Dear Vail doc: What you should know about cholesterol
VAIL CO, Colorado
The Good, the Bad and the Ugly. No, I am not talking about the Clint Eastwood’s famous spaghetti western. This week I really want to talk about the different types of cholesterol.
I was told my good cholesterol is too low. What does that mean, and what can I do about it?
Too Low in Avon
Dear Too low,
That is a great and timely question. With regards to cholesterol, there are several numbers you need to know. The least important number is your total cholesterol, although it is the one referred to most often. That total cholesterol can be broken down to your good cholesterol or your high density lipoprotein (HDL) and your bad or low density lipoprotein (LDL) as well as several other cholesterol subtypes. Those subtypes are important when your vascular risks are high and your LDL is elevated. Where does the ugly fit in? That would be your triglycerides. If you have ever collected fat drippings in a pan to make gravy and have seen the yellow fat that floats on top then you have seen triglycerides.
While each particle is important, the HDL is perhaps the least understood. It is the beneficial cholesterol and protects you from vascular disease. HDL is believed to help carry excess bad LDL cholesterol away from your blood vessels to your liver where it can be broken down. Levels of HDL should be over 40mg/dL. Lower levels increase your risk for vascular disease such as heart attack and stroke even if your LDL is not elevated. HDL levels above 60mg/dL are considered very beneficial and actually lower your risk for vascular disease.
If you need to raise your HDL, there are several things you can do. First and foremost are diet and exercise. Exercise, especially aerobic exercise, can raise your HDL. A diet moderate in fat is healthy. Generally that means keeping fats between 25 and 35 percent of your total daily calories. The choice of fats is very important too. Monounsaturated or polyunsaturated fats, such as those in olive oil, are much healthier than saturated and trans fats. Saturated fats are solid fats found in foods like butter, ice cream and fatty meats. Trans fats are created through a process called hydrogenation during food processing and are used by the food industry to help preserve food. With growing awareness and food labeling it is becoming easier to make healthy food choices.
If your body mass index or BMI is above 25, losing weight can help both raise your HDL and lower your LDL. Omega 3 fatty acids found in fresh fish or taken as a supplement can raise HDL as well. If you eat fish less than four times per week, it might be helpful to take an Omega 3 supplement. Niacin can also help raise your HDL. Both of these medications can also lower triglycerides. As with most things there are plusses and minuses – Omega 3s can leave you with a fishy taste or indigestion and for some people, may raise their LDL. Niacin often causes flushing and heart palpitations. Both are available over the counter, or in higher strengths as prescription medications. If you think they might be right for you to take, discuss it with your doctor.
Dr. Drew Werner is a medical staff leader at Valley View Hospital in Glenwood Springs, a family physician at TotalHealth Care and the Eagle County Health Officer. He lives in Eagle with his family. E-mail comments about this column to firstname.lastname@example.org.