"Good" vs. "Bad" Cholesterol: What's the Difference?

The HDL ("good") and LDL ("bad") of cholesterol can be confusing. Learn about high and low cholesterol numbers and what they mean.

HDL and LDL, “good” and “bad,” high and low — cholesterol terminology can be pretty confusing. But understanding how the terminology relates to your own cholesterol levels is important. Your body actually needs cholesterol to be healthy. In fact, 75 percent of the cholesterol in your body is made by your body. But certain factors can contribute to your body getting too much cholesterol.

"Cholesterol isn’t evil,” says Jessica Bartfield, MD, an internal medicine, nutrition, and weight loss specialist at Loyola University Health System's Gottlieb Memorial Hospital in Maywood, Ill. “The cells in your body couldn’t function properly without it."

The problem isn’t with cholesterol, but with lipoproteins — the substances that carry cholesterol throughout your body. Low-density lipoproteins, or LDLs, carry cholesterol in a way that allows it to be released in your blood, where it can lodge in the walls of your arteries, block blood flow, and cause heart disease or stroke. That makes LDL the "bad" cholesterol.

High-density lipoproteins, or HDLs, are the “good” cholesterol. “Think of the 'H' in ‘HDL’ as standing for healthy," Dr. Bartfield says. “HDL carries cholesterol around like a sponge. It can take excess cholesterol out of your bloodstream and carry it back to your liver, where it can be excreted,” she says. “That keeps cholesterol from sticking and building up in your arteries.”

Knowing Your HDL and LDL

You should have your cholesterol checked by age 20. As long as your cholesterol levels are normal, you should only have to get them checked every few years. If you have abnormal cholesterol levels, your doctor will want you to check them more frequently. Cholesterol is measured in milligrams per deciliter of blood, abbreviated as “mg/dL.” Aim for these cholesterol numbers:

• Total cholesterol less than 200 mg/dL
• HDL (or “good”) cholesterol 60 mg/dL or higher
• LDL (or “bad”) cholesterol less than 100 mg/dL

If your cholesterol levels fit into these categories, you know that your LDL cholesterol is under control and your HDL cholesterol is working to protect you.

Managing Your HDL and LDL

About 25 percent of your cholesterol comes from what you eat, so a healthy diet plays a big part in getting your cholesterol levels right. For some people, medications are needed to control high cholesterol, but the best place for most people to start is with simple lifestyle changes.

"Dietary LDL cholesterol comes from eating animal fats," Bartfield says. "HDL cholesterol comes from eating healthy fats from foods such as fish, nuts, soybeans, and olive oil."

Follow these five simple basics for lowering your LDL and raising your HDL:

• Don’t smoke.
• Exercise at least 30 minutes on most days of the week.
• Get your protein from lean meats, fish, nuts, and beans.
• Eat lots of fruits, vegetables, and whole grains.
• Maintain a healthy weight.

"A popular belief is that drinking alcohol is good for your cholesterol," Bartfield says. "Alcohol can increase your HDL or “good” cholesterol, but only if you drink in moderation. That means one drink per day for women and two drinks per day for men. If you don't drink, it’s not advised that you start just for your cholesterol,” she explains.

Knowing the basics about cholesterol can help you start managing your HDL and LDL cholesterol levels better. If your levels are normal, keep up the good work by making lifestyle choices that will keep your cholesterol in check. If your HDL cholesterol is too low or your LDL cholesterol is too high, work with your doctor to rebalance those numbers. The more you know about cholesterol, the more likely you are to be successful at reducing your risk of heart disease and stroke.