Several times a month or more, a friend thrusts their latest cholesterol results in front of me and asks for an explanation. “What do you think of these results?”  “Are they okay?” “My doctor said the HDL is too low.” “Why are my triglycerides so high?” “What should the LDL be?” “Why is the total cholesterol number high if all the individual numbers are good?” This week I’m talking about what your cholesterol results mean, and how to make them better.

First, let’s discuss how the total cholesterol is computed. Simple. Add the LDL to the HDL, and then add one-fifth of the triglycerides. That’s your answer. So if the LDL is 100, HDL is 50, and triglycerides (TG) are 100, the total cholesterol number will be the sum of 100 (LDL) + 50 (HDL) + 100/5 (TG) = 100 + 50 + 20 = 170. Very good. Here’s a second example: If the LDL is 150, HDL is 50, and triglycerides are 500, the total cholesterol will be the sum of 150 (LDL) + 50 (HDL) + 500/5 (TG) = 150 + 50 + 100, or 300. Not good. You want your total cholesterol below 200 or so, unless the HDL is high, in which case the total may be higher than 200, but that’s good. High HDL levels are beneficial; they lower your risk of coronary artery disease.

HDL & Triglycerides

In looking over a cholesterol profile, the first thing I consider is the HDL and triglycerides. These two numbers are highly affected by your intake of stripped carbs. The more white flour, sugar, corn syrup, corn starch and white rice you eat, the more your HDL drops and triglycerides rise. The triglycerides goal is below 150; higher results increase your risk of a heart attack. The HDL goal is above 55 for women and above 45 for men. The more HDL, the better; low HDL levels constitute an additional independent risk factor for heart disease.

If I see a cholesterol profile with an HDL of 30 and a triglyceride level of, say, 180, I know something very important about my friend. Either they have an uncontrolled sweet tooth or a fast food habit. Maybe it’s soda, with the equivalent of 12 teaspoons of sugar in each can. However you look at it, they’re eating way too much stripped carb. The numbers don’t usually lie, although I do occasionally see a low HDL that appears to have a genetic component.

What else makes HDL go down? Trans fat. That’s where fast food comes in. When I see an extremely low HDL, like in the 20s, I can pretty much guarantee that my friend spends lunch hours in the drive-thru at McBurger Ranchero. Or maybe they grab a couple of Glazin’ Donuts on their way to work every morning. No two ways about it; any combination of deep-fried, trans-fat patties, corn syrup, “processed cheese food,” and white flour is a prescription for a heart attack.

Substitute intact carbs and nutritious fats like fish, olive oil, nuts, and peanut butter for the stripped carbs and trans fat. Eat more dark, green leafy vegetables, like kale. You’ll see your HDL rise and your triglycerides drop. Start walking, and the numbers will get even better.

What if your HDL looks great, but the triglycerides are still high? Look for alcohol, especially beer. Alcohol (in moderation) happily raises your HDL, but beer, which is made from grain, is another type of stripped carb, and stripped carbs drive those triglycerides straight up. Everything in moderation: No more than one drink a day for women, two for men. And use ‘em or lose ‘em: you can’t save ‘em up for the weekend.

LDL

Next, I look at the LDL, a different matter entirely. LDL is linked to your intake of animal protein, including dairy, eggs, chicken, turkey, beef, lamb, and the like. If your LDL is around 130 or less, and you have no risk factors for coronary artery disease at all, you’re doing great. But the more risk factors you have, the lower your LDL goal should be.

Risk factors that increase your chance of a heart attack include cigarettes, diabetes, hypertension, obesity, family history of heart attack, prior heart attack, being a couch potato. If your only risk factor is that your father is a heart attack survivor, your doc may want to decrease your LDL goal to 100. If you’re diabetic, the LDL goal will likely drop closer to 70. Why? Diabetes raises your heart attack risk to equal that of someone who’s actually had a previous heart attack. (This is another good reason to avoid diabetes at all costs.) Genetics is sometimes a factor in high LDL levels. It can be difficult to make the dietary changes required to lower your LDL, which is why so many people take cholesterol-lowering medication.

How else to lower your LDL? Eat more intact carbohydrates. The fiber in vegetables, beans, fruit and whole grains acts as a scrubber, sweeping cholesterol through your intestines to prevent you from reabsorbing it into your bloodstream.

If you don’t like your cholesterol, you’ve got a plan now, and it has no surprises. Eat more fruits and vegetables, whole grains and beans. Skip the soda, doughnuts, and fast food. Be judicious about your intake of animal-based protein; save up to eat grass-fed or pastured, and not every day. Go for a walk (exercise raises your HDL). And, of course, don’t smoke. Then check your cholesterol again, and smile.