What is Cholesterol?

Cholesterol is a type of fat that your body needs to survive—it’s essential for cell structure, hormone synthesis, and vitamin D production.

When people talk about “good” versus “bad” cholesterol they’re not actually talking about the cholesterol itself, they’re talking about a structure that carries cholesterol called a lipoprotein.

There are 2 main types of lipoproteins that you’ll hear about when talking about cholesterol HDL (high density lipoprotein) and LDL (low density lipoprotein). Let’s break down the difference.

LDL vs. HDL

LDL is a lipoprotein responsible for transporting cholesterol to different body tissues. The reason LDL gets a negative reputation, often referred to as the “bad” cholesterol” is because if you have too much of it floating around, it can start to deposit where it doesn’t belong, like in the blood vessels. When cholesterol gets deposited in the blood vessels, it can harden forming plaque and lead to narrowing which can raise risk for heart disease.

Though too much LDL can be harmful, let’s be clear that it’s not all bad. LDL is essential for transporting cholesterol to places where it’s needed, such as in hormone production and cell membrane health.

HDL is a lipoprotein responsible for bringing cholesterol from the bloodstream to the liver to be processed or excreted. It gets a positive reputation as the “good” cholesterol because it helps to scrub excess cholesterol from the blood stream, which prevents it from ending up in places that it doesn’t belong like our arteries.

We need both HDL and LDL— the key is the ratio. Having a high level of HDL can help counteract the effects of high LDL. This is why, on blood tests, doctors often look at the ratio of HDL to LDL to evaluate your heart health. If your LDL is high but your HDL is also high, it can help offset the potential risks associated with elevated LDL.

How Much Does Dietary Cholesterol Impact Blood Cholesterol Levels?

The idea that foods high in cholesterol directly lead to high blood cholesterol levels has been mostly disproven. Like many things in nutrition, misinformation can spread quickly.

For most people, eating foods high in cholesterol—such as animal products like meat, cheese, and eggs—does not significantly raise blood cholesterol levels. However, for a small percentage of people with a specific genetic predisposition, consuming foods high in cholesterol can lead to an increase in blood cholesterol levels. These individuals are called “hyperresponders.” Interestingly, this increase in blood cholesterol has not been shown to significantly raise the risk of heart disease in most cases.

What Factors Impact Cholesterol Levels?

So, if food high in cholesterol doesn’t necessarily lead to high blood cholesterol levels, than what are the factors that contribute? There are several…

Genetics

There is a major genetic component to high cholesterol levels. For some people, not matter what they do, they will always be prone to high cholesterol levels because of their genes. That’s likely what will happen to me; my grandpa has high cholesterol, my mom has high cholesterol, and my cholesterol levels have been trending up over the last few years. It’s likely written in the stars for me no matter what lifestyle behaviors I engage in to combat it.

Stress & Sleep

Chronic stress leads to high cortisol levels which can result in increased LDL and decreased HDL. Lack of adequate sleep can impact the liver’s ability to regulate cholesterol production. Plus, being sleep deprived can trigger the body’s stress response and, as discussed, stress in and of itself can be harmful for our cholesterol profiles.

Alcohol & Smoking

Heavy drinking is known to raise LDL and can also lead to liver damage which can impair the liver’s ability to process cholesterol appropriately. Cigarette smoking both increases LDL and decreasing HDL, so it is doubly harmful to your cholesterol profile.

Medications

Some medications have side effects that include elevated cholesterol levels. These medications include steroids, beta-blockers, diuretics, and some anti-psychotics.

Physical Activity Level

Research shows that being physically active can lead to lower LDL and high HDL. On the contrary, being sedentary can contribute to an abnormal cholesterol panel.

PCOS, Age, & Gender

PCOS leads to abnormalities in hormone production and metabolism. As a result cholesterol profiles can be negatively effected.With age the body can become less effective at processing and metabolizing cholesterol. Plus, for women, going through menopause can result in hormone changes that contribute to high cholesterol as well.

Will Losing Weight Help Lower My Cholesterol?

You can probably find a bunch of studies on the internet correlating being higher weight with having higher cholesterol levels. But just because there is a correlation, doesn’t mean there is causation. In other words, this doesn’t mean that the reason people in larger bodies might have higher cholesterol is because of body fat in and of itself. We know weight and cholesterol don’t have a causal relationship because there are people in thin bodies with high cholesterol levels and there are people in larger bodies with normal cholesterol panels.

I’m a good example— I am someone who lives in a body with unearned thin privilege and my cholesterol is trending up. On the contrary, one of my best friends lives in a fat body and year after year, has a normal cholesterol panel.

Interestingly, folks with Anorexia — which often manifests in being underweight— commonly have very high cholesterol levels; another example of how weight is not a determinant of health outcomes.

And if you’re wondering, “okay Leah, then what about all that “research” out there suggesting that weight does impact cholesterol levels.

This could be a whole separate blog post, but what you need to know is this: research often fails to control for other variables that are part of the experience of being fat in our weight stigmatizing culture. To learn more, check out this episode of the podcast, 5 Reasons Why Your Weight Doesn’t Determine Your Health.

What’s The HAES, Intuitive Eating Approach to Managing Cholesterol Levels?

1. Adding, not subtracting.

   As an intuitive eating dietitian, my best piece of advice for you is to work on adding things in, not taking anything away. There is great evidence to show that foods like whole grains, nuts, seeds, legumes, fruits, and vegetables raise HDL, the protective form of cholesterol.

