Cholesterol is yet another misunderstood substance in health and nutrition. For years, it has been painted as the villain—solely responsible for clogged arteries and heart attacks. But cholesterol, like most things, is far more dynamic and absolutely critical to your body’s function.
Still, most people receive one-dimensional advice when their total cholesterol or LDL-C comes back high: "Avoid red meat and dietary cholesterol," or, worse, “go vegan.” This advice often leaves people in a nutritional and caloric deficit, potentially leading to cascading negative health outcomes.
We’ve seen countless consultations with individuals who, out of fear, switched to a “plant-based” diet only to find themselves with elevated cholesterol, fatty liver, and even deteriorating mental health (a reminder that cholesterol plays a key role in your brain).
Let’s break down what cholesterol really is, where it comes from, what influences it, and why it’s not the bad guy.
What Is Cholesterol, and Where Does It Come From?
Cholesterol is a smooth, waxy substance your body relies on for essential functions like:
Building cell membranes.
Producing hormones (e.g., estrogen, testosterone, cortisol).
Transporting nutrients like vitamin D and CoQ10 to cells.
Synthesizing bile acids to digest fats.
Supporting tissue repair.
As highlighted by David W. in his report for The Heart and Stroke Foundation of Ontario, cholesterol serves as a protective mechanism against inflammation and oxidative damage—often the real culprits in cardiovascular disease.
Cholesterol Sources:
Diet (20-25%): What you eat plays a smaller role than many think.
Your Liver (75-80%): Your liver produces most of your cholesterol, adjusting production based on your needs and intake.
Critical points:
Most of the cholesterol in your bloodstream is made by your liver—not ingested. Your diet plays a role. We are not suggesting you treat your body like a dumpster nor are we implying that quality and quantity does not matter but please understand it’s only part of the picture.
You could have the best diet and still see your lipid/cholesterol panel changing in a less than desired way.
You could have the best training and recovery protocol and still see your lipid panel (Cholesterol panel) changing and skewed!
What Can Influence Cholesterol Levels? Is Cholesterol a Protective Mechanism?
Cholesterol levels are dynamic and influenced by many factors beyond just what you eat. Cholesterol often rises in response to stress, injury, inflammation or infection because it plays a protective role. Here’s a breakdown of what can manipulate cholesterol:
Physiological Factors
Thyroid Function:
Subclinical and clinical hypothyroidism can raise Total and LDL cholesterol because thyroid hormones regulate LDL receptors in the liver. Fewer receptors mean less cholesterol is cleared from the blood. So the root of this situation is not your lipids, it is looking at supporting optimal thyroid function.
Sex Hormones:
Low estrogen or testosterone can negatively impact HDL and LDL levels, often raising LDL.
It is a fact that women in menopause and even many in perimenopause depending (ie: low hormones) will see a decline in HDL regardless of their diet (we are not suggesting treat your body like a dumpster, diet still matters). We will also see total cholesterol and as mentioned above LDL go up.
Noteworthy Bonus: for women in menopause we will also see elevating apolipoprotein B levels. We won’t go into apoB today but this is a LDL particle that is associated with CVD risk
Inflammation:
Chronic inflammation increases cholesterol as part of the body’s repair response, driving up LDL to deliver cholesterol to damaged tissues.
Insulin Resistance:
Can increase small, dense LDL particles while lowering HDL, creating a more atherogenic (plaque-forming) profile.
Dietary Factors
Note: This is an educated discussion. We recognize that specific circumstances may call for particular dietary strategies. The points outlined here are meant to provide insight, not rigid guidelines. Always approach dietary changes with context, individual needs, and professional guidance in mind.
Low-fat diets: May lower total cholesterol but can also decrease HDL
Low-carb, High fat diets (ie: Keto): Can raise LDL-C (cholesterol content in LDL particles) but often increase LDL particle size. This may reduce cardiovascular risk in some individuals. Keto is not an appropriate tool for everyone, but is a tool for some individuals in the short term. The biggest point here is this is an instance where a coach can help keep a thoughtful eye on a client's labs, have bigger discussions and open dialogue to what strategies are appropriate as well as what we are seeing.
Diets high in processed foods and excessive in calories: These can increase triglycerides and promote the formation of small, dense LDL particles. When these factors occur in the presence of inflammation or other risk conditions, the likelihood of plaque buildup increases.
Note: This information requires thoughtful interpretation. Avoid self-diagnosing or jumping to conclusions—consult a professional to assess your unique situation.
Myths About Cholesterol
1. Cholesterol Clogs Your Arteries
Cholesterol circulates in the blood—it doesn’t just “stick” to your arteries. For cholesterol to contribute to plaque buildup, damage to the artery walls must occur first (from inflammation, oxidative stress, or high blood pressure). Cholesterol shows up as part of the repair process, not the initial problem.
2. High Cholesterol Always Means Plaque
High circulating cholesterol does not guarantee plaque formation. It’s more about the type and behavior of the cholesterol particles (small, dense LDL vs. large, fluffy LDL) and the presence of inflammatory triggers.
3. Dietary Cholesterol Equals High Blood Cholesterol
The liver is the main regulator of blood cholesterol levels, producing more when dietary intake is low and less when intake is high. For most people, dietary cholesterol has minimal impact on blood cholesterol.
The Downsides of Lowering Cholesterol Too Much
While excessively high cholesterol isn’t ideal, lowering it too much can have unintended consequences:
Reduced production of hormones like estrogen and testosterone.
Impaired vitamin D synthesis.
Decreased immune function.
Can affect the brain negatively
LDL, often villainized, is essential for delivering fat-soluble vitamins and nutrients. So as you can see it is not as easy as “bad vs good”.
Action Steps
If your cholesterol levels are a concern, avoid reactionary solutions like cutting all dietary cholesterol or eliminating foods like eggs and red meat. Instead:
Evaluate your diet: Reduce processed foods and refined carbohydrates while focusing on nutrient-dense, whole foods.
Address root causes: Look for issues like thyroid dysfunction, insulin resistance, or chronic inflammation that may be driving changes in cholesterol.
Consider advanced testing: Lipid particle testing (LDL-P, HDL-P) provides a clearer picture of cardiovascular risk.
Assess gut health: Poor gut health can contribute to systemic inflammation, impacting cholesterol and overall metabolic function.
Work with a professional: Collaborate with someone who can help you interpret your day to day habits, lifestyle, history, labs, assess patterns, and identify meaningful interventions that address the bigger picture.
For Coaches: A Bigger Role in Advocacy
As coaches, we have the opportunity—and responsibility—to guide clients toward informed decisions about their health. Understanding nuanced topics like cholesterol helps you advocate effectively for clients.
If this feels overwhelming, you're not alone. Our 1-on-1 and group mentorships are designed to give you the tools and confidence to approach complex topics, interpret lab work, and navigate meaningful conversations with your clients. Whether you're just starting out or looking to refine your expertise, we’re here to help you level up your practice.