What is LDL cholesterol?

Posted on August 11, 2008. Filed under: cholesterol, diet, nutrition | Tags: , , , , |

Recently a journalist asked me to explain the different forms of cholesterol. Sometimes explaining the cholesterol number is time consuming and health care professionals only mention the total cholesterol. I try to explain to my patients these numbers and goals.
The LDL ‘bad guy’ cholesterol is the most deadly form and a desirable number in less than 130 mg/dl and an ideal number is less than 100.
The HDL ‘good guy’ cholesterol is protective from heart attack and higher is better. Desirable for women is 50 or higher and for men is 40 or higher. A 60 mg/dl HDL number is ideal and protective. If the HDL number is more than half of the LDL number your probably are protected and in good shape.
Triglycerides, the other blood fat, should be lower than 150 mg/dl.
What is a good ratio?
An ideal LDL/HDL ratio for women is 100/55 or 1.8 while the ideal for men is 100/45 or 2.2. The lower the ratio the better.
How can I improve my cholesterol numbers?Smoking increases risk of heart attack and lowers HDL. Exercise increases the HDL.
To decrease LDL, diet is the answer. Lose weight to desirable weight, mimimize animal fat intake (red meat, cheese, butter), increase fiber intake from whole grains, fruits, vegetables, oat cereals. Soy protein, two servings per day from soy milk, edamame, soy nuts, or tofu lower cholesterol. Psyllium fiber supplements are ways for busy people to get in their soluble fiber. I recommend oat cereal for breakfast, 4 psyllium capsules with lunch and four with dinner.
Why is high cholesterol so bad? High cholesterol levels increase risk for heart attack, stroke, heart failure and circulation problems. The same habits that raise the cholesterol also bring on diabetes prematurely.
Is it OK to eat eggs? Eggs are a concentrated from of cholesterol in the diet that I recommend avoiding altogether. Egg substitutes make good omeletes and go into recipes. Even if your LDL cholesterol is low, eating eggs increase your risk for heart attack and stroke.
In a nutshell, what are your recommendations?  The major things that affect LDL cholesterol are genes and diet. You can’t change your genes but most people can lower their LDL cholesterol by 30 to 70 points through diet, weight loss and exercise. Weight loss can lower the LDL by 20% (30 points) and raise the HDL by 10-25% (5-15 points). Exercise can raise the HDL by 25-50% (10-30 points). The diet to lower LDL cholesterol is low in animal fat (avoid the yellow death– eggs, butter, cheese), minmize intake of red meat, sausage, pork bacon, high fat dairy (full fat milk, ice cream) and excessive oil of any form (in salads, in cooking). Olive oil is very high in calories and should be used sparing. Be sure to get in three servings of whole grains, at least five servings of fruit or vegetables, and soluble fiber from oat products or psyllium fiber supplements.



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3 Responses to “What is LDL cholesterol?”

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Hi, Dr. Anderson,

I attended your compelling breakfast presentation in Toronto recently (Heart and Stroke Conference), and note the following two points, extracted from your larger presentation:

1/ by far the best way to improve one’s lipid status is with lifestyle behaviours;
2/ it’s almost impossible, at least using the methods of the from the MRFIT trial and the Women’s Health Initiative trial, to convince people to make significant behavioural changes.

However, I am far from nihilistic about that. This calls for a whole new approach, an outside-the-envelope attitude, and probably an expertise that will be hard to find but I’m sure exists and could be nurtured. It may be that the skills to effect the necessary changes are not “ours” – we know the medicine, but not much about population attitudinal interventions – so I see this as a next and completely different area of study.

I think that it will take a long time and a multi-faceted, pervasive approach. That won’t be easy. But I think it has to be done.

I found your article very interesting. My recent Cholesterol test by my Doctor showed 6.1 I don’t know the breakdown, but the Doc., said it was OK To get 6.1 I would have to devide 300 by 50. Surely this can’t be correct ?
Edinburgh Scotland.

Dear Stan, Your cholesterol value of 6.1 is high. The 6.1 mmol/l is equivalent to 236 mg/dl (multiply 6.1 x 38.7). The goal is less than 200 and the ideal is less than 170. From this total figure I can estimate that your bad cholesterol (LDL-cholesterol) is about 160 mg/dl with a goal of less than 130 and ideal of less than 100. People with heart disease should have LDL-cholesterol values of about 70 mg/dl. With the diet and supplements recommended ( soy protein, plant sterols and psyllium) you should be able to lower your values by one-third to near the 100 target. Good luck.

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