When It Comes to Cholesterol, Ignore the Fear

by Dr. Stephen Sinatra
Filed Under: Heart Health, Cholesterol
Last Reviewed 02/06/2014

It's been a week since those New Year's resolutions kicked in, and I hope you still feel enthusiastic about the changes you want to make. I also hope that one of your goals is to live a healthier lifestyle, whether through regular exercise, a more nutritious diet, or a new outlook that helps reduce stress.

I'd like to add another item to your list, if I may--and that's to tune out all of the fear-mongering about cholesterol.

Based on the amount of attention it receives from doctors and the media, you might think cholesterol is the biggest cardiovascular problem we face. After all, we're constantly told that reducing cholesterol is a must if we want to prevent a heart attack or stroke. However, statistics bear out a much different story: half of all people who die of heart attacks have healthy cholesterol levels.

The idea that cholesterol will kill you is one of the most misrepresented "problems" in medicine, and the relative risk of not reducing cholesterol has been grossly oversimplified. For example, we're told, "LDL is bad." In fact, LDL is dangerous only when you also have one or more of the following:

  • Too much of the wrong subtype of LDL (high levels of Lp(a) are especially problematic).
  • Low levels of HDL.
  • A family history of cardiovascular problems.
  • Abnormally high inflammatory markers (homocysteine, fibrinogen, or C-reactive protein). 
  • Other heart risk factors, such as insulin resistance or high blood pressure.

Meanwhile, no one ever talks about the ways in which cholesterol is essential for good health. Every day, your body uses cholesterol to make adrenal and sex hormones, bile acids, and nutrients such as vitamin D. Cholesterol is also needed to construct cell membranes, heal wounds, and make repairs to the endothelial lining inside artery walls. And if that weren't enough, it's absolutely essential for clear thinking--large amounts of cholesterol are used by the brain to facilitate cell communication and memory.

What's more, cholesterol levels fluctuate a great deal. You can have different cholesterol levels at different times of the day. Cholesterol tends to rise in the winter and fall in the summer. And because it is a healing agent, cholesterol will soar after any kind of injury or surgery.

Years of research show that there is a "sweet zone" for cholesterol, and that problems occur when you go too far above it or below it. I believe this is part of the body's innate intelligence. It makes the amount of cholesterol it needs--and if that level is higher than it should be, it makes sense to determine why. When the cause is successfully treated, cholesterol often comes down.

The bottom line is this: If your doctor says you need to reduce your cholesterol, it's wise to thoroughly assess all of your risk factors. But don't jump to the conclusion that you're in serious trouble just because you're outside of the normal range.

Still, I'm sure there are some of you who are wondering what range I consider to be "normal." Ideally, I like to see total cholesterol between 150 and 200 mg/dL; LDL between 90 and 130 mg/dL; and HDL between 40 and 120 mg/dL (for women), or 35 and 120 mg/dL (for men). But more important than these specific ranges is the ratio between your LDL and HDL. Aim for no greater than a 5:1 ratio (LDL:HDL). Ratios higher than 5:1 have been associated with increased risk of heart attack.

For more information on reducing cholesterol, visit www.drsinatra.com.

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