   So, can you look at adding some of these types of foods into your diet? Maybe this looks like sprucing up your pasta dish with some white beans and greens. Or adding thawed some frozen to your morning waffles. Whatever you do, make sure to focus on adding, not restricting. This will help prevent the feeling of deprivation making the behavior more sustainable.

2. Work on your relationship with food

   Working on your relationship with food by rejecting diet culture and embracing Intuitive Eating leads to lower stress levels and higher food-body-choice-congruence; when you eat not only considering immediate taste but also considering the way you want to feel in your body. In time, eating from this place of food-body-choice-congruence often leads you to naturally choose more nutrient-dense foods, for the most part, which can be supportive for your HDL levels.

3. Practice stress management and prioritize sleep

   Focusing on managing your stress levels to the best of your ability can help prevent your body from being in an elevated cortisol state, in turn supporting cholesterol management. I recognize that though there are several stress reduction techniques within our control, there are several systemic stressors in life beyond our control such as weight-stigma, racism, and other types of oppression based on identity, appearance, and more.

   Practicing good sleep hygiene —whatever that means to you personally— can help to foster ideal conditions for your body to metabolize cholesterol.

4. Work on incorporating gentle, joyful movement

   You don’t need to become a marathoner to start seeing benefits in your bloodwork. Any type of movement “counts,” ranging from something as small as rolling your neck and stretching while sitting at your desk to sweating at the gym. No movement is too small, anything you do is ultimately helping to promote blood flow and support metabolism (including cholesterol metabolism). If thinking about adding in more daily movement stresses you out, you’re so not alone! So many folks coming from diet culture have been burned by a coercive relationship with movement. Check out this episode, Finding Pleasure in Movement with Personal Trainer, Hannah Husband to get started rewiring your relationship with exercise.

5. Talk with your doctor about going on a medication

   For many people, even doing all of the above won’t move the needle because of other factors (age, genetics, gender, etc.) In these cases, medications are a great option. Though wellness culture will often try and make you feel like you failed for going on medication, cholesterol meds are very common and nothing to be ashamed of. If, you’re struggling with feeling a strong sense of shame and self-blame around needing medication, keep reading.

   Are Your Cholesterol Levels Your Fault?

   Maybe you’ve tried all of the above and your cholesterol levels are still high. Firstly, you are so not alone. This is such a common experience, especially because there is such a strong genetic component at play.

   Perhaps you logically know there are various factors out of your control, but you still feel like having high cholesterol is a moral failing.

   Many of my clients feel this way, and it makes sense why…

   Diet culture promotes this message that our health outcomes are solely a matter of personal responsibility. “It’s as simple as diet and exercise,” they say. By that logic, it’d make sense that you’re feeling a sense of shame and self-blame around you cholesterol levels.

   But the truth is, your health outcomes are not your fault. They are not solely a matter of personal responsibility. In fact, there are so many other factors at play, and our personal behaviors have a smaller impact than we’ve been led to believe.

In this podcast episode with my former client, Kayla, we walk through the belief she held that her cholesterol levels were her fault.

I ask her 3 questions:

Is it kind?

Is it true?

is it helpful?

Even if your cholesterol levels were solely a matter of personal responsibility, what’s the purpose of blaming yourself?

Is it kind to say “your cholesterol levels are your fault.”

Certainly not.

Is it true?

Well, this one is a little more complex. Likely, it’s not true, but we can hold a little space for the reality that, on some level, your personal behaviors may have contributed to your cholesterol levels. but even if it were true….

Is it helpful?

Does blaming yourself for your cholesterol levels help the situation at all? Does it change the fact that you have high cholesterol levels?

No! It just makes you feel worse. Shame is never a motivator for sustainable change.

If you’re currently trying to unlearn this idea that your health is your fault, I recommended coming up with some sort of impactful reframe. Listen to me coach my former client through this process on our recent episode of the podcast.

The Roseto Effect

Theres a great study I like to share with clients to illustrate what I mean when I say our health outcomes are not solely a matter of diet and exercise.

In this well-known epidemiological study called “The Roseto effect,” a community of Italian immigrants were curiously found to have very low incidences of heart disease despite having diets that were very high in foods that we normally associate with higher rates of heart disease.

Researchers studied this community and found that this group of people was extremely close knit, having really strong social cohesion and community support systems. It was determined that these close social relationships— and subsequent decreased communal stress levels— were what lead to these low rates of heart disease in the community (PBS).

Many people would likely be surprised to learn that community context can actually have a greater impact on health than one’s diet, but this study does a great job of capturing that reality. There have now been various other epidemiological studies with identical findings: social and community ties is an incredibly strong predictor for health outcomes.

Wrap-up

You can absolutely continue to practice intuitive eating even if you got a diagnosis of high cholesterol. You do not have to go down the slippery slope of cutting out foods in order to improve your cholesterol panel. You can take the approach of adding in high fiber foods, engaging in gentle movement, and practicing sleep hygiene and stress management. And remember, your health outcomes are not your fault— they’re a result of multiple factors, many of which are out of your control.

If you just read this whole blog post and you’re craving even more, I’d love to invite you to enroll in my self-paced, online course, The Return.

This course guides you step by step through making peace with food and finding body acceptance so you can live your most expansive life. The method I teach in The Return has already helped hundreds of human beings find food and body peace.  Learn more and enroll here.