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Cholesterol FAQs: Part 1

Cholesterol FAQs: Part 1

There's a lot of confusion around cholesterol.  So over the next few blogs I'll be taking on the most common questions people have about this topic.  If you have specific questions about cholesterol, please submit them to our customer support team and I will try to answer them as part of this series.

And here we go:

What is cholesterol?

Cholesterol is a waxy fat-like substance that is absorbed from the intestines during digestion and is also manufactured internally by the liver - and by every cell in our body.  The majority of cholesterol circulating in our blood and measured in a blood test does not come from the foods we eat but is rather manufactured internally.  Cholesterol is a component of every cell wall of every organ and serves as a substrate for the formation of various hormones as well as bile (which helps us digest food).  Cholesterol may be essential for various bodily functions but most of us have too much of it circulating in our bloodstreams.

How is cholesterol measured?

Cholesterol levels are measured by a blood test.  A typical cholesterol test will provide measurements of total cholesterol, HDL (“good”) cholesterol, LDL (“bad”) cholesterol and triglycerides.  In most cases, only the total cholesterol, HDL cholesterol and triglyceride levels are measured while LDL is calculated using a formula. The formula becomes inaccurate with very high triglyceride levels (over 400 mg/dL). Under those circumstances, LDL cholesterol needs to be measured directly to get an accurate reading.  A couple of other numbers may be provided as part of a cholesterol profile. One is “non HDL” which is calculated as Total Cholesterol minus HDL.  Another is a cholesterol ratio which is calculated as Total Cholesterol divided by HDL.  These latter two values are sometimes used to determine if there is enough “good” cholesterol to make up for all the “bad” cholesterol.

Do I need to fast before a cholesterol test?

According to the latest cholesterol management guidelines, fasting samples are not required for cholesterol testing and some clinicians even argue that a non-fasting sample is a more accurate picture of our cholesterol balance since we spend very little time during the day in a fasting state. However, all clinical trials that established cholesterol treatment goals were based on fasting measurements.  In addition, triglyceride levels can vary substantially after a meal and since the formula used to calculate LDL includes triglycerides in the equation, LDL estimates may end up being off.  Bottom line: If the cholesterol test is being used to help manage your medication dose or determine if you need to go on a medication in the first place, a fasting sample will be most accurate.

What are normal cholesterol levels?

Normal cholesterol results vary by age and gender. Here is a summary chart adapted from the Cleveland Clinic:



Total Cholesterol

HDL Cholesterol

LDL Cholesterol


Non-HDL Cholesterol

Children 19 years and younger

Less than 170 mg/dL

More than 45 mg/dL

Less than 110 mg/dL

Less than 150 mg/dL

Less than 120 mg/dL

Men aged 20 years and older

125 to 200 mg/dL

40 mg/dL or higher

Less than 100 mg/dL

Less than 150 mg/dL

Less than 130 mg/dL

Women aged 20 years and older

125 to 200 mg/dL

50 mg/dL or higher

Less than 100 mg/dL

Less than 150 mg/dL

Less than 130 mg/dL

Many clinicians specializing in cholesterol management would argue that these “normal” numbers are still too lax, especially when it comes to LDL.  To put it in perspective, all mammals share the same cholesterol biochemical processes as humans and the average LDL in other mammalian species is in the 35 to 50 mg/dL range. 

What is HDL or “good” cholesterol?

HDL is the Happy cholesterol and we want to keep our HDL number High.  HDL or high-density lipoprotein is the form of cholesterol that is not depositing in our arteries but rather is on its way out.  So we want as much of our total cholesterol in the HDL form.  HDL cholesterol is also the cholesterol particle that is delivering cholesterol to various glands to be used in the formation of hormones.  Although high HDL levels are felt to be protective against heart disease, this is not absolute which is why you can’t simply rely on a high HDL as being a guarantee against the risk of future heart events. 

What is LDL or “bad” cholesterol?

LDL is the Lousy cholesterol and we want to keep our LDL number Low.  LDL or low-density lipoprotein is the form of cholesterol that can deposit in our arteries and cause blockages.  This is the form of cholesterol that cardiologists obsess over and is the major target for cholesterol treatment.  You can think of LDL as garbage.  It’s what’s left over from other circulating cholesterol particles after the body has extracted all it needs from them.  Because all our cells can make cholesterol internally, LDL does not serve much of a biologic purpose and it’s easy to see why high LDL levels could cause blockages to build up.  That garbage has to pile up somewhere. 

More to come in blogs to follow!

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