High Cholesterol? It’s Not Just About Eating Less Cholesterol

Cholesterol is one of the most misunderstood topics in nutrition. For years, the message has been to simply “eat less cholesterol”—but that approach misses the bigger picture.

To really understand your labs, you need to understand what cholesterol is, why your body needs it, and what actually drives elevated levels. Let me explain.

Your Body Makes Cholesterol for a Reason

Your body makes its own cholesterol, primarily in the liver. About 75% of your cholesterol comes from your body naturally producing it. Your body makes cholesterol because it needs it to survive.

Cholesterol is essential for survival because it’s needed to:

• Produce sex and stress hormones including estrogen, progesterone, testosterone, and cortisol

• Make vitamin D when you are exposed to sunlight

• Be a part of the phospholipid bilayer in every cell membrane

• Make bile, which helps you digest fats and absorb key nutrients

What About Cholesterol From Food?

We can also get cholesterol in through the diet. About 25% of your cholesterol comes from your diet. Cholesterol is only found in animal foods. Foods high in cholesterol are:

• Eggs

• Meat

• Dairy

• Seafood

The interesting part about this is that when you eat more cholesterol, your body usually makes less of it, and vice versa so if you eat too little cholesterol, your body will make more. Your liver adjusts production based on intake (a feedback system).

Cholesterol is Only ONE Molecule

When clients get routine annual lab work, this typically includes lipid panel. A lipid panel will include total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. This leads people to think there are different types of cholesterol, but this is not the case. Cholesterol is only one molecule. Because cholesterol can’t travel through the blood on its own, it is carried through the body inside lipoproteins, which is why LDL (low-density lipoproteins) and HDL (high-density lipoproteins) are measured.

Understanding Your Lipid Panel

As I mentioned above, a typical lipid panel will include total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

LDLs carry cholesterol from the liver to the tissues and HDLs carry cholesterol from the tissues back to the liver for removal. This is why you hear that HDL is your ‘good cholesterol’ (cholesterol is being excreted) and LDL is your ‘bad cholesterol’ (cholesterol is being stored in tissues). While LDL is often labeled ‘bad’ and HDL ‘good,’ the full picture is more nuanced and depends on particle size and overall metabolic health.

Your total cholesterol is the sum of all cholesterol in your blood which includes LDL, HDL, and a portion of triglycerides. Alone, this number is not very useful.

Triglycerides are a type of fat found in your blood. They’re basically your body’s main way of storing extra energy. When you eat—especially carbs or fats—your body uses what it needs right away and the extra gets converted into triglycerides and stored in fat cells. When fasting or between meals, hormones release those triglycerides for energy. Elevated triglycerides are often a sign of insulin resistance, excessive alcohol intake, lack of exercise, or poor metabolic health. They are different from cholesterol. Another blog post on triglycerides is coming soon!

Cholesterol labs are essentially a metabolic health report card.

For example:

• High triglycerides + low HDL → often signals insulin resistance

• Elevated LDL → could be diet, genetics, inflammation, etc.

Not All LDL Is the Same

To dive deeper, there are 2 main types of LDLs.

1.     Large, buoyant LDL = “big fluffy particles floating by”

These are bigger, lighter particles, they are less likely to penetrate artery walls, and considered less atherogenic (less likely to clog arteries).

2.     Small, dense LDL = “tiny particles that can slip into artery walls and cause trouble”

These are smaller, heavier particles that are more likely to slip into artery walls and are considered more atherogenic (more likely to clog arteries). Small, dense LDL is the type most associated with increased cardiovascular risk

A standard lipid panel does NOT differentiate the different types of LDL particles. An LDL particle test is not a lab doctors routinely order. You may want to request your doctor order it or get it done yourself through a lab if you want a more accurate picture of your cardiovascular risk.

What Negatively Affects Cholesterol Labs?

When clients get their lipid panel results and see abnormal cholesterol levels, the first instinct is often to cut out dietary cholesterol. But for most people, that approach misses the bigger picture. Cholesterol levels are less about a single food and more about how the body is managing energy overall. Over-focusing on restriction can backfire—it doesn’t address root causes and often leads to unnecessary food fear without meaningful improvements in labs.

In reality, abnormal cholesterol is usually driven by a combination of factors, not just one. Genetics and insulin resistance play a major role, while dietary patterns can either support or worsen the situation. Diets high in refined carbohydrates and ultra-processed foods—and low in fiber—tend to disrupt metabolic health, increase inflammation, and negatively impact lipid levels. In other words, it’s not just what you eat, but how your body processes it that ultimately shapes your cholesterol markers.

What Actually Helps Improve Cholesterol Labs?

Here are some things to do instead of eating less cholesterol to normalize labs:

1.     Increase fiber intake

Fiber helps to pull excess cholesterol out through the stool. Great sources include vegetables, fruits, beans, chia seeds, and flax seeds. My best tip for getting enough fiber in is to aim to eat 4-5 cups of vegetables per day.

2.     Support liver function

Your liver makes and clears cholesterol. If the liver isn’t functioning optimally, cholesterol clearance can be impaired. Support your liver by eating adequate protein, micronutrients such as B vitamins, choline, and limiting excess alcohol.

3.     Consistent exercise

Exercise can help your body clear LDL from the bloodstream more efficiently by increasing LDL receptor activity in the liver and enhancing uptake of LDL particles out of circulation. Exercise can also improve HDL function. HDL becomes better at collecting cholesterol and delivering it to the liver for removal.

4.     Focus on eating a whole food, minimally processed diet

Ultra-processed foods are associated with more small, dense LDL particles. Ultra-processed foods are naturally very low in fiber. Low fiber intake leads to less bile excretion and therefore less cholesterol gets removed and your body recycles (reuses) more cholesterol instead of clearing it.

5.     Balance blood sugar

By balancing blood sugar, this will help insulin become more sensitive, decreasing insulin resistance that may be present.

Does Eating Cholesterol Cause Heart Disease?

Research has shown that dietary cholesterol has a relatively small impact on blood cholesterol levels for most people.

Because of this, dietary cholesterol alone is not a primary driver of heart disease. Our bodies are smart—when you eat more cholesterol, your body typically makes less (feedback system).

Heart Disease is Driven By Multiple Factors

The bigger drivers are:

• Chronic inflammation

• Insulin resistance/poor blood sugar control

• Ultra-processed foods

• Low fiber intake

• High blood pressure

• Excess visceral fat (belly fat)

• Alcohol (especially excess intake)

• Smoking

• Stress

• Poor sleep

• Inactivity

• Genetics

Translation: it’s the overall metabolic environment.

Putting it all together

Cholesterol isn’t the enemy. A dysfunctional metabolic environment is. When you focus on supporting your metabolism, your body becomes better at regulating cholesterol naturally.

If you want help understanding your labs, improving your blood sugar, insulin sensitivity, or lipid markers in a sustainable way, this is exactly what I help clients with inside my practice. Book an appointment with me today on my website.

References

Berger S, et al. (2015). Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. American Journal of Clinical Nutrition.

Muscella A. (2020). Exercise training and lipid metabolism: effects on cardiovascular risk. American Journal of Physiology–Heart and Circulatory Physiology.