Cholesterol: The Good, the Bad and the Ugly

by Jason, Liu, MD, FACP, Lexington Internists Northeast

Despite what you've heard, cholesterol isn't all bad. The waxy, fat-like substance is secreted by your liver and is essential to your body's production of new cells. 

But having too much cholesterol in your bloodstream can lead to serious problems, including heart attack and stroke. So, what's the right amount of cholesterol? 

 You may have heard that the ideal cholesterol level is 200 or under, but it's more complicated. Two types of cholesterol play different roles in your body:

High-density lipoprotein (HDL) is "good" cholesterol. It helps remove excess cholesterol from the bloodstream and carries it back to the liver for elimination. Higher levels of HDL are beneficial because they reduce the risk of heart disease.

Low-density lipoprotein (LDL) is "bad" cholesterol. It can build up on the walls of arteries, leading to plaque formation, increasing blood pressure and raising the risk of heart disease and stroke. 

Triglycerides are another type of lipid (fat) found in the blood. High triglycerides often accompany High LDL and Low HDL. Triglycerides come primarily from excess calories, especially those from sugar, alcohol and refined carbohydrates. High triglyceride levels increase the risk of heart disease and pancreatitis. 

Ideal lipid levels (in mg/dL) are:

• Triglycerides: Less than 150
• HDL (Good): 60+ (higher is better)
• LDL (Bad): Less than 100 (lower is better)

High lipid levels are:

• Borderline high LDL: 130–159 
• High LDL: 160+ 
• Low HDL (risk factor for heart disease): Less than 40 in men, less than 50 in women

Since high triglycerides and high cholesterol often go hand in hand, managing both is crucial for heart health.

Food to Avoid

Certain foods can increase LDL ("bad" cholesterol) levels, contributing to plaque buildup in the arteries and increasing the risk of heart disease. Here are the main culprits to Avoid:

Trans Fats: These artificially created fats that significantly raise LDL and lower HDL, the worst combination for heart health. Examples are:

• Fried fast foods (French fries, fried chicken)
• Baked goods with hydrogenated oils (cookies, cakes, pastries, doughnuts)
• Margarine and some processed spreads

Processed and Refined Carbohydrates: Though not high in fat, refined carbohydrates contribute to obesity, insulin resistance, and increased triglycerides, which worsen LDL levels. Examples include:

• White bread, white rice, and pasta
• Sugary cereals
• Soda, candy, and processed snacks

Foods to Moderate

Not everyone is affected the same way. Many with genetic dispositions are sensitive to diet with the following food. In general, sticking with higher quality foods and limiting quantity

Saturated Fats: Found mainly in animal-based products and some plant oils, including:

• Fatty cuts of red meat (beef, pork, lamb)
• Full-fat dairy (butter, cheese, whole milk, cream)
• Lard and shortening
• Coconut oil and palm oil (despite being plant-based, they are high in saturated fat)

High-Cholesterol Foods: While dietary cholesterol doesn't affect everyone the same way, some individuals (especially those with genetic predispositions) are more sensitive to it. These foods include:

• Organ meats (liver, kidney)
• Shellfish (shrimp, lobster)
• Egg yolks (though eggs are generally healthy for most people)

Alcohol in excess: Moderate alcohol might increase HDL, but excessive drinking can raise LDL, triglycerides, and overall cardiovascular risk.

Foods to Enjoy

Certain foods can help increase HDL ("good" cholesterol), which plays a key role in removing excess LDL ("bad" cholesterol") from the bloodstream. Here are the best foods to boost HDL levels:

Healthy fats (monounsaturated and polyunsaturated fats) increase HDL while lowering LDL and include: 

• Olive oil (extra virgin is best)
• Avocados
• Nuts (almonds, walnuts, cashews, peanuts)
• Seeds (chia, flaxseeds, sunflower seeds)
• Fatty fish (salmon, tuna, mackerel, sardines

High-fiber foods: Soluble fiber binds to cholesterol and helps remove it, leading to higher HDL and lower LDL. High fiber foods include:  

• Oats and oatmeal
• Beans and lentils (black beans, chickpeas, kidney beans)
• Fruits (apples, pears, berries, citrus fruits)
• Vegetables (broccoli, carrots, Brussels sprouts)

Omega-3 fatty acids boost HDL while reducing inflammation and triglycerides. They can be found in: 

• Fatty fish (salmon, herring, trout, mackerel)
• Chia seeds & flaxseeds
• Walnuts

Dark chocolate and cocoa contain antioxidants (flavonoids) that can increase HDL levels.

Green tea is rich in catechins, which may slightly increase HDL and improve heart health.

Red wine, in moderation, contains resveratrol, which may raise HDL levels when consumed in small amounts (1 glass/day for women, 2 for men). Too much alcohol, however, can raise triglycerides and harm the liver.

While not a food, regular exercise (especially aerobic activities like walking, running, and cycling) is one of the best ways to increase HDL. Quitting smoking also significantly raises HDL levels.

It is important to have your cholesterol checked regularly. Healthy adults with no risk factors should have their cholesterol checked every 4-6 years, starting at age 20. Those with high cholesterol or risk factors should have their cholesterol checked every 1-2 years or as recommended by a doctor.

Risk factors include:

• Family history of high cholesterol or heart disease
• High blood pressure
• Smoking
• Diabetes or prediabetes
• Overweight/obesity

Sedentary lifestyle If your cholesterol level is high, your physician can help you develop a diet and exercise plan to lower your level. There are also medications that can help lower cholesterol.


Jason, Liu, MD, FACP, Lexington Internists Northeast
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