Every once in a while, a friend thrusts their latest cholesterol lab results in front of me and asks a barrage of questions:

“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?”
“And why is the total so high if the individual numbers are good?”

This week we’re talking about what your cholesterol profile results mean, and how to make them better.

First, you should know how the total cholesterol is computed. Actually it’s pretty simple: just add the LDL plus HDL, and then add one-fifth of the triglycerides. That’s it.

So if your LDL = 100, HDL = 50, and triglycerides (TG) = 100, the total cholesterol will equal 100 (LDL) + 50 (HDL) + 100/5 (TG) = 100 + 50 + 20 = 170. Nice.

Here’s another example: If the LDL = 150, HDL = 50, and triglycerides = 500, the total cholesterol will equal 150 (LDL) + 50 (HDL) + 500/5 (TG) = 150 + 50 + 100 = 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 okay because high HDL levels lower your risk of coronary artery disease (heart attacks).

HDL Cholesterol + Triglycerides

When I check a cholesterol profile, my eyes always look to the HDL and triglycerides. These two numbers are highly affected by your intake of stripped carbs and ultraprocessed oils. The more white flour, sugar, corn syrup, corn starch, white rice, corn oil, soybean oil, cottonseed oil and “vegetable” oil you eat, the lower the HDL goes and the higher the triglycerides rise. Your want your triglycerides below 150; higher triglyceride levels increase your risk of a heart attack. The HDL goal depends on your gender; the goal for women is at least 55 (or higher) and the goal for men is at least 45. HDL levels below 55 (women) or 45 (men) are an independent risk factor for heart disease. So the higher the HDL, the better.

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. Something is driving that HDL down and spiking the triglycerides, whether it’s an out-of-control sweet tooth or a regular fast-food habit. Or maybe they have a daily 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 and ultraprocessed oils. The numbers don’t usually lie, although I do occasionally see a low HDL that appears to have, at least in part, a genetic component. But they can still usually raise it by eating more veggies, beans, olive oil, nuts, seeds. Etcetera.

What else makes the HDL drop? Trans fat. That’s where fast food really plays a role. Whenever I see an extremely low HDL, like in the 20’s, you can pretty much guarantee that it’s due to a daily lunch in the drive-thru at McBurger Ranchero. Or a couple of Glazin’ Donuts on the way to work every morning. There are no two ways about it; any combination of deep-fried, trans-fat patties, corn syrup, processed cheese food, sugar, and white flour is a prescription for a heart attack.

How can you get your HDL up and triglycerides down? Eat more intact, whole, colorful carbs and nutritious fats like fish, olive oil, nuts, and peanut butter. Eat more dark, green leafy vegetables, like boy choy, or Swiss chard, or dandelion greens, or collards, or red leaf lettuce, or even kale. Your choice, any green leaves you like. And remember that exercise raises your HDL, too, so start walking, and your numbers will get even better.

What if your HDL looks great, but the triglycerides are still high? Look to the amount of alcohol being consumed, especially beer. Alcohol in moderation happily raises your HDL, but beer, made from grain, is a 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. [A drink is defined as 1 oz of liquor or 5 oz of wine or 12 oz of beer.] And use ‘em or lose ‘em because you can’t save up.

LDL Cholesterol

I also look carefully at the LDL, which is a different matter entirely. LDL is linked to your intake of animal-based foods, including dairy, eggs, chicken, turkey, beef, pork, lamb. If your LDL is around 130 or less, and you have no risk factors whatsoever for coronary artery disease, you’re doing great. But the more risk factors you have, the lower your LDL should be.

Risk factors that increase the likelihood of heart attacks include smoking, diabetes, hypertension, obesity, having a family or personal history of heart attacks, and/or being a couch potato. Being sedentary (inactive) is an important and reversible risk factor for heart disease.

Even if your only risk factor is that your father is a heart attack survivor, your doc may choose to be more aggressive and decrease your LDL goal to 100. If you’re diabetic, the LDL goal will likely drop closer to 70. Why? Diabetes is such a significant risk factor that it raises the risk of heart attack to equal that of someone who has already had a previous heart attack. (Add this to your list of reasons to avoid diabetes at all costs.) Genetics can also be a factor in high LDL levels. For some people, it can be difficult to cut animal-based foods enough to lower LDL, which may be part of the reason that we use so much cholesterol-lowering medication to lower the risk of having a heart attack.

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

Summary

If you don’t like the way your cholesterol profile looks, you’ve got a plan now, and it has no surprises. Eat more fruits and vegetables, whole grains, beans. Cut down on treats, and skip the soda, doughnuts, fast food. Be judicious about your intake of animal-based foods; save up to eat grass-fed or pastured, and not every day. Go for a walk because exercise raises your HDL. And get someone to help you figure out how to quit smoking.

Then have your cholesterol rechecked in a couple of months, and smile. Because you’re figuring it out.