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Your Cholesterol Questions Answered

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Your Cholesterol Questions Answered

When it comes to cholesterol, there’s a lot to know — and making sense of cholesterol can be tricky. Is cholesterol “bad”? What do your cholesterol numbers mean when you get them checked at your doctor’s office? Are eggs off limits? And should you be taking medicine to lower your cholesterol? Let’s get these questions answered!

Is cholesterol “bad”?

Not necessarily. Cholesterol is a waxy, fat-like substance that is found in all the cells in your body. Your body needs cholesterol for certain things, such as making hormones, vitamin D, and substances that help you digest food. We make all the cholesterol that we need. If there’s too much cholesterol in the blood, however, that’s when it can become a problem. Too much cholesterol can lead to plaque buildup in the arteries (called atherosclerosis). If the arteries get narrowed or blocked by plaque, it’s called coronary artery disease, or CAD, for short. People with diabetes have a higher risk of CAD than people without diabetes.

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What are HDL and LDL cholesterol?

When your health care provider checks your cholesterol, he or she may order what’s called a lipid profile. Included in the lipid profile are HDL and LDL cholesterol. HDL (high-density lipoprotein) is the “good” cholesterol because it carries cholesterol back to the liver. The liver then flushes it from the body, helping to lower your risk of heart disease and stroke. LDL (low-density lipoprotein) is the “bad” cholesterol because it raises the risk of heart disease and stroke. There’s another lipoprotein that might be measured: VLDL, or very-low density lipoprotein. This lipoprotein carries triglycerides, a kind of fat, in the blood. High triglycerides can also raise the risk of heart disease and stroke. Triglycerides are also typically included in a lipid panel.

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dl). Cholesterol goals can be different, based on age and other health conditions, so you should always check with your provider about your own goals. Here are general goals for people with diabetes:

  • Total cholesterol: Less than 200 mg/dl
  • Non-HDL: Less than 130 mg/dl (non-HDL is total cholesterol minus HDL cholesterol)
  • HDL: Greater than 40 mg/dl for men and 50 mg/dl for women
  • LDL: Less than 100 mg/dl or less than 70 mg/dl if at high risk of heart disease
  • Triglycerides: Less than 150 mg/dl

What raises my risk for having high LDL cholesterol?

There are certain factors that can make it more likely to have high cholesterol, including:

  • Family history
  • Age: High LDL cholesterol is more common as you get older
  • Race: African American and Mexican men have a higher incidence of high cholesterol
  • Overweight or obesity
  • Unhealthy diet: high saturated/trans fats, low fiber
  • Lack of physical activity
  • Smoking: Smokers tend to have higher LDL and lower HDL cholesterol
  • Drinking too much alcohol

It’s important to know your risk factors. While you can’t change your family history, age, or race, you CAN make changes to your diet, weight, and level of physical activity, and you can take steps to stop smoking and drink less alcohol.

Can I eat foods that are high in cholesterol, such as eggs and shrimp?

The short answer is yes! All foods that come from animals contain cholesterol (animals have livers, too!). But when it comes to your blood cholesterol levels, it’s really the type of fat that you eat that affects your cholesterol. Saturated fat, which is solid at room temperature, is the main driver of high cholesterol levels. Foods high in saturated fat include butter, lard, cheese, and red meat. Trans fat, another unhealthy fat, can also raise blood cholesterol. Cholesterol in food has little to no effect on your blood cholesterol levels.

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Can any foods help to lower your cholesterol?

Again, the answer is yes! If your cholesterol is high, don’t get discouraged. Focus on eating foods that can help you lower your cholesterol. Soluble fiber, a type of fiber that binds to cholesterol in the digestive tract; unsaturated fats, which lower LDL cholesterol; and plant sterols and stanols, which prevent the body from absorbing cholesterol, are foods to include in your eating plan. Foods high in soluble fiber include:

  • Oats and oatmeal
  • Barley
  • Beans
  • Apples
  • Citrus fruits
  • Carrots
  • Eggplant
  • Brussels sprouts
  • Psyllium, found in some cereals and fiber supplements

Foods rich in unsaturated fats include:

  • Avocado
  • Olives and olive oil
  • Peanuts and peanut oil
  • Nuts and nut butters
  • Seeds
  • Fatty fish (salmon, tuna, mackerel, sardines)

Foods that contain plant sterols and stanols include:

  • Vegetables
  • Fruits
  • Whole grains
  • Beans
  • Vegetable oils
  • Foods that may have added plant sterols/stanols: margarine, cheese, bread (read the label)

My HDL cholesterol is low — what can I do to raise it?

