HDL, LDL, WTF: Cholesterol?

Dealing with an abnormally high concentration of fats or lipids in the blood can be frightening and perplexing -- just what do those numbers mean and why do they matter? Well, let's start with the basics.
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No, this is not the new "must know" texting lingo; it's the response I get from many of my patients who struggle with hyperlipidemia. Dealing with an abnormally high concentration of fats or lipids in the blood can be frightening and perplexing -- just what do those numbers mean and why do they matter? Well, let's start with the basics.


Cholesterol is not the bad boy he has been painted to be. In fact, we need cholesterol to be present for many healthy bodily processes such as cell membranes, hormones, vitamin D, and bile acids that help you digest fat, so let's not toss this guy out so soon. If we strip him of this "leather jacket" and let him be the waxy mix of fat and protein we all knew he can be, cholesterol becomes less scary. When you go to your doctor, you'll get a lipoprotein test panel, which provides results for four different types of lipoproteins.

These four types of lipoproteins are low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and then a total of all cholesterol (chylomicrons, VLDL IDL, and Lp(a), are included too). Below is a description of these four main measurements:

Total cholesterol. The desired reading is less than 200mg/dL. This test is the measure all of the cholesterol in all the lipoprotein particles. That being said, while understanding the total number is important, it's kind of like reading a book cover only -- the real info is in on the pages inside.

Triglycerides. The desired reading is below 150 mg/dL. The role of these little guys is to package the fatty-acids in your body together and store them later for energy. If you were to take a look in your fat stores, you would see a ton of triglycerides -- they float around in your blood moving to where they are needed, so high triglyceride readings can point to something being wrong.

HDL (high-density lipoprotein). The ideal amount is 60 mg/dL and higher, which is the amount considered protective against heart disease. This is the "good cholesterol." HDL is considered good because it is like the roommate that's always gathering your dirty dishes with left over spaghetti sauce stains on them and returning them to the sink; HDL removes excess cholesterol and carries it to the liver for removal.

LDL (low-density lipoprotein). A reading below 100mg/dL is optimal for this "bad cholesterol." Now this guy is bad because he don't care where he puts his stuff -- when you lean over to say you are going to think about cleaning up today he's like, "You know me, I am clean," but all he does is leave his stuff everywhere, and in this case he's trying to get the fatty acids into the cells. LDL can get caught in the walls of the blood vessels, the subendothelial space, and are attacked by our immune system. This becomes the plaque that contributed to atherosclerosis. So the more LDL you have the higher the chances it may get caught in the subendothelial space and become something we don't want.

You're never going to get rid of all your LDL or its friends VLDL and IDL, but we can keep LDL from putting stuff everywhere by having a good ratio of HDL to LDL. The idea with the HDL and LDL ratio is that you need a balance: one cleans, one dirties.

Usually after I've explained this people look at me bewildered and ask, "Gina, that's good but, how do we get a better ratio?" My answer is annoyingly simple and very difficult at the same time: simply eat. Here are three foods you can start adding to your diet to help improve your HDL to LDL ratio today:

Fish. Most fish (shell fish included) have omega-3 fatty acids, an essential poly-unsaturated fat that your body can get only through diet. At this point, I feel like a nutritional mermaid, because I'm always saying, "Eat fish, eat fish, eat fish!" Yes, my favorite dish makes its way into this article as well. You may be saying, "But I take fish oil pills," -- well, the research is sketchy, at best. There are some studies that show there is a benefit of taking only the oil but not beyond doses that would be available in fresh or frozen fish three times a week. Plus, you're missing out on all of the zinc and protein by skipping the fish and going to the pill.

Pears. This is kind of a dessert food for me. I like to lightly grill them and add some ricotta, cinnamon and honey. Lurking beneath the surface is a significant amount of dietary fiber. Fiber will benefit your gut as well as your lipoprotein panels. I've written a bunch on fiber here if you're interested.

Sunflower seeds. I am not just saying this because they are literally my favorite snack. I enjoy them ranched with a diet Dr. Pepper -- hey, don't judge me! But seeds are rich in mono- and polyunsaturated fatty acids that aid in keeping blood vessels healthy.

The good news is that just by reading this article you are on the road to improving your health. Educating yourself about what you can do nutritionally, along with support from your doctor, will help to make some sense of this crazy alphabet called your lipoprotein panel.

Remember, Be Fearless, Be Full.

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