Interviewer: You go to your doctor, they say your cholesterol is too high. Why should you care and what does that mean for your health? And what can you do about it? That's next on The Scope.
Interviewer: All right, Dr. Tom Miller, you know every year you go get you physical. One of the numbers you're going to get back is your cholesterol numbers. There are two or three of those numbers, and my doctor my tells me, "Oh, your cholesterol doesn't look good." What's going on?
Dr. Miller: Well, we've known for many years that high cholesterol can generally imply poor outcomes in the long term. It's related to vascular disease over many, many years, and it's associated with other risk factors for vascular disease, such as high blood pressure.
Interviewer: And which all can lead to heart attack or stroke?
Dr. Miller: Exactly.
Interviewer: Yes. So that's why if you see those high numbers they're predictor score, that this person is more likely to have those outcomes.
Total Cholesterol: HDL & LDL
Dr. Miller: That's exactly right. So there's several things when people talk about cholesterol. Let me break those down real quick for you. First, is total cholesterol. And generally, if your cholesterol is over 200, that's too high, but you can break it down further from there. You break it down into triglycerides, you break it down into HDL, that's the good cholesterol, and then you break it down into LDL, the bad cholesterol. The way I kind of think about, Scott, is when you have a high HDL, that's the good stuff, it reminds me of a taxi that's ferrying sort of cholesterol and bad stuff away from the arteries and takes that back to the liver where it's chewed up and metabolized, and you don't have to worry about it anymore.
Interviewer: So you want lots of that HDL to help your body dispose off that stuff.
Dr. Miller: Yes, high HDL is better. High HDL is better.
Dr. Miller: And you know how you get high HDL? Exercise.
Interviewer: Oatmeal. No, exercise.
Dr. Miller: Well, not so much oatmeal but exercise and weight loss and stopping smoking actually raises HDL as well. So really, what you do when you do those three things is you increase the number of taxis that are delivering bad cholesterol away from the arteries into the liver where it's chewed up. LDL, you think about that as a taxi taking cholesterol down to the arteries and depositing it into the sides of the arteries into the lumen or the walls of the arteries. And so that's where it sits, and over long periods of time, you get these plaque build-ups, and if those plaques rupture, then you can have bad things like a heart attack or a stroke.
Interviewer: So is the total cholesterol a sum of your HDL/LDL in the triglycerides? Is that where that number comes from?
Dr. Miller: Yes, basically, there's a little equation of that, but not to trouble ourselves too much about it. But the higher the HDL, the higher the total cholesterol. The higher LDL, the higher the total cholesterol. So if you actually have a nice high HDL and a low LDL, that's okay if your total cholesterol is just a little elevated.
Dr. Miller: So total tells you kind of, is a sign post about you need to look at this more closely.
Interviewer: Okay. So you get that big number. Well, if the number is not big then you're probably fine. But if it's a big number then you need to look at how does that break down; the good versus the bad. If you got more good, fine.
Dr. Miller: Well, sometimes you can look at that ratio too. So you can look at that ratio total cholesterol and HDL. And there are calculators now that are put out by the American Heart Association in conjunction with the American College Cardiology that look at not only the total cholesterol and HDL, but they mix in your blood pressure and your other risk factors, whether you smoke, whether you have diabetes, and if you're on blood pressure medication. And it gives you score, and that score kind of tells you what your 10-year risk is.
Now, no calculator is perfect, Scott, but it's a pretty good indication of, "Wow, I'm doing really well. I'm eating right. I have low blood pressure and I don't have other risk factors," or, "Warning, I've got to do some other things to improve my health." Now, one of these things might be that you need to take a medication to lower your cholesterol while you're waiting for the lifestyle things to catch up.
How You Can Lower Your Cholesterol
Interviewer: Let's go back to the original question. Your doctor is concerned about your cholesterol numbers, so odds are at the point what he's going to say is you have high LDL, which is bad.
Dr. Miller: That could be one thing he says . . .
Interviewer: Exercise. I need you to exercise more. I need you to quit smoking.
Dr. Miller: Right, and you would say those things anyway, right?
Dr. Miller: I mean, generally, those are great ideas, but we stress them more if your cholesterol and blood pressure are elevated.
Interviewer: What else would you doctor tell you to do to try to get that under control then?
Dr. Miller: So you want to follow a low cholesterol based diet, and there are ways to do that. You can Google a step one cholesterol diet and it will tell you. And basically, it's common sense. Don't eat a lot of animal products because animal foods have cholesterol, plants don't, they don't have cholesterol. So you're not going to get cholesterol from plants, so the more vegetarian based your diet is, the more leafy green vegetables you eat, the chances are you will help lower your LDL cholesterol.
And so you want to stay away from high cholesterol meats, fatty meats. You want to trim fat off of any kind of meat that you are eating chicken or steak, and some common sense things. And most of us have heard these over and over on the news and on the media but we have to pay attention to it on the cholesterol side. But at some point it might be high enough, you actually need to be treated for it.
Interviewer: You could do all the right things and still . . .
Dr. Miller: Yes, there are some folks that have a genetic predisposition to have high LDL cholesterol and they are predisposed to really heart disease. And so we do get after them with drugs and we have good drugs now to treat high cholesterol.
Interviewer: And nothing you can do if you're genetically disposition, if you do all the other stuff right.
Dr. Miller: Yes. First step in this treatment basically, and this is true for high blood pressure as well, is to get after your lifestyle improvements. So getting your body mass index down between 18.5 and 25 and exercising on a daily basis. And I'm not talking about on Schwarzenegger type weight room stuff, I'm just talking about going out and getting to walk for 30 to 60 minutes a day.
Interviewer: Elevating that heart rate.
Dr. Miller: Yes, getting your heart rate up to a moderately elevated level. We're not talking about Olympian athlete type redlining heart rates, we're just talking about getting out and doing a brisk walk or a swim or cycling.
Interviewer: Do you find that patients when you give them this information that they tend to think, "Well, really how much is that going to make a difference?" Are they skeptical?
Dr. Miller: I don't think patients are skeptical. I think we all want to do the right thing. And I think the vast majority of us believe that exercise is healthy. It makes us feel better and losing weight makes us feel better. There's a body image piece there. It's just hard to do. We don't have a pill to help you lose weight effectively.
Interviewer: And for cholesterol. . .
Dr. Miller: And we don't have a pill to make you exercise. So it's a lot of coaching. It's like you can do this, go out and do it. So you build your patient's will power up by suggestion.
Interviewer: And doing that will noticeably decrease cholesterol numbers?
Dr. Miller: Yes, it will definitely help reduce cholesterol in the vast majority of people, but not always to a level that would be necessary.
Interviewer: Got you. But it does make a difference?
Dr. Miller: It does make a difference, and it a makes difference for reasons other than just lowering cholesterol and lowering blood pressure. So there's many different reasons to stay healthy with lifestyle interventions.
updated: March 10, 2023
originally published: May 27, 2017
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