Are you worried because your cholesterol is over 200mg/dL? Hearing high cholesterol fills people with fear. In my practice, most of my clients who’ve been told they have elevated cholesterol levels assume they’re at a higher risk for heart disease and are scared. They often don’t know their actual numbers, as their doctors have not shown them their lipid panels. They are given statins–not told of side effects such as muscle pain/weakness, fatigue, flushing, increase in blood glucose levels–and sent packing with advice to avoid saturated fat, eggs, and butter (groan). ALWAYS ask for your test results. You are your best health advocate, and your doctor’s advice may not always be right for you.
If you’ve had your lipids checked and your doctor recommends a cholesterol-lowering drug, such as a statin, it’s typically because your total cholesterol is over 200, or your LDL (known as the “bad” cholesterol) is over 140mg/dL. And we’ve been told that these higher levels increase your risk for heart disease.
But what if I told you not to worry if your total cholesterol was over 200? And that your doctor’s stance on cholesterol levels is likely outdated and maybe even wrong? That statins and other cholesterol-lowering drugs have serious side effects and may not prevent heart disease? Finally, what if I told you higher total cholesterol levels are associated with better health and a longer life span and that saturated fat isn’t the enemy here?
Cholesterol isn’t bad and it’s not to be feared. It’s a waxy substance in your bloodstream and cells and is used to make cell membranes, hormones, vitamin D, and the bile acids that help you to digest fat. Cholesterol is also vital for neurological function. Cholesterol in the blood does not mean it will be deposited in your arteries and clog them.
Standard recs from the American Heart Association tell you your total cholesterol shouldn’t be over 200 for disease prevention, but what they don’t tell you is that your total cholesterol is fairly meaningless for predicting disease risk (unless it’s very high, over 300 mg/dL).
Guidelines on cholesterol are beginning to change, and we now know that high cholesterol over 200 (Again, over 300 may indicate inherited hypercholesterolemia or excessive inflammation) isn’t an accurate predictor of heart disease. Elevated cholesterol is a symptom, and preventing heart disease isn’t as simple as forcably lowering cholesterol levels.
High Cholesterol: Should You Worry?
Dr. Stephen Sinatra, a cardiologist who’s been practicing for over 30 years, concurs. Only half of all patients hospitalized for heart disease have high cholesterol, meaning the other half do not. He concluded that cholesterol didn’t cause heart disease: “I was doing angiograms on people with (cholesterol levels of) 150, who had far advanced heart disease,” he recalled. “And the converse, I was doing angiograms on somebody with cholesterol of 280 and they had no heart disease.” (source)
In one well-designed study (the Minnesota Coronary Experiment), participants who ate a “heart healthy diet” low in saturated fat and higher in unsaturated fats (primarily from corn oil and vegetable oils) had an increased mortality rate over those who ate more saturated fat. More concerning, those who had the greater reduction in serum cholesterol had a higher rate of death. A 30mg/dL decrease in serum cholesterol was associated with a 22 percent increase in the risk of death from any cause, even after adjusting for baseline cholesterol, age, sex, adherence to the diet, body mass and blood pressure.
To get a true assessment of disease risk, look beyond your total cholesterol number. Look at your fasting blood glucose levels, insulin, HDL, LDL, and triglyceride levels. HDL is considered the “good” cholesterol, as it has cardio-protective benefits. I like to see this number over 60mg/dL. 80 would be excellent.
LDL is considered the “bad” cholesterol, though it’s not all bad: it’s used for repair and to make vitamin D and steroid hormones. When it’s excessively high, however, (say over 150mg/dL) it’s a warning sign for high inflammation in the body. How does that work? LDL is used for repair. Chronically high levels of inflammation create damage throughout the body, such as small lesions on arterial walls; the body sends LDL to heal those lesions. This is how it can build up and contribute to atherosclerosis.
That’s the real issue here: your cholesterol numbers give you information about levels of inflammation in the body. Statins forcably lower cholesterol levels without addressing the root of what’s causing higher cholesterol. So, don’t shoot the messenger! Cholesterol is doing its job: to repair nicks and other damage associated with inflammation. Taking a statin is basically like turning off the ‘check engine’ light when it comes on in your car rather than looking under the hood to determine the problem. The best approach is to figure out what is driving abnormal or unbalanced cholesterol numbers.
Causes of Higher Cholesterol Numbers (elevated total cholesterol over 250 and LDL over 150)
- congested liver and gall bladder: check bilirubin, AST, & ALT levels on blood work
- hypothyroidism: check for elevated TSH over 2.5 or low T3, T4
- too much sugar, alcohol, refined carbs, high glycemic foods in the diet
- inflammatory foods such as refined vegetable oils, conventionally raised red meat & dairy
- systemic inflammation
- carrying excess weight
- genetics, especially if levels very high, over 300. Though too often “genetics” can mean you inherited poor lifestyle habits.
