Hi everyone. This is Dr. Michael Smith. I am WebMD’s Chief Medical Editor and am really excited to be hosting today’s chat on cholesterol because it can be such a confusing topic. Good cholesterol. Bad cholesterol. Triglycerides. When is diet enough or when do you need meds? We’re going to tackle this and more today. We’ll get started in a few minutes, but you can submit questions now by clicking the “comment” link.
And as a reminder: WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD.
WebMD does not endorse any specific product, service or treatment. If you think you have a medical emergency, call your doctor or dial 911 immediately.
Dr. James Beckerman, our heart health expert, is joining us to answer your questions. Dr. Beckerman is a cardiologist at the Providence St. Vincent Heart Clinic in Portland, Oregon. He specializes in the treatment and prevention of coronary artery disease and congestive heart failure, and he has a particular interest in helping patients achieve their lifestyle goals. Dr. Beckerman will be joining us very shortly.
Good morning everyone! Happy to be with you all today - and looking forward to your questions!
Let's go ahead and get started ...
Dr. Beckerman, even though we often think of cholesterol as a bad thing, our bodies actually need cholesterol. Can you explain why our bodies need cholesterol and what happens if we have too much?
A lot of people are surprised to learn that our bodies actually produce cholesterol - that's one of the many jobs of our livers. Cholesterol is one of the main ingredients of our cell membranes - present everywhere throughout our body. So we need cholesterol to be healthy. But it can also get us into trouble...
So yes, we all need cholesterol. The problem is many of us have too much cholesterol in our blood and bodies.
...and we get into trouble when the cholesterol/lipid contents of our blood result in injury to the inner linings of our blood vessels and lead to the development of atherosclerosis - which can manifest as coronary artery disease (in our hearts) and cerebrovascular disease (in our brains!).
The primary problems with high cholesterol are heart disease and stroke. That's why it's so important to get it under control.
We often talk about “good” and “bad” cholesterol. How do you explain the difference to your patients?
Exactly - cholesterol can result in blockages which get us into trouble. Ah yes, the good, the bad, and the ugly...!
We call the good cholesterol "HDL" or "High Density Lipoprotein." Bad cholesterol is called "LDL" or "Low Density Lipoprotein." I think of the bad cholesterol as being responsible for plugging up our blood vessels, and the HDL cholesterol (the good one) is like a street sweeper that (tries) to help clean things up and lower our overall risk.
Great explanation! The fact that we have good and bad cholesterol is quite confusing and we've received several questions about that, so let's get a bit more into what we can do about the good and the bad.
So good cholesterol ... what happens if our HDL cholesterol is actually too low?
There have been lots of research studies that suggest that a low HDL is associated with a higher risk of developing heart disease, and that a high HDL is associated with a lower risk.
And many people want to know how to raise good cholesterol. That can be tough but there are a few things we can do. Dr. Beckerman, can you share a few ideas?
Sure! I agree that increasing HDL is a challenge. Some studies suggest that eating fish (or taking fish oil), drinking small but consistent amounts of alcohol, and exercising (pretty intensely) may result in some increase in HDL. And one confusing point about this is that we don't actually have great research that proves that increasing HDL actually lowers heart disease risk.
One of my favorite ways to control cholesterol -- both the good and the bad -- is exercise! Let's take some questions from our live audience.
That's a great question Viola because it's the LDL "bad" cholesterol that we really care the most about and the one that is most linked to heart disease and stroke.
Viola, great question. We actually do have good data that lowering LDL helps to reduce risk. And the fantastic news here is that diet and exercise are very, very effective. Some studies suggest that you can lower LDL by around 30% with a healthier diet and regular exercise - that's similar to some cholesterol medications!
There may not be any signs. In some less common situations, a person can actually develop little cholesterol deposits on their skin (called xanthelasma or xanthoma) but usually there are no signs or symptoms. The key thing? See your doctor regularly, and get checked! Your doctor will typically check your total cholesterol, LDL, HDL, and also your triglycerides.
Gertrude - great question. The American Heart Association currently recommends that all adults age 20 or older have a cholesterol check every five years. This is because we realize that your cholesterol today impacts your heart tomorrow...!
And it's important to remember that we see high cholesterol even in kids. One member emailed us about her 10 year old son and the challenges with diet. So no matter your age, you should talk to your doctor about your cholesterol or your kids' cholesterol. It's an increasing problem.
Even though we seem to focus on cholesterol levels that are too high (and we try to bring them down with lifestyle changes and medicines), you are right to be concerned about it being too low as well. There are studies that suggest that having a low level of LDL may be associated with an increased risk of some health problems. We don't understand it very well yet, but there seems to be some increased risk of cancer and possibly depression.
It's mostly about diet. Try to avoid foods high in saturated fats (like processed meats, cheeses), reduce refined sugars and foods loaded with carbs, and avoid any foods with trans fats (think fried foods, etc.). Eat more vegetables, fiber-rich foods, and fish!
There are also some studies that suggest that stress can increase your cholesterol too...
Speaking of vegetables, one member says "I'm a vegetarian. Can I get high cholesterol?
Great question. Yes. Remember that French fries are vegetables! Sort of :)
It's possible to eat too much oil/fat and too many refined sugars/carbs - even with a veggie diet.
And then there's genetics. But don't let that be an excuse for high cholesterol. Yes, your genes affect your cholesterol but you can do a lot to counter that with a healthy diet and exercise.
Agreed. I try to remind patients that genetics accounts for about 10-20% of your heart disease risk - lifestyle is the rest...
Flaxseed - great question. Some people call it a superfood - high in fiber and omega-3 fatty acids (the good ones!) and there is some research that suggests that flaxseeds may lower cholesterol - and even the severity of diabetes. Easy to incorporate into your diet - in baking, your morning yogurt, salads, etc.
Genes can definitely be frustrating sometimes! Even if you are doing everything right (diet, exercise, and medications sometimes) it can be hard to get to "goal." But keep in mind that everything that your husband is doing is still lowering his risk, even if his numbers don't hit the "ideal" range.
In my experience, people's cholesterol does go up with age. Whether that's a natural process or whether it may be associated with some changes in diet, exercise, and weight that often accompany age, I'm not sure. But it does speak to the fact that it's recommended to continue to be screened at regular intervals - along with blood pressure - as we grow older...