My Cholesterol Is What?

A recent trip to the doctor raised some super confusing questions about cholesterol. So I talked to an expert.

If you’ve been keeping up with the Saga That Is My Health, you know I finally went to the doctor earlier this month. Two updates: 1) She was absolutely fantastic—exactly what I would have expected, given how kind and helpful her receptionist was, and 2) she told me I have high cholesterol, which was a surprise. Well, it’s not high exactly, but … er, let me explain.

I went for my annual physical and had blood work done, which is pretty much standard-operating procedure for these things. The doctor told me she would be checking my cholesterol and vitamin D levels. As I’ve never had bad results come back before, I figured all was well.

A few days later, I received the following email from my doctor:

Hi Emily,

Your test results came back fine.  Your total cholesterol was 224; a little over the target of 200, but your breakdown was ok: your good cholesterol (HDL) was 78 (over 60 is great) and your bad cholesterol (LDL) was 119 (under 130 is good).  Your vitamin D level was normal. Please continue to be mindful of your diet choices to keep the cholesterol low. Have a nice week!

Huh. Strange. If both my good and bad cholesterol were better than on target, why was my total cholesterol 24 points higher than what’s recommended? To quell the alarm bells that immediately started going off—high cholesterol, of course, increases heart-attack risk—I decided to find out what was really going on.

So I put my sources to good use (hey, there have got to be some perks to being a health editor), and wound up chatting with Irving Herling, the director of clinical cardiology at Main Line Health’s Lankenau Medical Center. Turns out, the 200 target is more of a general guideline than a hard-and-fast rule. “When a physician is looking at blood lipids, he’s most concerned about the components—the HDL, LDL and triglycerides,” he said. In other words, the parts are greater (or at least, more telling) than the sum. The reason is simple: A person could have very low good cholesterol and wind up with a total score of under 200. While the total looks good on paper, having low good cholesterol is actually a risk factor for heart disease, which, obviously, isn’t a good thing.

In my case, the numbers turned out to be artificially high. Since cholesterol is calculated by adding the HDL, LDL and 1/5 of the triglycerides, we can work backwards—or have the internet work backwards for us—to determine my triglyceride level: an exceedingly normal 135. So while my total score of 224 looks slightly alarming on paper, it’s less so when you get into the weeds.

Herling said family history and environment play a big role in determining “normal” for a patient, another reason why a hard-and-fast 200 point cut-off doesn’t always make sense. “If you are a smoker, diabetic, have heart disease or a strong family history of heart disease, we might want to see your bad cholesterol under 100, or even under 70,” he said. That’s why it’s important to be up front and thorough with your doctor about your health habits and history. Numbers don’t always tell the whole story; you have to fill in the blanks.

Diet’s a good place to start. Foods that can raise cholesterol include ones that are high in saturated fats, like red meat, cheese, dairy products and eggs. Cholesterol-lowering foods are oatmeal, fish and vegetables.

I told Herling what I told my doctor: That my diet’s typically in pretty good shape. Of course I splurge every now and then, but I mainly eat my three squares a day, with lots of veggies, fruit and lean meats to fill me up. And my family is largely heart-trouble free.

“Bottom line, doc,” I said. “Whaddya think?”

“I would tell you that you probably are going to live a long time,” he said. “Normally, elevated good cholesterol confers protection from heart disease.”

“So I’m in good shape?” I asked.

“Yes,” he chuckled. “You’re just fine.”


  • Ali Shapiro

    Hey Emily,

    220 used to be the normal range for high cholesterol until pharmaceutical companies lobbied to have it lowered (for obvious reasons: sell more drugs!).

    I think it’s important for you and readers to realize your chances of heart trouble are much higher with high insulin levels versus high cholesterol levels. People with high insulin levels are 6x more likely to have a heart attack versus high cholesterol only 2x as likely.

    And, I politely disagree that eggs cause high cholesterol. I’ve had more clients go back on eggs and have had the bad kind of cholesterol reduced. Pasture-raised eggs are important as they have Omega 3s, really important in cooling inflammation…the root of most high cholesterol.

    And that study that just came out about eggs being worst than smoking (I know what you are thinking) was extremely poorly executed. They didn’t control for the major factors (exercise, waistline, etc) that would influence health!

  • Erin

    Consider going vegan for real lasting impact on your cholesterol levels. I particularly like Happy Herbivore’s blog for help with that (especially her Herbie of the Week stories!)

  • Ed Terry

    Ali Shapiro is almost right. Back in 1980, the rule-of-thumb for a normal healthy total serum cholesterol was 200 + your age. In 1952, Ancel Keys, one of the scientists who strongly pushed the idea that saturated fat increases serum cholesterol, published a paper in which he states that humans have an extraordinary capacity to regulate serum cholesterol regardless of dietary consumption. He stated that in order to appreciably raise serum cholesterol, one would have to eat 10,000 to 15,000 mg of cholesterol daily, which is equivalent to 50 to 75 eggs (or 350 to 525 eggs per week). The really interesting thing about his paper is after going on and on about the lack of effect of dietary cholesterol on serum cholesterol, he recommends that one should limit egg consumption to no more than 7 per week.

    Years ago, eating a vegetarian diet rich in polyunsaturated fats and almost no saturated fats, my total cholesterol was 221 and my HDL 30. I now eat 3 dozen eggs a week with bacon and cheese and coconut oil, and I cannot get my total serum cholesterol above 180 and my HDL stays around 60.

    The famous Framingham heart study showed that for women, the higher their serum cholesterol, the longer they lived.

    The World Health Organization’s morality study that included data from 164 countries, showed that the lowest overall mortality was associated with a total serum cholesterol level between 200 and 240. As total cholesterol dropped to 150, death from heart disease doubled and death from any cause quadrupled.