Cholesterol Demystified

May 28, 2024

What is cholesterol? Is all cholesterol bad? Do eggs have too much cholesterol? Should I be on a vegetarian diet if I have high cholesterol?

Do you have similar questions in regards to your cholesterol? The facts can be confusing.

Cholesterol is a key factor in the development of your hormones, it is the key factor in the steroidogenic pathway. Everyone needs cholesterol to survive. Cholesterol is present in our brains, cell membranes, and endocrine system. 80% of our cholesterol is made in our bodies. However, too much of a good thing is not always good. Elevated cholesterol levels can lead to cardiovascular disease and stroke. It’s important to dive deeper into your cholesterol panel by looking at the total numbers of cholesterol. The standard lipid test measures cholesterol levels by the weight of the particles. However, there is another way to evaluate cholesterol, by looking at the direct number and particle size through NMR (nuclear magnetic resonance). This gives us a better understanding of the type of cholesterol your body makes as well as if you are developing insulin resistance.

Not all cholesterol is bad.

There is a delicate balance. HDL often known as the “good cholesterol” should not be too low or too high. Just like in Goldilocks, you want it to be just right. Triglycerides, think “sugary, sticky substance” needs to be on the lower side. LDL cholesterol, aka “bad cholesterol” are more likely to turn into plaque and can clog the arteries. 

Now the question on eggs? 

Eggs do contain cholesterol in the yolk ranging from 180-210 mg of cholesterol per egg. Eggs are chocked full of essential nutrients, like protein, choline, lutein, Vitamin D, etc.  

In 1999, research claimed that eggs were too high in cholesterol and that we should limit our intake of eggs. However, after much further research, it has been found that eggs in moderation ~ 6 per week, have not been shown to elevate cholesterol levels. It is often the saturated fats, from meats, butter, and oils that are eaten at the same time as the eggs that tend to elevate cholesterol.

Lowering your cholesterol naturally can begin with lifestyle modifications. You do not have to become a vegetarian or vegan to lower your cholesterol. However, shifting your mindset and incorporating more plants into your diet can help! Think, plant-centered diet.

When eating red meat, opt for grass-fed, grass-finished meats. Incorporate more cold water fish like salmon, mackerel, anchovies, sardines and herring. 

Implementing 150 minutes of exercise a week can help lower your levels, along with reducing your alcohol intake and smoking cessation. 

There are some natural supplements that can be incorporated to help lower your cholesterol levels as well, Red yeast rice, CoQ 10, plant sterols, to name a few.

Many people can be successful in lowering their cholesterol levels by implementing these lifestyle modifications. Specialized testing can also help your healthcare provider dial in a specific plan to meet your specific needs.

Understanding Cholesterol: Myths and Facts

Cholesterol plays a crucial role in hormone development; it is a key component of the steroidogenic pathway. Contrary to popular belief, not all cholesterol is harmful. In fact, it’s essential for various bodily functions, including brain health, cell membrane structure, and endocrine system function. Around 80% of required cholesterol is synthesized within our bodies. However, excessive levels can pose serious health risks, such as cardiovascular disease and stroke.

When assessing cholesterol levels, it’s important to delve deeper than just standard calculated lipid levels that measure cholesterol by particle weight. Utilizing methods like NMR (nuclear magnetic resonance) can provide a more detailed analysis that includes particle number and particle size. LDL particle testing assesses the relative amounts of particles with differing properties in the blood, a practice often referred to as subfraction testing. Unlike traditional lipid testing, which measures the amount of LDL cholesterol (LDL-C), LDL particle testing evaluates the number of LDL particles (LDL-P). Research indicates that increased numbers of small, dense LDL particles (sdLDL) are associated with inflammation and pose a higher risk of atherosclerosis compared to fewer light, fluffy LDL particles.

It’s worth noting that individuals with elevated sdLDL levels may experience heart attacks despite having total cholesterol and LDL cholesterol concentrations that are not particularly high. This suggests that the presence of an increased number of sdLDL particles could be a contributing factor to cardiovascular events.

HDL, often referred to as “good cholesterol,” should ideally be within a moderate range, neither too low nor too high. Triglycerides, on the other hand, should be kept on the lower side to minimize health risks. LDL cholesterol, often labeled as “bad cholesterol,” has a higher propensity to form plaque, potentially leading to artery blockages.

Lowering cholesterol levels naturally begins with lifestyle modifications. A shift towards a plant-centric diet decreases inflammation and in turn decreases lipid levels and chronic disease risk. This is because animal protein (think meat and dairy) contains more omega-6 fatty acids, the inflammatory fatty acids that can increase risk of chronic disease, in contrast to the anti-inflammatory omega-3 fatty acids found in wild caught fish. This doesn’t necessarily mean adopting a vegetarian or vegan diet, but instead focusing on what is plentiful in a diet – lots of plants! Think of animal protein as an “accompayny-meat” to all the vegetables and whole grains on your plate and stick to grass fed, pastured, and wild-caught options.

Now, let’s address the common question about eggs. Yes, eggs do contain cholesterol, primarily found in the yolk, with levels ranging from 180-210 mg per egg. However, eggs are also rich in essential nutrients such as protein, choline, lutein, and vitamin D. Despite past concerns suggesting limitations on egg consumption due to cholesterol content, recent research indicates that moderate egg intake, approximately 6 per week, does not significantly elevate cholesterol levels. 

Additionally, regular physical activity, at a minimum of 150 minutes of moderate exercise per week, can contribute to cholesterol reduction, along with limiting alcohol intake and quitting smoking. 

Many individuals can effectively manage their cholesterol through lifestyle adjustments. Specialized testing and personalized guidance from healthcare providers can further tailor a plan to meet individual needs. We do advanced lipid testing on our patients here at Spruce MD and then establish a collaborative treatment plan to help lower cardiovascular risk if levels are elevated that can involve lifestyle recommendations, nutrition counseling, supplements, and/or medication.

Cynthia Boswell is a board certified and Functional Medicine trained adult Nurse Practitioner with expertise in hormone, thyroid, geriatric, and chronic disease management.

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Mary Brittain Blankenship, MD, FAIHM

Dr. Blankenship

Mary Brittain Blankenship, is the founder and physician at Spruce MD Integrative Medicine. Board certified in both Internal Medicine and Integrative Medicine, she sees patients locally at her practice in Greenville, SC and virtually nationwide.

Registered Dietician

Integrative and Functional Medicine Providers