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CHOLESTEROL! It’s one of those health scare-words that’s supposed to make you eat fewer eggs and more salmon, but what does it even mean?

Cholesterol is a waxy goo made by the liver and circulated through your blood to help with all kinds of processes, like making hormones, vitamin D, and acids for digesting fatty foods.

Since the liver makes enough cholesterol, you don’t need to get it from dietary sources like meat, eggs, and dairy.

A blood cholesterol test will reveal numbers for LDL, HDL, and triglycerides. Low density lipoprotein (LDL) is the “bad” kind — the higher this number, the higher your risk for heart disease.

High density lipoprotein (HDL) is the “good” kind because it carries excess cholesterol to the liver to be disposed of.

Triglycerides are another type of fat in the blood that are associated with higher risk of heart disease and stroke.

Cholesterol levels tend to rise between the ages of 20 and 65. Men usually experience higher cholesterol up to the age of 55. For women, menopause often triggers cholesterol to rise.

Total cholesterol is made up of HDL, LDL, and triglycerides. Considering cardiovascular health, you want more HDL, and less LDL and triglycerides, with the total being under 200 milligrams per deciliter.

According to the American Heart Association’s 2018 guidelines, these are the latest recommendations for cholesterol and triglyceride levels in adults.

Values are in mg/dL (milligrams per deciliter). Cholesterol tests should be performed while the person is fasting, so don’t forget to skip breakfast before your test.


Total cholesterolHDL cholesterolLDL cholesterolTriglycerides
GoodLess than 200 (but the lower the better)Ideal is 60 or higher; 40 or higher for men and 50 or higher for women is acceptableLess than 100; below 70 if coronary artery disease is presentLess than 149; ideal is less than 100
Borderline to Moderately elevated200–239n/a130–159150–199
High240 or highern/a160 or higher; 190 is considered very high200 or higher; 500 is considered very high
Lown/aless than 40n/an/a

A child’s cholesterol should be lower than the adult guidelines, but a number of factors such as higher weight, diabetes, liver disease, kidney disease, or an underactive thyroid can contribute to higher numbers.


Total cholesterolHDL cholesterolLDL cholesterolTriglycerides
Good170 or lessGreater than 45Less than 110Less than 75 in children aged 0–9; less than 90 in children aged 10–19
Borderline170–19940–45110–12975–99 in children aged 0–9; 90–129 in children aged 10–19
High200 or highern/a130 or higher100 or more in children aged 0–9; 130 or more in children aged 10–19
Lown/aLess than 40n/an/a

Eat this fat, not that fat

Eat more healthy fats like those found in olive oil, canola oil, avocados, nuts, and fish, while avoiding saturated fat, trans fat, and dietary cholesterol.

The TLC program: self-care for your blood lipids

The National Heart, Lung, and Blood Institute recommends Therapeutic Lifestyle Changes (TLC) for managing cholesterol, including these tips:

  • Reduce saturated fat to less than 7 percent of daily calorie intake.
  • Reduce dietary cholesterol to less than 200 mg per day.
  • Add 5 to 10 grams of soluble fiber per day.
  • Add 2 grams of plant sterols/stanols per day.

Fiber: the fat blocker

Eat more soluble fiber to create a gel-like barrier in your intestines that blocks cholesterol and fats from being absorbed. Kinda gross, but awesome, right? Here are some good sources of soluble fiber:

  • oatmeal
  • whole fruit
  • beans and lentils
  • flaxseed and sunflower seeds
  • hazelnuts
  • barley

Skip the cigs

If you smoke, stop it. Aside from lowering good HDL cholesterol, smoking damages blood vessels, creating weak spots for fat to deposit and cause atherosclerosis, which can lead to stroke or a heart attack.

Secondhand smoke increases cardiovascular risk for children.

Party sober

Drinking alcohol can cause heart damage and raise triglycerides. Doesn’t sound that fun anymore, does it? The American Academy of Pediatrics recommends that women have one or fewer drinks per day and that men have two or fewer drinks per day to minimize risk to cardiovascular health.

You’ve got to move it, move it

Regular physical activity can raise HDL and lower triglycerides. To improve cholesterol levels, adults should get at least 30 minutes of moderate-intensity physical activity most days of the week.

Children aged 5 and older should get moderate to vigorous physical activity at least 1 hour per day, 3 days per week. Moderate to vigorous activities include jogging or things like playing baseball. Vigorous activities include running, tennis, and playing soccer.

And now the award for most common medical advice goes to…

If you live in a body that’s larger than the “acceptable” number on that chart in your doctor’s office and you have elevated cholesterol levels, you’ll likely be advised to lose weight.

The lifestyle modification tips mentioned here might contribute to weight loss for some but not for others.

Discuss with your doctor how changes to your diet, activity level, supplements, or medication may improve your cholesterol (and cardiovascular health), even if your weight doesn’t change.

According to the American Academy of Pediatrics, all children between the ages of 9 to 11 should be screened for high blood cholesterol levels. Children between the ages of 2 to 10 should be tested if they have any of the following risk factors:

  • Parents or grandparents have had heart attacks or have been diagnosed with blocked arteries or a disease affecting the blood vessels at age 55 or earlier in men, or 65 or earlier in women.
  • Parents or grandparents have total blood cholesterol levels of 240 mg/dL or higher.
  • Family health history is unknown.

Adults aged 20 and older should have their cholesterol tested every 5 years, or more often if cholesterol is elevated.

High cholesterol has no symptoms, so a blood test is necessary to get the scoop.

Your doctor may prescribe cholesterol-lowering medicine if:

  • You have a history of heart attack, stroke, or peripheral arterial disease.
  • Your LDL cholesterol is 190 mg/dL or higher.
  • You’re 40 to 75 years old with diabetes and have an LDL cholesterol level of 70 mg/dL or higher.
  • You’re 40 to 75 years old with a high risk of developing heart disease or stroke, and have an LDL cholesterol level of 70 mg/dL or higher.

Medication is not recommended for children under 10 years old.

Omega-3

Omega-3 fatty acids, found in fatty fish and some nuts and vegetable oils, can reduce triglycerides and may help prevent blood clots and inflammation. Omega-3 supplements are available by prescription and over the counter.

Niacin

Niacin (or nicotinic acid) is a B-vitamin that can raise HDL levels while decreasing LDL, triglycerides, and total cholesterol.

Cholesterol absorption inhibitors

Cholesterol absorption inhibitors mainly decrease LDL with slight improvement on triglycerides and HDL levels.

Bile acid sequestrants

Bile acid sequestrants lower blood cholesterol by removing bile acids, which are used to break down LDL cholesterol.

Statins

Statins cause the liver to produce less cholesterol, while revving up its ability to remove LDL cholesterol from the blood.

Fibrates

Fibrates are used primarily to decrease triglycerides, but may also increase HDL cholesterol.

Nearly one-third of American adults and 7 percent of American children aged 6 to 19 have high cholesterol.

High cholesterol increases the risk of cardiovascular disease, but it can be lowered with diet modification and exercise. For adults and children at high risk, there are medications that can help lower cholesterol.