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. And it’s this extra cholesterol that can cause a world of hurt in our arteries.

How does cholesterol cause a heart attack?

Cholesterol, particularly one type of cholesterol called LDL (bad) cholesterol, seeps 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 LDL cholesterol numbers lead to heart attacks.

The higher the LDL cholesterol, the more plaques tend to form, and the more inflamed the arterial skin becomes. Plaque build-up is also known as atherosclerosis.

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, triggering 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 your LDL cholesterol 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.

One type of cholesterol – HDL cholesterol – is often called the “good” cholesterol for cardiovascular health. Think of HDL as garbage trucks and LDL as trash. HDL tends to pick up LDL 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 LDL trash from the body.

But in recent years, scientists have been discovering that HDL may not be as “good” as everyone thought.  (We’ll talk more about this later.)

Your cholesterol numbers

A standard cholesterol panel measures four key values:

  • LDL (bad) cholesterol
  • Total cholesterol
  • HDL (good) cholesterol
  • Triglycerides

Total & LDL Cholesterol

LDL (Bad) Cholesterol

What are optimal levels?

To avoid a heart attack, numerous studies have found that lowering your LDL (bad) cholesterol is the single most important thing you can do.

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 LDL can be higher than those who have risk factors.

Generally, for individuals at minimal cardiovascular risk, a desirable LDL cholesterol level is less than 100.

In those who already have advanced atherosclerosis (they have suffered a heart attack, they need heart surgery or angioplasty, they have diabetes, or testing has identified plaque formation), LDL levels below 70 are advised.

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.  There is much we can do to lower our total and LDL (bad) cholesterol levels.

Recommended Value For LDL (Bad) Cholesterol:

Less than 100, ideally less than 70

Total Cholesterol

What are optimal levels?

Heart disease rarely occurs in people with total cholesterol levels below 150. The large Multiple Risk Factor Intervention Trial found that the men with the lowest death rates had a total cholesterol value of 122.

A total cholesterol of 122 sounds very low, particularly in a country like the U.S. where the norm is 206, but in nature, a total cholesterol of 122 is the rule. The total cholesterol of primates like chimpanzees ranges from 110 to 140, as does the total cholesterol of primitive hunter-gatherers living today – and neither primates nor hunter-gatherers have heart attacks. By every line of evidence, having a total cholesterol value below 130, or certainly below 150, is ideal for avoiding heart disease.

Recommended Value For Total Cholesterol:

Less than 150, ideally even lower.

Key lifestyle actions to lower LDL (bad) and TOTAL cholesterol:

  • Eat far fewer saturated fats (such as butter, palm oil, coconut oil, meat fats, and milk fats); trans fats (such as margarine, vegetable shortening, and partially hydrogenated oils); and dietary cholesterol.
  • 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).
  • Eat frequent smaller meals (grazing) rather than one or two big meals each day.
  • 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.*
  • Use 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, in terms of lowering your total and LDL cholesterol, is lowering your abdominal girth. Of particular concern are males who measure more than 40″ around the waist and females who measure more than 35″.  Belly fat is a key contributing factor 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 (Good) Cholesterol

What are optimal levels?

With HDL (good) cholesterol, the general rule is: the higher, the better. The National Heart, Lung, and Blood Institute recommends we aim for levels over 40; optimally, over 60.

However, if you don’t have much garbage (LDL bad cholesterol) to begin with, you may not need as many garbage trucks (HDL good cholesterol).  It’s important to point out that the populations with the lowest rates of heart disease in the world, such as the people living in Okinawa and other rural regions of Asia, have very low levels of HDL (good) cholesterol – often in the 20s and 30s. But their total and LDL (bad) cholesterol levels are very low, too.

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. The total cholesterol of these 6,000+ rural Chinese averaged between 135 and 140. Their HDL (good) 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 the functionality of HDL appears to improve significantly. Research has shown, for example, that a healthy Pritikin lifestyle may allow HDL particles to become better garbage trucks; they return more quickly to the artery wall and pick up more LDL bad cholesterol.

But keep in  mind there is growing controversy regarding HDL in the scientific community. Scientists are questioning if HDL is always “good.” They’re learning about dysfunctional forms of HDL that actually promote rather than prevent plaque build-up.

What’s heartening to know is that research has found that a Pritikin lifestyle can help “clean up” HDL, that is, convert it from being dysfunctional, or pro-inflammatory, to anti-inflammatory.

Bottom Line: While high HDL (good) cholesterol levels are often desirable, very low LDL (bad) cholesterol levels and total cholesterol levels are even more desirable.

Recommended Value For HDL (Good) Cholesterol:

Above 40, optimally above 60*

* Risk of low HDL was established for those following a typically American diet (a high-fat, calorie-dense diet). Lower levels of HDL do not appear as risky if you are following a Pritikin-style diet and if your LDL is less than 100.

Key lifestyle actions to raise HDL (good) cholesterol levels:

  • 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.

The most up-to-date optimal levels of fasting triglycerides, according to the American Heart Association, are less than 100.

High levels of triglycerides can be considered an additional risk for cardiovascular disease, especially when associated with excess abdominal girth, low HDL cholesterol, and a variety of other risk factors.

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.

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.

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.
  • 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 like statins?

Many people with high total and LDL (bad) cholesterol levels want to go straight to medications, which are generally effective. But by doing so, they will have missed the many other benefits – and they are priceless – of lifestyle changes like the Pritikin Program, such as losing weight, looking better, becoming more physically fit, and lessening the risk of not only heart disease but also cancer, diabetes, high blood pressure, arthritis, impotence, and gall bladder disease.

We encourage you to try the Pritikin Program first. It may improve your cholesterol profile enough so that you don’t need medications. Or, if you’re already on medications, Pritikin living might allow you to significantly reduce your dosages.

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