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The Good, the Bad, and the Cholesterol

It gets a bad rap, but cholesterol isn't always the villain. Your body actually needs cholesterol to survive and perform essential functions, such as building cells and making hormones. But, as is often the case, too much of a good thing can be bad for your health. Because high cholesterol is a major risk factor for heart disease and stroke, we’re breaking down the facts on cholesterol below.

Monitoring blood sugar levels

What is cholesterol, anyway?

Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods from animals, such as dairy products, eggs, and meat. But not all cholesterol is bad! Here are some terms your clinician might mention if you get a cholesterol test:

  • Total cholesterol: The total amount of different types of cholesterol in your blood
  • Low-density lipoprotein (LDL): This is the "bad" cholesterol. LDL transports cholesterol particles throughout your body. Think of your blood vessels like pipes. If you have too much LDL cholesterol in your blood, you can develop fatty deposits in the walls of your blood vessels. These blockages clog your arteries, making them hard and narrow and prevent blood from moving freely throughout your body. What’s more, cholesterol deposits can break off suddenly, forming a clot that causes a heart attack or stroke.
  • High-density lipoprotein (HDL): HDL, or "good" cholesterol, picks up excess cholesterol and takes it back to your liver.
  • Non-HDL cholesterol: Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol.
  • Triglycerides: While triglycerides are not cholesterol (they’re actually another type of fat), they often get measured when cholesterol is measured. Having high triglycerides also seems to increase the risk of heart attacks,  strokes, and pancreatitis.

It’s important to ask your clinician what your cholesterol numbers should be because it differs from patient to patient. In general, people who do not already have heart disease should aim to have:

  • Total cholesterol below 200
  • LDL cholesterol below 130 (or much lower if they are at risk of heart attacks or strokes)
  • HDL cholesterol above 60
  • Non-HDL cholesterol below 160 (or lower if they are at risk of heart attacks or strokes)
  • Triglycerides below 150

Keep in mind, though, that many people who cannot meet these goals still have a low risk of heart attacks and strokes.

What causes high cholesterol?

High cholesterol can be inherited, but more often than not, it’s the result of lifestyle choices. There are certain factors that put you at a greater risk of developing high cholesterol including:

  • Diet: Consuming a lot of saturated and trans fats can raise your LDL levels. While some high-saturated fat foods may already be on your radar (meats, dairy products, deep-fried foods), there are some sneaky sources too: chocolate, coffee creamer, and ice cream, to name a few. Foods high in trans fat include commercially baked cookies and crackers, microwave popcorn, and frozen pizza. Processed sugar can raise your triglyceride levels. If you're worried about your cholesterol, it's best to consume these foods in moderation. 
  • Weight: While weight is not always an indicator of overall health, having a body mass index of 30 or more puts you at risk of high cholesterol.
  • Activity levels: Exercise is a win-win for cholesterol: it boosts your good cholesterol levels (HDL) while reducing artery-clogging triglycerides and LDL. 
  • Smoking:  Lung cancer isn't the only smoking-related health risk. As it turns out, cigarettes can throw your cholesterol out of whack, too. Smoking damages the walls of your blood vessels, making them more likely to accumulate fatty deposits. Cigarettes may also lower your good cholesterol levels. 
  • Age: Your body goes through natural chemistry changes as it ages, putting you at higher risk for cholesterol buildup. For example, as your liver becomes less able to remove LDL cholesterol as you get older.
  • Diabetes: Not only can high blood sugar damage the lining of your arteries, but it can also lower your good cholesterol levels. What's more, high blood sugar contributes to higher levels of dangerous cholesterol called very-low-density lipoprotein (VLDL).

How do I know if I have high cholesterol?

High cholesterol doesn't have any symptoms, so you may not know if you have it. To get a handle on your cholesterol levels, your doctor will need to perform a simple blood test called a lipoprotein profile, or cholesterol panel. Most healthy adults should have their cholesterol checked every 4 to 6 years. If you have either a personal or family history of heart disease or diabetes, you will need to get your cholesterol checked more often.

Stop it before it starts.

When it comes to high cholesterol, the best treatment is prevention. Since high cholesterol is often the result of your lifestyle choices, there are ways you can help keep it in check by simply making healthy lifestyle choices.

  • Eat less “bad” fat. Try to lower the amount of saturated fat, trans fat, and cholesterol in your diet. Cutting back on carbohydrates and substituting meat with lower fat protein choice can help, too. 
  • Maintain a healthy weight. If you’re overweight, losing weight can help reduce bad cholesterol.
  • Get moving. Moderate exercise can lower cholesterol. Aim for 30 minutes five days of the week, if you can. 
  • Moderation is key. Alcohol can raise cholesterol levels, so it’s a good idea to drink only in moderation.
  • Manage stress. High levels of cortisol from chronic or long-term stress can cause high cholesterol, along with other heart disease risks.

How is high cholesterol treated?

If you already have high cholesterol, you may be able to lower it by changing your diet. While this method alone doesn’t work for everyone, you can still improve your overall health by eating better. In general, it’s a good idea to avoid or limit red meat, butter, fried foods, cheese, and other foods that have a lot of saturated fat. Other things that might help lower cholesterol include:

  • Try a vegetarian or vegan diet: A vegetarian diet contains no meat while a vegan diet contains no animal products at all, including meat, eggs, or milk
  • Nuts: Some studies show that eating certain nuts, such as walnuts, almonds, and pistachios, can help lower cholesterol and even the risk of heart attack or death.
  • Eat more soluble fiber: Found in fruits, oats, barley, beans and peas
  • Eggs: There are a lot of news stories about the health benefits or risks of eggs, but the truth is that eggs are a good source of protein and do not raise cholesterol much. Bottom line: Eggs are OK if you want to eat them, just don't overdo it.
  • Foods rich in omega-3 fatty acids: Foods rich in omega-3 fatty acids include flaxseed, oily fish, and olive and canola oil. These foods seem to raise good cholesterol and might lower certain types of bad cholesterol. More importantly, studies show that people who eat lots of these foods are less likely than those who eat less of them to have heart disease. If you want, it's fine to eat 1 to 2 servings of oily fish a week (such as salmon, herring, or tuna).

Research has also shown that some dietary supplements, like red yeast rice and omega-3 fatty acid supplements, might help lower cholesterol, but there is little evidence showing that supplements can help prevent heart attacks, strokes, or any of the problems caused by high cholesterol. Always talk to your clinician before starting any new supplements to ensure that they’ll be an effective treatment and that they won’t interact with your existing medications.

While cleaning up your diet and certain supplements can improve cholesterol levels, some people can’t manage their cholesterol through lifestyle changes alone. That’s when medications may be necessary. The most commonly prescribed medications for high cholesterol are commonly called  “statins”. These block your liver from producing more cholesterol. For people who cannot take statins, medications called cholesterol absorption inhibitors are another option.


Consult your Firefly team

Virtual primary care allows you to take back control of your health at your convenience, including managing your high cholesterol. Be sure to reach out to your care team with any questions through the Firefly app.

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