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Spokane, Washington  Est. May 19, 1883
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House Call: Cholesterol, the rest of the story

Dr. Alisa Hideg

I recently saw my last blood tests, which included my cholesterol results with my levels for HDL, LDL and trigylcerides. Many people do not know what these numbers mean or the difference between HDL and LDL. Cholesterol is both good and bad.

The good

Cholesterol is an important component of the outer coating of each of our bodies’ cells. It is made mostly in your liver and used to make hormones like estrogen and testosterone, vitamin D – a fat soluble vitamin important to your immune system – and bile that aids with the digestion of fats.

You may have heard of “good cholesterol” and “bad cholesterol” when people refer to HDL (high density lipoprotein) and LDL (low density lipoprotein) cholesterol. HDL and LDL cholesterol are actually packets of cholesterol, fat and proteins. HDL has a lot of proteins and less fat and LDL has a lot of fat and few proteins. HDL is considered good because it removes excess cholesterol from your cells and carries it to your liver to be reused or turned into bile. LDL takes cholesterol to the cells in your body that need it, so it also serves an important function. Triglycerides in your blood are a kind of fat used for energy.

Your body is capable of making enough cholesterol to serve your needs even if you do not eat foods containing cholesterol. Unfortunately, many foods include a lot of fat and cholesterol.

The bad

The right amount of cholesterol is important, but when we have too much or too little, things go wrong.

Low cholesterol (also known as hypocholesterolemia) is rare, but should be taken seriously, especially if your cholesterol levels drop suddenly when you are not trying to lower them. Low cholesterol can be associated with cancer, depression and other health conditions.

A high level of cholesterol (hypercholesterolemia), especially the LDL, is more common. LDL cholesterol has a bad reputation because too much LDL cholesterol blocks arteries leading to heart attack, stroke, erectile dysfunction and other problems. There are not any symptoms of high cholesterol, so you will only know if you need to lower your cholesterol levels if you have your blood tested.

A total cholesterol score – adding your LDL, HDL, and triglyceride numbers together – of less than 200 is usually considered healthy. If your cholesterol is over 200, you will be advised to take measures described below to improve your score. Sometimes if you have other risk factors for a heart attack (diabetes, family history, smoking or high blood pressure) or your LDL is very high, your health care provider will recommend medication as well as lifestyle changes.

The rest of the story

Whether your total cholesterol is high or you only have high LDL, I recommend losing excess weight, lowering your blood pressure, eating a healthy diet with lots of fruits and vegetables and limiting high cholesterol foods (red meat, fried foods, dairy fats and processed foods), getting regular exercise and not smoking. Your health care provider may also prescribe a statin medication. This class of medications lowers cholesterol and reduces the risk of heart attack. Which is recommended depends on your age, overall health and whether you experience side effects.

If you are a man 35 or older or a woman 45 or older, talk with your health care provider about checking your cholesterol levels. When you get the results, be sure you understand what they mean, and if necessary, what you can do to reduce your risk of heart attack, stroke and other health problems.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.
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