Understanding Cholesterol: What You Need To Know
- Dr. Nancy
- Feb 26
- 6 min read
Heart disease is the leading cause of death of women in the United States. Much focus has been placed on controlling cholesterol. Even so, there’s a lot of conflicting information about the role of cholesterol on well-being. It often has a bad reputation, but cholesterol is an essential part of cellular and hormonal health. Let's take a look at the different types of cholesterol and how you can obtain the best balance for your body.
What Is Cholesterol?
At the most basic level, cholesterol is a waxy lipid produced by your liver and found in your blood. There are two central types of cholesterol.
LDL or low-density lipoprotein
LDL cholesterol is the “bad cholesterol.” LDL cholesterol can build up on artery walls, leading to plaque formation, known as atherosclerosis. This, in turn, can lead to decreased blood flow to the heart muscle (a condition called coronary artery disease), decreased flow to the leg muscles (peripheral artery disease), or a heart attack or stroke due to abrupt closure of an artery in the heart or brain.
There are two types of LDL particles, but the standard blood test measures them together. The majority (80%) of circulating LDL is Type A. These are large particles that are increased by dietary fat consumption. Type A particles are reduced by eating a low-fat diet, taking statins or the supplements decribed below. The problem is that these particles do not drive the accumulation of plaque in the arteries.
The second type of LDL particle is Type B. These particles are small and dense, and are predictive of risk for heart attack. Unfortunately, neither statins nor a low-fat diet will impact Type B particles. Type B particles rise in response to processed and ultra-processed carbohydrates, especially sugar, which are essentially devoid of fiber. This is the connection between insulin resistance and heart disease.
HDL or high-density lipoprotein (HDL)
HDL cholesterol is sometimes referred to as “good” cholesterol. HDL cholesterol removes “bad” cholesterol from the blood by returning it to the liver. This reverse cholesterol transport can help to prevent buildup of plaque in the arteries and reduce the risk of heart disease and stroke.
An easy mnemonic for telling them apart is to think that you want the number on your HDL blood tests to be higher and the number for LDL to be lower. Having a bad balance of HDL and LDL cholesterol doesn’t typically carry any symptoms until damage is well under way, so it’s important to have regular tests to monitor your cholesterol levels.
You can use your standard bloodwork to look deeper and calculate your Triglyceride-to-HDL ratio to identify your risk for cardiovascular disease and insulin resistance without additional lab work. Determine your Triglyceride-to-HDL ratio by simply dividing your triglycerides by your HDL. This is not a standard metric used within the standard medical practice; however, it can provide you will valuable information so that you can reclaim power over your health and make changes to your diet and lifestyle to minimize your cardiometabolic disease risk.
Anything above a ratio of 3 is strongly suggestive of insulin resistance. This will be driving up your Type B particles and increase your risk of heart disease and stroke. You want a ratio of 1 or less.
Understanding Risk Factors For Cholesterol Problems
High LDL cholesterol can dramatically raise your odds of heart attack, stroke, and heart disease. Having high LDL cholesterol levels is often the result of several different factors including:
Smoking. It turns out cigarette smoke does more than damage your lungs. Studies show smoking can increase your odds of heart problems by up to 400%. Smoking both increases your LDL cholesterol and lowers your HDL. But smokers take heart. The risk of heart disease is cut in half just a year after quitting.
Obesity. Being obese (having a BMI over 30) can change the way your body metabolizes cholesterol, leading to high levels of LDL cholesterol. Having a lot of fat around your waist carries the greatest risk.
Genetics. Sometimes it’s hard to escape your genes, even if you do all the right things. The genetic cause of high LDL cholesterol is called familial hypercholesterolemia (FH). It’s important to note that only one in 250 people has FH. For most people with high LDL cholesterol, lifestyle is a big factor.
A sedentary lifestyle. Exercise can raise your levels of HDL cholesterol, which in turn lowers LDL. Studies show that for people of normal weight, a lot of time playing video games and other sedentary activities correlates with low HDL and high LDL cholesterol levels.
A diet high in processed foods. One study found that eating just two ounces of processed meats can raise your risk of heart disease by 42%.
How To Improve Your Cholesterol Levels
Improving your levels of HDL cholesterol lowers your cardiac risk. Here are some good steps to raise HDL cholesterol the natural way.
Quit smoking and reduce or eliminate alcohol. Some studies show moderate alcohol consumption (one drink a day for women and two for men) can increase HDL cholesterol levels, but drinking does carry other risks. If you’re not able to consume alcohol at a moderate level, it’s often best to eliminate drinking.
Exercise. The best activity is always the one you will keep doing, but research shows that high-intensity cardio and resistance training often have the best results for maintaining good cholesterol levels. If intense workouts aren’t your thing, no worries - moderate exercise also improves cholesterol ratios.
Lose weight. Losing just a few pounds can lead to a marked increase in your HDL cholesterol levels. Of course, weight loss is a complex issue for many people, so you want to make sure you approach it in a sustainable, healthy manner.
Look for healthy fats. When it comes to your cardiac health, fat isn’t necessarily a bad thing. One key is to look for fat that is high in omega-3 fatty acids, like salmon, sardines, chia seeds, and flax seeds. Food with monounsaturated fats, like avocados, nuts, and olive oil, also increases HDL cholesterol.
Increase your fiber intake. Soluble fiber binds to LDL cholesterol in the lower intestine, and then “flushes” it out. Good sources of soluble fiber include oats, psyllium, apples, and beans.
Supplement smartly. Several supplements have been proven to improve cholesterol levels, including:
Niacin supplementation can boost HDL cholesterol by as much as 30%. At prescription levels, it can pose a risk of side effects, so take niacin under a healthcare provider’s supervision. Dietary sources of niacin include poultry, peanuts, avocados, mushrooms, and grass-fed beef.
Citrus bergamot contains antioxidants that can raise HDL cholesterol levels.
Ginger can lower LDL cholesterol and boost HDL.
Red Yeast Rice works like a statin without the side effects.
Berberine improves insulin resistance, blood sugar regulation and gut health. It reduces cholesterol absorption from the gut.
Take a look at your medicine cabinet. Some medications have the unwanted side effect of raising LDL cholesterol, including beta blockers, birth control pills, retinoids, some steroids, and anticonvulsants.
Understanding cholesterol can be confusing. I can help you figure out a personalized plan for sustainable health. As with any health program, you should always consult your physician before making any radical changes, especially if you have been diagnosed with a disease or are on prescription medication.
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