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May 23, 2018  |  Login
High Cholesterol
by James F. Balch, M.D. and Mark Stengler, N.D.
Normal Cholesterol Levels
  • Total cholesterol: 165-200 mg/dL.

  • LDL cholesterol: below 130 mg/dL.

  • HDL cholesterol: 50 mg/dL or higher.

  • Total cholesterol/HDL ratio: less than 3.7

  • LDL/HDL ratio: less than 3.0

Note: The relative amount of total cholesterol to HDL, and the ratio of LDL to HDL is considered more important than total cholesterol.

Getting More Specific with Cholesterol

Apolipoprotein B (apoB) is a cholesterol particle that is believed to promote heart disease by affecting how cholesterol is transported into the arteries and the tissues. ApoB is found in low density lipoprotein (LDL) and other potentially harmful cholesterols, such as very low density lipoproteins (VLDL). Conversely, apolipoprotein A (apoA-1) is found in HDL cholesterol and provides a protective effect against heart disease.

A large study known as the AMORIS (Apolipoprotein-related Mortality Risk) measured the levels of apoA-1 and apoB, as well as other lipids, in more than 175,000 men and women in Sweden. Researchers found that people at greatest risk of dying from a heart attack tended to have the highest ratios of apoB to apoA01. In this study, these newer markers were more predictive of a heart attack than were the typical total, HDL, and LDL cholesterol and triglycerides. Men with the highest apoB/apoA-1 ratio had almost four times the risk of a fatal heart attack, compared to those with the lowest ratios; and in women the relative risk was threefold. ApoB appears to be an important marker for people with normal to low LDL cholesterol, as well as for those with diabetes and insulin resistance.

  • ApoB reference range: 55-125 mg/dL

  • Apo A-1 reference range: 125-215 mg/dL

  • ApoB/ApoA-1 ratio reference range: 0.30-0.90


High levels of cholesterol in the blood are one of the many risk factors for serious future health problems (see cardiovascular disease for information on other risk markers). Too much cholesterol can increase the chances of developing heart disease (including possibly fatal heart attacks) and stroke. By inhibiting circulation, too much of this substance can also cause gallstones, impotence, high blood pressure, and loss of mental acuity.

Cholesterol isn't all bad, however. Your body requires it in moderation for the proper function of cells, nerves, and hormones. It is an essential component of every cell in your body, and life without it would be impossible. To distribute cholesterol throughout the body, substances called lipoproteins transport it in the blood. One class of lipoproteins, called low-density lipoproteins, or LDLs for short, carries cholesterol from the liver, where it is produced, to the cells that need it. Then another kind of lipoprotein, called high-density lipoproteins, or HDLs, picks up the excess cholesterol from the cells and takes it back to the liver, where it is broken down and excreted from the body or reprocessed.

Under normal conditions, the lipoproteins keep cholesterol levels in balance. But this carefully calibrated system can be overtaxed when the body creates more cholesterol than HDL can sweep away. After the cells take what they need, the existing HDLs remove what they can, and the extra cholesterol simply remains in the blood. Then if cholesterol becomes oxidized (especially LDL cholesterol) and attaches to the artery walls, it sets the stage for inflammation of the arteries. This chronic inflammation contributes to further buildup and deposition of cholesterol and plaque on the interior walls of the arteries. We call this buildup, which narrows the arteries and limits the amount of blood that can pass through them, arteriosclerosis or hardening of the arteries. Arteriosclerosis is the first stage of heart disease; when left untreated, it will lead to a heart attack or stroke. For more information about arteriosclerosis, see cardiovascular disease.

Elevated cholesterol levels are often caused by the standard Western diet, which relies heavily on animal products, saturated fats, and refined carbohydrates. It can also be caused by heredity conditions or preexisting diseases like diabetes and insulin resistance, or syndrome X. Although, in these cases, diet usually plays a role as well. It stands to reason, then, that high cholesterol can often be treated with dietary changes and exercise. Specific supplements discussed in this section are also excellent nonpharmacological ways to normalize cholesterol levels. Stress reduction has a beneficial effect as well. It is strongly suggested that you employ these natural strategies before trying any of the cholesterol-lowering medications on the market. These drugs, while effective at reducing cholesterol, are potentially toxic to the liver and may cause nutritional deficiencies. While they may be necessary in some cases, many doctors prescribe them as a matter of routine-often because they're afraid that their patients won't make the lifestyle changes that can lower cholesterol naturally.

If your doctor wants to prescribe a cholesterol-lowering agent for you, explain to him or her that you're willing to embark on a new regimen in the hopes of avoiding a lifelong dependency on drugs. Whatever your decision, be sure that it is based on your physician's and your analysis of your individual situation.

Next: What are the Symptoms of High Cholesterol?

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