Understanding Cholesterol and Heart Health

by Dr Faith Christensen

Cholesterol is Needed for Optimal Function of Hormones, Cortisol, Vitamin D and Digesting Dietary Fats.

Cholesterol is a fat used by the body to build cell walls, and to make hormones such as testosterone, estrogen and cortisol. It is necessary for the transmission of nerve impulses and Vitamin D production. It aids in digesting dietary fats as part of bile production by the liver.

Many people are surprised to learn that approximately 80% of our total body cholesterol is manufactured by our own liver and only about 20% is obtained from food such as eggs, dairy, meat, poultry, fish and shellfish.  As our total body cholesterol level increases, our liver’s production of cholesterol decreases and vice versa. However, excessive dietary cholesterol and sugar intake (among other factors) causes this mechanism to fail and as a result, blood cholesterol rises to unhealthy levels.

Healthy Blood Cholesterol Levels

A diagnosis of hypercholesterolemia means high or excessive blood cholesterol levels. About 1 in 300 individuals inherits the genetic tendency to develop hypercholesterolemia. All others develop hypercholesterolemia due to poor dietary and lifestyle habits including a high fat, high sugar and low fiber diet, lack of exercise, smoking, alcohol and coffee consumption and poor stress management. Diabetes and obesity also contribute to the development of hypercholesterolemia and, subsequently, to the development of heart disease. 

Cholesterol Transport 

Cholesterol is carried in the blood to proteins called lipoproteins (LDL, VLDL, HDL, etc).  LDL ?, sometimes referred to as “bad cholesterol”, and VLDL carry cholesterol from the liver to body cells while HDL ? carries cholesterol back from cells to the liver for breakdown and elimination via bile (HDL is sometimes referred to as “good cholesterol”). Total blood cholesterol actually includes HDL, LDL(Small Dense LDL, LPa, VLDL, etc., while the calculation of total blood cholesterol on a lab report simplistically includes the levels of HDL and LDL.

Plaque Formation

Cholesterol becomes a problem when it starts to build up in the arterial walls causing plaques.  The excess of LDLs circulate in the blood to the point where HDLs are unable to sweep the excess back to the liver. Over time plaques can become calcified, gradually decreasing the flow of blood leading to heart attack or stroke depending on the arteries involved. 

Plaque formation occurs when there is inflammation in the arteries + excess cholesterol. Reducing inflammation in a key part of heart health that is often overlooked when only focused on lowering cholesterol. Arterial inflammation can be measured by looking at RLP, and CRP in blood tests. Plaque formation can be measured by arterial scans.

Hidden causes of inflammation in the body:

  • Food sensitivities/allergies, dental infections, gastrointestinal infection, environmental sensitivities, chronic viral infections, blood sugar imbalances.

What Can I Do to Optimize my Blood Cholesterol Level?

  • Get detailed blood work that evaluates all the different cholesterol markers, inflammatory markers, and clotting factors to understand your risk beyond LDL vs HDL cholesterol and what natural therapies are most effective at treating the imbalance.
  • Identify hidden sources of inflammation listed above through further laboratory testing. 
  • Decrease cholesterol intake by decreasing animal products and increasing plant products ( flaxseed oils, olive oil, etc.)     
  • Increase soluble fiber (oat and barley bran, citrus fruits, dried beans, asparagus, bananas, broccoli, cabbage, cantaloupe, eggplant, garlic, grapefruit, green leafy vegetables, melons, peas, prunes, raisins, squash and sweet potatoes). See Fiber handout.
  • Increase garlic and onion consumption
  • Decrease or eliminate sugar consumption
  • Steam, bake, roast or boil vegetables instead of frying, sautéing, stir-frying, etc. Use a non-stick skillet and water or broth-sauté vegetables. Chill meat or poultry broth until the fat solidifies and then spoon it off. 
  • Season vegetables with herbs and spices, rather than with sauces, butter or margarine
  • Try lemon juice on salads instead of oil-based dressings
  • Use oil instead of shortening in baked products
  • Replace whole milk with skim or low-fat milk in soups, baked goods, cereal and coffee
  • Substitute plain non-fat or low-fat yogurt, blender whipped low-fat cottage cheese or buttermilk in recipes that call for sour cream or mayonnaise
  • Choose the leanest cuts of meat (grass-fed and organic as opposed to grain-fed and conventionally raised). 
  • Trim all visible fat and skin from poultry and meat before cooking
  • Roast, bake, broil or rotisserie meats, poultry or fish so that fat will drain while cooking
  • Exercise: so helpful for increasing HDL cholesterol, decreasing inflammation, and balancing blood sugar.
  • Manage stress effectively. If you have been really stressed, get your adrenals tested to see what support is needed to balance cortisol.
  • Stop smoking
  • Drink alcohol only in moderation (or eliminate it) as it contributes to inflammation.


Murray ND, Michael and Pizzorno ND, Joseph. Encyclopedia of Natural Medicine. Rocklin, CA: Prima Publishing. 1991; 156-170. 

Bastyr Clinic Handouts Cholesterol: The Good, the Bad and the Ugly