Understanding Cholesterol Readings (+ 6 Cholesterol FAQs)
In the 90s, elevated cholesterol readings—and cholesterol in general—got a bad rap.
“Don’t eat eggs—they’re high in cholesterol. The lower your cholesterol, the better.”
“Eat margarine—it’s better for your cholesterol than butter.”
Wrong, wrong, and wrong again. Yes, there are some bad side effects from excess cholesterol, but there are some very good things that come from cholesterol as well! In fact, cholesterol is the backbone of all hormones. We need it. Without cholesterol, you cannot make stress hormones, sex hormones, or vitamin D. However, the type and balance of cholesterol you have pulsing through your veins is important. Here’s what you need to know about cholesterol, your cholesterol readings, and what they mean for your health.
What is Cholesterol?
Cholesterol is a waxy substance your liver makes naturally in order to create and maintain healthy hormones levels, brain health, energy production, and more. But it doesn’t only come from the liver. The cholesterol you eat is called dietary cholesterol. You get it from foods that contain fat. The source is not only food derived from animals, such as meat, poultry, and full-fat dairy, but also from healthy fats, such as avocados and coconut oil. 
Historically, LDL cholesterol has been incorrectly termed as “bad,” and HDL cholesterol has been labeled as “good.” However, anything naturally produced in the body has to contain some value, so let’s not resort to calling LDL “bad” cholesterol quite yet.
Your Cholesterol Measurements Decoded
As part of a health workup, you may get blood tests to measure your total cholesterol, which is part of a complete lipid profile that measures the following levels while fasting:
This is a calculation that represents all the cholesterol numbers, including the HDL and LDL cholesterol numbers combined.
Low-density lipoprotein, or LDL cholesterol
This lipid often gets a bad reputation because, in significant excess, it can deposit in your arteries, especially if your body is already inflamed. However, LDL actually has tremendous value to your health!
It makes the hormones pregnenolone, DHEA, and cortisol to help your adrenal glands properly respond to stress. You may be surprised to learn that LDL also makes estrogen, testosterone, and progesterone.
LDL is also the primary backbone for the vitamin D, which is a nutrient deficiency in many people. And even more importantly, it is a structural part of every cell membrane in your body, making it critical for your health. In fact, there are far more benefits to LDL than there are risks.
High density lipoprotein, or HDL cholesterol
HDL is often called “good” cholesterol because it acts like a “Pac-man” and consumes other excess cholesterol so they can be removed by your liver. Keep in mind that if you have a higher level of HDL, your total cholesterol number may also be elevated, but this would not be a concern.
This a form of fat and your body’s primary source of energy. After you eat, triglycerides increase in the blood. And in properly working bodies, they are converted into energy. If you are sedentary, or if you eat too many fats and have a lower activity level, excess triglycerides will store as fat.
When you increase your activity level in between meals, these stored fat molecules break down and release energy. It’s important to know that excess triglycerides in the blood can cause inflammation. And this increases your risk of cardiac disease.
Very low-density lipoprotein, or VLDL cholesterol
VLDL carries excess triglycerides around the blood. If you have higher levels of VLDL, it’s usually an indication your triglycerides are increasing or that you are not giving your body enough activity to convert them into energy. VLDL can also contribute to inflammation.
Cholesterol Readings: What Do They Mean?
Stemming from the obsession with cholesterol in the past few decades, we’ve been conditioned to give a lot of weight to our cholesterol readings. In 2018, the American HeartAssociation revealed new guidelines on the management of blood cholesterol. These emphasize a more personalized approach to cholesterol measurement rather than focusing just on numbers. After all, these numbers are an estimated calculation dependent upon many factors, not simply a straight forward value.
No doubt, your cholesterol numbers matter, but your entire health picture has to be considered. Significantly higher levels of LDL cholesterol increase your chances of a heart attack or stroke. And this is especially true when coupled with high triglyceride levels, family history, and other risk factors for heart disease such as inflammation and lifestyle. However, cholesterol readings shouldn’t be interpreted in a vacuum.
Other factors—for example, whether the person is menopausal, stress level, physical fitness, and hormone supplementation—all play a role. Also, the more we learn about cholesterol, the more we find out that it’s the VLDL cholesterol and triglycerides that actually matter more than the LDL level.
The bottom line here is that your cholesterol readingsare part of a big picture: Your total cholesterol levels are not the end all, be all when it comes to your risk of heart disease.
6 Cholesterol FAQs
To help you better understand cholesterol readings, here are five frequently asked questions about cholesterol.
1. What cholesterol numbers should I be most concerned about?
In my patients, I watch triglyceride levels and VLDL cholesterol levels more closely than total cholesterol and LDL levels. This is because VLDL and triglycerides are inflammatory and more likely to produce plaque in the blood vessels and arteries. 
You also have to look at other factors when interpreting cholesterol levels. For example, I had a conversation with a patient recently who had an LDL of 114. All her other numbers were fine. She had just stopped hormone supplementation, so her LDL increased to try to make more.
Borderline high cholesterol readings are not a huge concern if a person’s lifestyle is good and their inflammatory markers (C-Reactive Protein) are low. People at the highest risk for heart attack and stroke are those who have high cholesterol, high inflammation, and a sedentary lifestyle.
