By Dr. Faith Christensen
Cholesterol gets a bad reputation, but your body genuinely needs it. It’s a fat used to build cell walls and to make hormones like testosterone, estrogen, and cortisol. It’s necessary for nerve impulse transmission and vitamin D production, and it helps digest dietary fats as part of the bile your liver produces.
Most people are surprised to learn that about 80 percent of your total body cholesterol is made by your own liver — only about 20 percent comes from food, like eggs, dairy, meat, poultry, fish, and shellfish. Normally, as your total cholesterol rises, your liver produces less, and vice versa, keeping things in balance. But excess sugar intake, along with diet quality overall, can cause that feedback system to fail, and blood cholesterol climbs to unhealthy levels.
What Counts as Healthy Cholesterol
Hypercholesterolemia means high or excessive blood cholesterol. About 1 in 300 people inherit a genetic tendency toward it. For everyone else, it usually develops from diet and lifestyle — a diet high in saturated fat and sugar and low in fiber, lack of exercise, smoking, alcohol and coffee intake, and poor stress management. Diabetes and obesity contribute too, and both raise your risk of heart disease along the way.
Current research points to saturated fat, more than dietary cholesterol itself, as the bigger driver of high LDL. That’s part of why the old advice to strictly limit cholesterol-containing foods like eggs has relaxed in recent years — though many high-cholesterol foods are also high in saturated fat, so the two are still worth paying attention to together.
How Cholesterol Travels Through Your Body
Cholesterol travels through your blood attached to proteins called lipoproteins — LDL, VLDL, HDL, and others. LDL and VLDL, sometimes called “bad cholesterol,” carry cholesterol from your liver out to your cells, while HDL, the “good cholesterol,” carries it back to the liver for breakdown and elimination through bile. A standard lab report’s “total cholesterol” is really just a simplified combination of your HDL and LDL, even though your full lipid picture includes other particles too, like small dense LDL and Lp(a).
How Plaque Forms
Cholesterol becomes a problem when it builds up in your arterial walls and forms plaque. When LDL levels get high enough, HDL can’t keep up with sweeping the excess back to the liver. Over time, plaque can calcify and gradually restrict blood flow, leading to heart attack or stroke depending on which arteries are affected.
Plaque doesn’t form from excess cholesterol alone — it takes inflammation in the arteries plus that excess cholesterol together. Reducing inflammation is a key piece of heart health that often gets overlooked when the focus stays narrowly on lowering cholesterol. Arterial inflammation can be measured through markers like RLP and CRP on blood work, and current cardiology guidelines now give coronary artery calcium (CAC) scoring a top-tier recommendation for directly measuring plaque buildup in the arteries — it’s become one of the most useful tools we have for understanding your actual risk, not just your numbers on paper.
Hidden Causes of Inflammation
- Food sensitivities or allergies
- Dental infections
- Gastrointestinal infections
- Environmental sensitivities
- Chronic viral infections
- Blood sugar imbalances
What You Can Do to Optimize Your Cholesterol
- Get detailed blood work that evaluates your full cholesterol picture, not just LDL and HDL. Current cardiology guidelines now recommend checking Lp(a) at least once in your lifetime, since it’s largely genetic, and ApoB can be especially useful for understanding your real cardiovascular risk when your LDL already looks fine on paper.
- Identify hidden sources of inflammation, listed above, through further lab testing.
- Decrease cholesterol and saturated fat intake by reducing animal products and increasing plant-based fats like flaxseed and olive oil.
- 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.
- Increase garlic and onion consumption.
- Decrease or eliminate sugar.
- Steam, bake, roast, or boil vegetables instead of frying or sautéing in oil. Use a non-stick skillet, or water- or broth-sauté instead. Chill meat or poultry broth until the fat solidifies, then spoon it off.
- Season vegetables with herbs and spices instead of sauces, butter, or margarine.
- Try lemon juice on salads instead of oil-based dressings.
- Use oil instead of shortening in baked goods.
- Swap whole milk for skim or low-fat milk in soups, baked goods, cereal, and coffee.
- Substitute plain non-fat or low-fat yogurt, blended low-fat cottage cheese, or buttermilk for sour cream or mayonnaise in recipes.
- Choose the leanest cuts of meat, ideally grass-fed and organic over grain-fed and conventionally raised.
- Trim visible fat and skin from poultry and meat before cooking.
- Roast, bake, broil, or rotisserie meats, poultry, and fish so the fat drains off while cooking.
- Exercise — it raises HDL, lowers inflammation, and helps balance blood sugar all at once.
- Manage stress effectively. If you’ve been under significant stress, get your adrenal function tested to see what support your cortisol levels actually need.
- Stop smoking.
- Drink alcohol only in moderation, if at all — it contributes to inflammation.
— Dr. Faith Christensen
Sources: 2026 ACC/AHA Dyslipidemia Guideline, National Lipid Association — 2026 Guideline Overview, Dietary Saturated Fat and Cholesterol: Cracking the Myths Around Eggs and Cardiovascular Disease