If your HDL cholesterol is below 50 if you’re a woman or below 40 if you’re a man, there are some lifestyle changes that may help give it a boost. These include:

  • Being more physically active
  • Losing 5% to 10% of your weight if you are overweight
  • Stopping smoking
  • Drinking alcohol in moderation (no more than one drink daily for women, no more than two drinks daily for men)
  • Cutting back on refined carbohydrates (e.g., white bread and pasta, sugars, and sugary foods and drinks)

There isn’t enough evidence to recommend taking medication to raise HDL cholesterol. And keep in mind that having a high HDL cholesterol doesn’t “override” having a high LDL cholesterol — you still need to focus on getting your LDL to a safe level.

Should I be taking medication to lower my cholesterol?

Some people can achieve healthy cholesterol levels by making lifestyle changes. But some people may also need to take medication to manage their cholesterol levels. These include:

  • People with a genetic condition called familial hypercholesterolemia which, left untreated, can greatly raise the risk for heart disease, heart attack, and stroke at a young age.
  • People who have heart disease or who are at high risk for heart disease.
  • People who have diabetes, who tend to have low levels of HDL (good) cholesterol and high triglyceride levels, and have an increased risk of heart disease.

Talk with your provider about your risk factors and if you should start on a medication to lower your cholesterol. Remember that cholesterol-lowering medication is not a substitute for making healthy lifestyle changes.

My doctor wants me to take a statin, but I’m worried about the side effects. Are statins safe to take?

All medications have side effects — some more so than others. Whenever your provider recommends that you start taking any type of medication, be sure to talk about the pros and cons to make sure that it’s right for you. Statins are potent, effective medicines that help to lower LDL cholesterol and protect against heart attacks and strokes. The American College of Cardiology states that “statins are very well tolerated and about 85-90% of patients report no side effects.” The most worrisome side effects include muscle pain and damage, liver damage, memory loss or confusion, and an increased risk of type 2 diabetes. Keep in mind, though, that not everyone who takes a statin will have side effects. You may be at risk for side effects if you:

  • Take multiple medicines to lower cholesterol
  • Are female
  • Have a small body frame
  • Are 80 years of age or older
  • Have kidney or liver disease
  • Have hypothyroidism or neuromuscular disorders such as ALS
  • Take other medications, such as cyclosporine, gemfibrozil, antifungal azoles, or protease inhibitors

Most people can safely take a statin with few, if any, side effects. If you’re concerned about taking a statin, talk with your provider and decide, together, if this is the best medicine for you. And if not, there are other types of cholesterol-lowering medicines that can be prescribed.

Can I take a supplement to lower my cholesterol?

There are some dietary supplements that may help you lower your cholesterol. But before you rush to start taking a supplement, realize that, like medications, supplements can have side effects and may interact with medications that you’re taking. Don’t be fooled into thinking that because supplements are “natural” they are automatically safe to take.

Here are a few supplements that can help lower cholesterol and/or triglyceride levels:

  • Flaxseed
  • Psyllium
  • Fish oil
  • Green tea extract
  • Berberine
  • Niacin
  • Plant stanols and sterols

Fish oil, flaxseed, and green tea extract may interfere with blood thinning medication; niacin can cause itching and flushing at high doses; and psyllium, flaxseed, and berberine may cause gas, bloating, and diarrhea.

Another supplement that is often touted to lower cholesterol is red yeast rice. Red yeast rice products may not be safe — some may contain monacolin K, which is chemically identical to the active ingredient in lovastatin, a drug used to lower cholesterol. Other red yeast rice products might contain citrinin, which could cause kidney failure. Despite actions from the FDA, some red yeast rice products on the market in the U.S. may contain monacolin K, although it’s practically impossible to know which ones do or don’t. It’s best to avoid taking this supplement; definitely don’t use red yeast rice if you are pregnant or nursing, or if you are already taking a statin.

Want to learn more about maintaining healthy cholesterol levels? Read “Natural Ways to Lower Your Cholesterol,” “Statin Alternatives: Other Medications That Can Lower Cholesterol,” and “HDL: Nine Ways to Lower Your Cholesterol.” 

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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