Cholesterol has had a terrible PR run. For decades it’s been blamed for heart disease, stripped out of foods, and treated as something to suppress at all costs. Many people agonise over a single blood test number (total cholesterol usually), convinced it tells the full story about their health.
But I can assure you - it doesn’t.
Cholesterol is not something that has ‘gone wrong’ in the modern body. It’s a fundamental biological substance, tightly regulated, and deeply involved in repair, hormone production and cellular function. The real issue is not cholesterol itself, but context - what’s happening metabolically and inflammatory-wise in the body that cholesterol is responding to.
I’d also highlight that the demonising of cholesterol, and the push for very low levels, directly correlates with the huge spike in neurodegenerative disease prevalence. This is because the brain is actually made from cholesterol, and without it our brain cannot function or repair itself properly.
Let’s slow it down and look at what cholesterol actually is, how it works, and when it does (and doesn’t) matter.
What is cholesterol?
Cholesterol is a waxy, fat-like molecule that your body needs to function. Every cell membrane relies on cholesterol for structure and fluidity, particularly brain cells. Without cholesterol, nerve signalling, hormone production and digestion would quite literally fall apart.
It’s also the building block for:
- Steroid hormones (oestrogen, progesterone, testosterone, cortisol)
- Vitamin D
- Bile acids, which allow us to digest and absorb fats and fat-soluble vitamins
Crucially, around 80-90% of the cholesterol in your body is made by your liver. Only a small proportion comes from food. That alone should tell us that cholesterol is not a dietary accident, but a carefully regulated internal system. If cholesterol were inherently harmful, evolution would have dealt with it a long time ago!
The different types of cholesterol (and why the names are misleading)
What we call ‘cholesterol’ on a blood test is actually a set of lipoproteins, transport particles that carry cholesterol and fats around the bloodstream.
LDL (low-density lipoprotein AKA more fat than protein in this combined molecule)
Often labelled the ‘bad’ cholesterol, LDL’s job is to deliver cholesterol to tissues that need it. This includes tissues undergoing repair, hormone-producing glands, and the immune system during periods of stress or inflammation. LDL isn’t harmful by default. It’s responsive.
HDL (high-density lipoprotein AKA more protein than fat)
HDL is often called the ‘good’ cholesterol because it helps transport excess cholesterol back to the liver for recycling or disposal. Higher HDL is generally associated with better metabolic health, but again, context matters.
Total cholesterol
This is simply a calculation. On its own, it tells us very little.
What standard tests don’t usually show is particle size, oxidation, or how LDL is behaving in an inflammatory environment - which is where the real risk lies. For an accurate picture of your cardiac risk and lipid handling you’d want a test like this or this.
When cholesterol can go wrong
Cholesterol doesn’t cause cardiovascular disease in isolation. It becomes a problem when it’s involved in a broader picture of metabolic dysfunction and chronic inflammation.
For cholesterol to contribute to plaque formation, the lining of the blood vessels must already be damaged. That damage is driven by factors such as:
- Chronic inflammation
- Insulin resistance and blood sugar dysregulation
- Oxidative stress
- Smoking
- Nutrient deficiencies
- Long-term psychological stress
In these conditions, LDL particles are more likely to become oxidised and be smaller and denser - forms that are more likely to contribute to atherosclerosis (chronic inflammation-driven damage and repair of arteries).
This is why someone can have ‘normal’ cholesterol and still be at high cardiovascular risk, while another person has elevated LDL but excellent metabolic markers and low inflammation.
Cholesterol is not the fire, but in the wrong conditions it can become the kindling that is then ignited by one of the sparks above.
When we do need to pay attention
Cholesterol becomes more clinically relevant when it appears alongside other warning signs, such as:
- High triglycerides
- Low HDL
- Elevated fasting glucose or HbA1c
- Markers of inflammation
- Strong family history of early cardiovascular disease
Even then, the most useful question is not How do we lower cholesterol? but Why is the body handling cholesterol this way?
Lowering a number without addressing the underlying drivers doesn’t equal improved health.
What actually supports healthy cholesterol
From a functional medicine perspective, ‘healthy cholesterol’ is really shorthand for a healthy metabolic and inflammatory environment.
That means focusing on:
- Stable blood sugar. Repeated glucose spikes drive inflammation and alter lipid patterns far more than dietary cholesterol ever will.
- Reducing chronic inflammation. This includes addressing gut health, nutrient status, sleep quality, stress load and exposure to ultra-processed foods.
- Supporting liver function. The liver is central to cholesterol production, recycling and bile flow. If it’s overwhelmed, cholesterol handling suffers.
- Appropriate fats. Traditional fats - olive oil, butter, ghee, oily fish - behave very differently in the body compared to industrial seed oils, which are prone to oxidation.
- Lifestyle factors. Movement, sleep, stress management and not smoking all have a measurable impact on lipid patterns.
Practical top tips
- Don’t fixate on total cholesterol in isolation
- Look at triglycerides and HDL together, they’re often more informative
- Prioritise blood sugar regulation before worrying about fat intake
- Eat real, minimally processed food
- Don’t fear cholesterol-rich foods like eggs - for most people, they’re nutritionally valuable
- Address stress seriously; cortisol and cholesterol are biochemically linked
- If cholesterol is high, ask why before trying to suppress it
Cholesterol isn’t the enemy it’s been made out to be. It’s a biological tool, and one that reflects what’s happening beneath the surface. When we stop trying to silence it and start interpreting it properly, it becomes a useful piece of information rather than something to fear.
And yes - eggs are still very much allowed! 🍳
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