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Since September is National Cholesterol Education Month, our concierge doctors want to review the often-confusing facts about this vital blood component.

What is cholesterol?

Cholesterol is a type of waxy, fat-like substance found in every cell in your body. Made by your liver and also present in some foods, it allows your cells to function properly. It helps synthesize Vitamin D in the body as well as some necessary hormones. These include cortisol and cortisone, and the sex hormones estrogen, testosterone and progesterone, among others. It also helps create the bile you need for digestion.

Cholesterol gets transported through the body on proteins called “lipoproteins.” There are two types of lipoproteins: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The LDL type makes up most of the cholesterol in the body (between two-thirds to three-quarters). The HDL type absorbs excess LDL cholesterol and returns it to the liver, where it gets flushed from the body.

Why is high cholesterol bad for you?

Despite the role cholesterol plays in keeping the body healthy, only a small amount is needed to maintain critical functions. When your body has too much of the LDL-type of cholesterol, it can build up on the walls of your blood vessels. This causes them to become narrow. This in turn begins to block the free flow of blood to and from your heart and other organs in the body. When blood flow to the heart is blocked, it can cause chest pain (angina), a heart attack or a stroke, among other cardiovascular problems. Therefore, too much LDL is “bad” for your body when it isn’t balanced by higher HDL levels.

The confusion surrounding “high” and “low” cholesterol no doubt arises from their names. If we say your cholesterol levels are too high, you might think, “But isn’t ‘high’ cholesterol the good kind?” High-density lipoproteins (HDL) are good, and the higher that number, the better. But when we say you have “high” cholesterol, we’re talking about the “bad” type, meaning the low-density lipoproteins.

To confuse matters even more, triglycerides that are too high further contribute to fatty buildup in the arteries. Triglycerides are the most common type of fat in the body. High levels of triglycerides combine with high levels of LDLs to raise the risk of cardiovascular disease even further.

How to lower bad cholesterol

The optimal mix is low triglycerides, low LDL levels and high HDL levels in the blood.

According to the National Heart, Lung, and Blood Institute (NHLBI), the leading cause of high LDL cholesterol and triglycerides are unhealthy lifestyle choices. Certain medical conditions and medications, as well as genetics, also play a role.

There are a number of LDL lowering drugs available, including the very successful statins. But, as always, it is preferable to try to lower LDL levels naturally first. There are a number of ways to go about this:

• lose weight
• avoid trans fats (most commonly found in fried foods and pastries as well as margarine)
• avoid red meat and dairy products
• cut sugar consumption
• keep alcohol consumption no greater than one drink daily
• keep stress levels low

These steps, combined with increasing HDL levels in the blood, are often sufficient for many people to remain healthy.

How to raise good cholesterol

Medications to raise HDL cholesterol have not proved effective in lowering the risk of heart attacks and strokes. The best way to increase your supply is through lifestyle changes:

• quit smoking
• increase aerobic exercise to a total of at least one hour a week
• consume more monounsaturated fats, e.g., nuts, seeds, avocados
• increase intake of polyunsaturated fats, e.g., salmon, tuna, trout, and walnuts
• consume more soluble fiber, e.g., fruits, vegetables, whole grains, beans, and legumes

In addition, avoid drugs that contain testosterone or other anabolic steroids, which have been shown to lower HDL levels.

Because there are no symptoms of high cholesterol, the only way to know for sure if your levels are within acceptable levels is through a simple blood test. This is especially important if you have a family history of heart disease, are a smoker, are regularly exposed to cigarette smoke or have high blood pressure or diabetes. The National Institutes of Health recommends that all adults have their cholesterol levels checked beginning at age 20.

It’s not difficult to keep “bad” cholesterol levels in check, unless you have a genetic predisposition toward high LDLs. Let us help you sort out the confusion surrounding cholesterol and heart health.