It’s waxy. It’s a lot like fat. And it’s found in every cell of your body. Yes, we’re talking about cholesterol—a topic that probably doesn’t come up too often at the dinner table since it’s not exactly, uh, appetizing.
Like so many health terms, cholesterol is one of those important things you know you should care about but don’t necessarily understand. That’s why we’re here. We’ve rounded up the top four facts you need to know about cholesterol.
1. Your body needs cholesterol (but not too much).
“We all have cholesterol in our bodies,” says Kimberly Gomer, R.D., the director of nutrition for Pritikin Longevity Center and Spa. “It makes hormones, it carries out many cell functions, but it also builds up plaque in our arteries.”
Our bodies actually make all the cholesterol we need, but the food we eat can raise or lower the amount in our blood. Having too little cholesterol (a condition called hypocholesterolemia) is pretty rare—and usually caused by things like malnutrition, chronic anemia, liver disease, or genetic conditions.1 Docs mostly get concerned when you have too much cholesterol in your body (referred to as “high blood cholesterol” or hypercholesterolemia) because it means you have a greater chance of developing plaque buildup in your arteries, called atherosclerosis.
Plaque is a combination of cholesterol, fat, and calcium that can build up around the walls of your arteries and make it difficult for blood to circulate. Depending on where the buildup occurs, it can result in vascular diseases such as coronary heart disease, carotid artery disease, and peripheral artery disease.
If you think you’re too young or that this concerns only folks your parents’ age, think again. Even mildly high cholesterol levels over a long period of time can increase your risk of heart disease later in life. Translation: What seems like a slight issue right now could end up hurting you later.
“You don’t get plaque on your 41st birthday, and up until then everything was fine,” says Howard Weintraub, M.D., a cardiologist at NYU Langone Medical Center. But it also isn’t as easy as pointing the finger at high cholesterol. It’s usually a combination of things, including genetics, weight, diet, and—this is a big one—smoking, Weintraub says.
- Hypocholesterolemia. Moutzouri E, Elisaf M, Liberopoulos EN. Current vascular pharmacology, 2011, May.;9(2):1875-6212.
2. Not all cholesterol is bad.
Cholesterol gets around your body via tiny packages called lipoproteins, which are made up of fat (lipids) and proteins. (Genius name, right?) Your body makes two types: HDL (high-density lipoprotein) and LDL (low-density lipoprotein).
Keeping these two straight is one of the most confusing things about cholesterol. Try this—it’s an oversimplification, but might help you remember: When you hear HDL, think “healthy.” HDL is commonly referred to as the “good” cholesterol because it carries cholesterol to your liver, and then your liver removes cholesterol from your body.
LDL is sometimes referred to as the “bad” kind because it’s the main source of the cholesterol that builds up in your arteries. The higher your LDL number, the greater your risk of heart disease. “We tell patients to remember ‘L’ for lousy cholesterol,” Weintraub says.
Experts recommend getting your cholesterol checked at least once every five years. You ideally want your total cholesterol to be below 200 mg/dL. Go here for a more detailed breakdown of the numbers you want to aim for.
3. Genetics play a role in cholesterol.
Not to sound pessimistic, but you can’t completely control your risk for heart disease or high cholesterol by diet and lifestyle choices.
“[Heart disease] isn’t just due to one thing, so we have to consider the question of genetics,” Weintraub says. This is the part where you get to blame your parents. (Just kidding!) “Diet does play a role, but because of genetics, there are some who can eat birdseed and cardboard and still have high LDL,” he jokes.
Familial hypercholesterolemia (try saying that three times fast) is a genetic condition that causes someone to have high cholesterol often from a young age due to the body’s inability to remove LDL from the blood. There are two types, and one is relatively common. In fact, about 1.5 million people in the U.S. are estimated to have it.
But don’t feel defeated. “If you have familial hypercholesterolemia, diet and exercise are critical, but in many cases, [patients] might need medications,” Weintraub says. “And they should not feel disappointed by that. Fighting genetics is not usually a battle you’re going to win.”
4. But so do diet and lifestyle.
When it comes to high cholesterol, the most talked-about culprit is saturated fat. And the science behind their relationship is more controversial than ever.
If you listen to the USDA, you want less than 10 percent of your total daily caloric intake to come from saturated fats. That’s because a diet high in saturated fats can raise cholesterol levels, and, as we went over earlier, high cholesterol can lead to plaque buildup, ultimately putting you at a greater risk for heart disease.
There’s still plenty of debate around how much saturated fat should be part of a healthy diet and how much of a role it plays in overall health. But as a general guideline, “we want people to eat more fiber-rich foods and more plant-based proteins—beans, lentils, tofu—and to be careful with highly refined carbohydrates,” Gomer says.
You’ve also probably noticed cholesterol amounts on nutrition labels. Though we once thought dietary cholesterol could change your blood cholesterol, the science has changed. For most people, ingesting cholesterol in foods will have only a modest effect on their overall levels. So as long as you haven’t been told otherwise by your doc, you can officially go back to eating eggs (including the yolks!) a few times a week, guilt free.
But in Gomer’s opinion, there is a lifestyle change that can make a huge difference: “The No. 1 thing you can do to lower your cholesterol is quit smoking,” Gomer says. (If you’re looking to kick the habit, try here or here.)
Your Action Plan
We get that high cholesterol sounds a little scary. After all, there aren’t really any symptoms early on. But that’s one of the reasons it’s so important to take control of your health now: High cholesterol and heart disease don’t happen overnight.
“Certainly with millennials, high cholesterol is preventable in many cases,” Weintraub says.
If cholesterol runs high in your family, see your doctor and take the necessary steps to be healthier. That means eating a healthy diet in accordance with USDA Dietary Guidelines, getting regular exercise, and not smoking.