2. How does stress affect my cholesterol?
Stress can increase cholesterol levels. In a 2017 study published in the journal Medicine, researchers found that psychological stress led to increased triglyceride levels and LDL cholesterol levels and decreased levels of cholesterol. 
It seems the stress hormone cortisol can increase abdominal obesity and stimulate appetite. During times of stress, people tend to turn to comfort foods high in sugar and carbs, which can lead to weight gain and, therefore, higher levels of triglycerides, which may increase LDL cholesterol. 
It’s also important to recognize that cortisol, the hormone released in times of stress, is made from LDL cholesterol. So, if the cortisol demand is high, you will see an increase in LDL and total cholesterol numbers.
Lowering the stress in your life is good for all aspects of your health, not just your cholesterol. I recommend yoga, deep breathing, and other stress relieving techniques. It’s worth noting that the study mentioned above also found that exercise combated the effects of stress on your rising cholesterol numbers—so let’s get moving!
3. Does cholesterol affect blood pressure?
Increased cholesterol alone does not increase blood pressure. However, prolonged levels of elevated cholesterol combined with inflammation can cause your arteries to narrow and harden due to cholesterol plaque (a condition called atherosclerosis).
This condition can cause your heart to work harder to pump the blood. As a result, blood pressure rises. Blood pressure can also rise due to stress, which is often found in conjunction with higher LDL levels that are also a stress-related response. High blood pressure can also occur independently of high cholesterol, however.
4. Do hormone levels impact cholesterol?
As I mentioned above, cholesterol is the backbone of hormone production, so there is a direct relationship between the two. One example that I see commonly in men is the need for testosterone replacement after starting a statin for cholesterol.
If your LDL cholesterol is too low, your sex hormones will be impacted, often resulting in the need to add hormone therapy to your medication list. This may sound simple, but excess hormones can cause issues as well if you are not physically active, so the root cause remains the same. It will save you a lot of time and money to work on lifestyle factors to improve cholesterol balance. Plus, these factors will also support your body in general.
Women often see a spike in LDL right after menopause. Why? Because the body tries to adapt to make more hormones by producing more LDL from the liver. So, if you are told you need a statin from a small increase in LDL right after menopause, think twice.
5. Should I go on a plant-based diet to lower cholesterol?
Foods that come from animals tend to be high in saturated and trans fats, and those fats cause your liver to retain more cholesterol than it should, especially if you have a sedentary lifestyle. In some people, this added cholesterol drives total cholesterol levelsand triglyceride levels to an unhealthy point. Therefore, a plant-based diet can help lower cholesterol levels in those whose numbers are elevated due to their diets. And it can help maintain proper levels in those who do not have cholesterol issues to begin with.
Eating a plant-based diet will also help control your weight and blood sugar, support healthy blood pressure levels, and help reverse atherosclerosis. A plant-based diet is also made up of inflammation-fighting foods, which reduces atherosclerosis. There’s actually evidence that plant-based diets may reduce risk of coronary artery disease by 40 percent and risk of cerebral vascular disease by 29 percent. 
6. What are some things I can do to lower my levels of unhealthy cholesterol?
If your cholesterol readings are high, first and foremost, adopting a healthy lifestyle that includes physical activity and a diet low in saturated fat is a must. The best way to reduce excess fat in the blood is to turn it into burned energy via activity. Beyond that, there are several remedies you can try, including the following:
- Red yeast rice for cholesterol. Red yeast rice appears to contain the compound monacolin K, which can lower LDL cholesteroland triglycerides via the same mechanisms as a statin drug, but with fewer side effects. However, this is simply a quick-fix to lower risk of excess cholesterol from sticking to your artery walls. It works best when combined with exercise and a plant-based diet to reverse your risk of cardiovascular disease altogether. 
- Keto diet for cholesterol. There’s some evidence that a properly executed ketogenic diet (i.e., mainly full of healthy, plant-based fats) can help lower cholesterol levels. In one study, people who went on a keto diet for cholesterol experienced weight loss, lower triglycerides, lower blood sugar, and increased HDL cholesterol. 
As a naturopathic physician, my philosophy is to find the obstacles that are blocking your body from healing itself. If you have elevated cholesterol numbers, the first order of business is to correct the reason why. This is why I do not regularly prescribe statins for cholesterol before exploring lifestyle elements first—especially if the levels are not dangerously elevated.
I encourage you to consult to your doctor about lifestyle changes before committing to statin therapy, especially if your levels are not dangerously high. In some cases, a statin may be the best answer, but often, simple lifestyle and diet changes can reverse your high cholesterol for good and help you avoid having to use further medications.
- We make some cholesterol and get some cholesterol from food. Although it is often labeled as good cholesterol and bad cholesterol, there are actually many benefits of cholesterol.
- Cholesterol readings should be interpreted as part of a big picture by also looking at other health and lifestyle factors.
- Stress can increase cholesterol levels.
- There are several things you can try to reduce your cholesterol readings if they are unhealthy, including a plant-based diet and exercise.