very low levels of HDL, in the 20s and 30s.

Studying rural Chinese populations in the 1990s, Dr. Colin Campbell of Cornell University found that their death rates from heart disease were 94% lower than that of American men. Their HDL cholesterol was about 30. Yes, very low HDL, but very good heart health.

The diet of these rural Chinese? Like the Pritikin Eating Plan, it was rich in vegetables, fruits, and other whole, unprocessed plant foods – and had three times more fiber than a typical American diet.

Indeed, HDL levels tend to go down a little when people first start the Pritikin Program. But, as discussed earlier, the functionality of HDL appears to improve significantly.

Bottom Line: While high HDL cholesterol levels may often be desirable, low non-HDL levels are even more desirable.

Recommended Value For HDL Cholesterol:

Above 40, but lower levels do not appear problematic if you’re following a heart-healthy lifestyle like Pritikin and if your non-HDL level is healthy.

Key lifestyle actions to raise HDL (the well-functioning form of HDL):

  • Exercise regularly: 1) Aerobic exercise daily, a minimum of 30 minutes and optimally 60 to 90 minutes, alternating moderate-intensity days with vigorous-intensity days; 2) Full-body resistance routine two to three times weekly; and 3) Stretching exercises daily to greatly enhance your overall flexibility and ability to exercise more freely.
  • Lose excess weight.
  • Stop smoking.
  • Eat fewer trans fats (preferably none).
  • Drink alcohol in moderation. For women, no more than 4 drinks weekly (not more than 1/2 to 1 drink per day). For men, no more than 7 drinks weekly (not more than 1 to 2 drinks per day).

Unfortunately, no medication has been shown to significantly and safely raise HDL. Lifestyle improvements appear more effective.

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What are optimal levels?

Triglycerides are fats in the blood. Chronically elevated triglyceride levels (greater than 150) are associated with atherosclerosis (the build-up of plaque within the arteries) as well as a variety of other disorders, including pancreatitis. Recently, the American Heart Association recommended even lower levels: less than 100.

High levels of triglycerides can be considered an additional risk for cardiovascular disease, especially when part of a cluster of conditions now epidemic in the U.S. called the metabolic syndrome, which includes belly fat, high blood pressure, and high blood sugar.

Chylomicrons and strawberry milkshakes

Immediately after eating a fatty meal, most triglycerides are temporarily packaged in particles called chylomicrons. Blood drawn shortly after a fatty meal will appear creamy, like a strawberry milkshake. It takes hours for these fat-rich particles to be cleared from the bloodstream.

Silent but deadly

Research is now finding that high levels of chylomicrons nearly triple the risk of heart problems. Scientists refer to chylomicrons as “silent but deadly” because by the time we have a fasting blood test, their dirty work is done and they’re gone, and therefore undetected by the standard fasting blood lipid test.

Studies have found that fat- and cholesterol-rich meals can dramatically increase the production of chylomicrons and lead to greater amounts in the blood for several hours after each fat-rich meal.

Pritikin Eating Plan

The Pritikin Eating Plan, low in fat and high in unprocessed, whole foods, has been proven to dramatically lower triglyceride levels, which means it likely lowers chylomicron levels as well.

Recommended Value For Triglycerides:

Less than 150, ideally less than 100.

Key lifestyle actions to lower triglyceride levels:

  • Lose excess weight.
  • Eat less sugar and other highly refined and processed carbohydrates, like white breads. Focus on good carbs.
  • Eat more fish and omega-3 fats.
  • Drink very little alcohol.
  • Exercise regularly: 1) Aerobic exercise daily, a minimum of 30 minutes and optimally 60 to 90 minutes, alternating moderate-intensity days with vigorous-intensity days; 2) Full-body resistance routine two to three times weekly; and 3) Stretching exercises daily to greatly enhance your overall flexibility and ability to exercise more freely.

What about medications?

“Our emphasis at Pritikin on a healthy lifestyle does not imply that all individuals should stop medications to improve cholesterol and triglyceride numbers,” clarifies Dr. Danine Fruge, Medical Director at the Pritikin Longevity Center.

“We simply wish to say that we have a responsibility to ourselves to adjust and modify the things that we can. If lifestyle modification does not sufficiently improve lipid levels, medication is clearly appropriate and for some people essential. But it is far better to begin changing our lifestyles so that we can prevent plaque build-up.”

Moreover, a healthy Pritikin lifestyle gives us much more than what any pill can give us. With Pritikin living, we’re also losing weight, looking better, feeling better, becoming more physically fit, and lessening the risk of cancer, diabetes, high blood pressure, arthritis, impotence, cognitive decline like Alzheimer’s, and many other conditions.

“We encourage you to try the Pritikin Program,” recommends Dr. Fruge. “A Pritikin lifestyle helps not only our cholesterol numbers look good, it helps virtually all of us look good..”

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