Ideal Lipid Numbers for Optimal Health
Cholesterol isn’t the total picture for inflammation assessment. You need to look at your entire lipid panel, your blood glucose, insulin, and a few others for good measure (explained below). A standard lipid panel measures total cholesterol, HDL, LDL, triglycerides, and sometimes VLDL.
Many studies have indicated that the ratio of your trigs to HDL (Triglycerides/HDL) correlates strongly to heart disease risk factor. A ratio over 4 is a very strong predictor of cardiovascular disease; less than 2 is ideal. So, what should you look for?
- Total cholesterol is a combo of HDL, LDL, and VLDL. This total number doesn’t tell you much about your health. It’s the breakdown that matters. But optimal levels for women are between 180-250, and for men between 170-220.
- Keep LDL below 130. 100 or lower is ideal.
- HDL is an important risk factor for CVD if it’s too low, because it’s so cardio-protective. Aim for 70 or higher. Anything below 50 is cause for concern. (HINT: coconut oil will raise HDL! Try 1-2 tbsp daily).
- VLDL stands for very low density lipoprotein. Also considered a “bad” cholesterol, indicative of inflammation. The lower the better.
- Triglycerides are composed of fatty acids, and higher is worse in this case. You want your trigs around 60-80 ideally, under 100 is best. Too low (under 50) means you may not be getting enough carbohydrate. Too high means you’re getting too MUCH carb, sugar, and booze that’s being converted to circulating fat.
- Also check hsCRP levels which will give you an idea of the levels of inflammation in your body. It should be below 1.0.
How to Optimize Cholesterol & Triglyceride Levels
Notice I don’t say “lower” your cholesterol, because we’ve already established that your overall cholesterol number is pretty meaningless. You can easily optimize your lipid levels by raising cardio-protective HDL and lowering LDL and trigs by reducing your consumption of sugar and refined carbs like flour, bread, pasta, soda, alcohol, crackers, baked goods, and cereals. Too much sugar causes inflammation, and we know that sugar is a greater contributing factor to heart disease than fat, because excess sugar converts to fat, raising your trig levels and lowering HDL. So, reducing incoming sugar and foods that break down into sugars will help. Anything that isn’t a protein or a fat breaks down into glucose in the body.
The first and fastest way to reduce inflammation and improve your lipid panel is to ditch the soda (including diet soda!) and sugar snacks you’re eating (goodbye, afternoon M&Ms). Reduce or eliminate alcohol and cut out bread and pasta. This alone will help immensely. If you’re past that point already, take a look at how much other sugar (honey, naturally sweetened paleo treats, too much juice?) and carbohydrate (grains, starchy veggies) you’re consuming.
Incorporating an anti-inflammatory mediterranean-type diet with plenty of cold water fatty fish (like salmon and sardines), good fats, and organic meat and vegetables works really well here. Ditch the gluten and pasteurized dairy, both of which can be inflammatory, and add coconut oil therapeutically. A diet higher in good fat and lower in carb is key. Click here for my anti-inflammatory diet guidelines.
Fats matter immensely. Avoid inflammatory vegetable oils like corn and soy which are highly refined and processed (my guess as to why the vegetable oil eating group in the study I mentioned above had higher mortality rates). Stick to healing, beneficial fats like olive oil, coconut oil, and butter. I use coconut oil as my main cooking oil. Black seed oil may help also. Also note that some people do not do well with too much saturated fat. It depends on genetics and how much fat you personally can metabolize. But if you’re eating a diet that’s generally too high in fat for your body’s needs, you may also have higher cholesterol levels.
And add some exercise! Critical for optimal insulin levels.
What Tests to Request to Assess Levels of Inflammation
- CRP (C-reactive protein)
- insulin: insulin resistance and high insulin is a risk factor for CVD
- blood glucose: should must be under 92; 85 is ideal. Over 95 is a problem.
- assessing the particle size of your LDLs: you want more fluffy pattern A and fewer small, dense pattern B. This can be tested via an NMR lipoprofile test.
- Lipoprotein (a)
Bottom line: don’t worry so much about your total cholesterol number. Remember that cholesterol levels around 200 or even up to 250 are associated with longevity. Read between the lines: Cholesterol alone isn’t a determining factor for heart disease. Look at fasting glucose and insulin, your overall weight & fitness level, your HDL, LDL, LDL particle size, other inflammatory markers listed above, and trigs. Reduce refined carbs, eat lower on the glycemic index, and if you eat a higher carb diet in general, know that high carb diets negatively influence lipid levels and are pro-inflammatory. Inflammation is the precursor to heart disease, cancer, and most other diseases. How many carbs you need will depend on your physiology.
One final thought: address your stress level! Get enough sleep. I can’t say it enough. Stress = high cortisol = high blood sugar = high insulin = high trigs/low HDL.