Understanding the ‘bad guy’ cholesterol (or is it?) and how to support a natural balance
Making sense of cholesterol and factors that may influence it
Introduction
Cholesterol is an essential substance that plays a vital role in the body, yet it is one of the most misunderstood areas of health. Many people view cholesterol purely as something harmful, when in reality we need some for cell structure, hormone production and metabolic health. This article outlines what cholesterol is, how it fits within the broader group of lipids, the different cholesterol carrying particles, why our needs change throughout life, how cholesterol is regulated and how nutrition and lifestyle can support balanced levels.
What cholesterol is and why we need it
Cholesterol is a waxy, fat like substance and is one type of lipid. Lipids are a family of fats that include cholesterol, triglycerides and fatty acids. Although these terms are often discussed together, they each play different roles. Cholesterol is produced mainly by the liver, and although we consume some cholesterol from foods such as meat, eggs and dairy, the body makes the majority because it is required for several essential functions. These include building cell membranes, making hormones such as oestrogen, progesterone and testosterone, producing vitamin D and forming bile acids that support fat digestion. Cholesterol is present in every cell in the body where it contributes to structure, flexibility and communication.
Why cholesterol needs change throughout life
During infancy and childhood, cholesterol supports rapid brain and nervous system development. In reproductive years, cholesterol is required for the creation of sex hormones. As we move into midlife, factors such as changes in metabolism, reduced physical activity, weight gain and hormonal shifts can begin to cause cholesterol imbalance. In women, after menopause, the drop in oestrogen often results in increased LDL and decreased HDL cholesterol (see below for what those are). In men, cholesterol levels can tend to rise gradually with age as metabolism slows, body composition changes and testosterone levels decline. These shifts may raise cardiovascular risk, particularly if other health factors are less than optimal. In older age, maintaining cholesterol balance becomes increasingly important for both cardiovascular health and brain function.
Types of cholesterol, its carriers and other lipids you may hear talked about
Cholesterol travels around the body in particles called lipoproteins. These particles transport cholesterol and triglycerides to and from cells.
LDL cholesterol
LDL stands for low density lipoprotein. It transports cholesterol from the liver to cells. When LDL cholesterol is discussed, it refers to the amount of cholesterol contained inside LDL particles. Although LDL cholesterol is often referred to as bad cholesterol, it is essential for normal function. Problems can arise when LDL becomes too high or when the particles become oxidised, which may contribute to the development of fatty deposits in artery walls.
HDL cholesterol
HDL stands for high density lipoprotein. It collects excess cholesterol from the bloodstream and returns it to the liver for recycling or removal. Higher HDL cholesterol levels are associated with a reduced risk of cardiovascular disease.
Lipoprotein(a)
Lipoprotein(a), often written as Lp(a), is a cholesterol containing particle similar to LDL but with an additional apolipoprotein attached. This structural feature makes it more likely to contribute to inflammation, plaque formation and clotting risk. Lp(a) is genetically determined and is not significantly influenced by diet or lifestyle. Around one in five people have raised levels. A one off blood test can be used to check Lp(a), and testing may be helpful for people with a family history of cardiovascular disease or unexplained high cholesterol.
Non HDL cholesterol
Non HDL cholesterol includes all potentially more harmful cholesterol containing particles and is considered a useful marker of overall cardiovascular risk.
Other lipids and carriers you may hear about when cholesterol is mentioned:
Triglycerides
Triglycerides are another important type of lipid and are different from cholesterol. They are the main form of stored energy in the body. When we eat more energy than we need, the body converts the excess into triglycerides, which are transported in the blood and stored in fat cells for future use. Levels may rise with high intakes of added sugars, refined carbohydrates, alcohol or overall excess energy, and can be influenced by insulin sensitivity and physical activity. Persistently raised triglycerides may contribute to cardiovascular risk, particularly when combined with other metabolic factors.
VLDL
Very low density lipoproteins, or VLDL, primarily transport triglycerides through the bloodstream. They also carry a smaller amount of cholesterol. As VLDL delivers its triglycerides to tissues, it becomes smaller and denser and eventually converts into LDL. Raised VLDL can be associated with metabolic health issues and increased cardiovascular risk.
Fatty acids
Fatty acids are another type of lipid, distinct from both cholesterol and triglycerides in structure and function. They are the basic building blocks of most fats. On their own, they can be used for energy or to support cell structure and signalling. When three fatty acids attach to a glycerol molecule, they form a triglyceride, which is the body’s main form of stored fat. Cholesterol, in contrast, has a ring shaped structure and specific roles in hormones, cell membranes, vitamin D and bile acid production. Triglycerides and cholesterol both require lipoproteins for transport, whereas fatty acids can also circulate freely or be used directly by cells. In simple terms, fatty acids help build and fuel the body, while cholesterol supports structure and metabolic processes.
How cholesterol is regulated in the body
Cholesterol regulation is a dynamic process. The liver produces the most cholesterol in the body (alongside a little in our intestines, adrenal glands and reproductive organs), and also removes it from the blood. Receptors on liver cells play a significant role in clearing LDL from circulation. Bile acids, which are produced in the liver from cholesterol, stored in the gallbladder and released into the small intestine to support fat digestion, are recycled several times a day. The body will adapt its own production depending on dietary intake, but because cholesterol is also influenced by hormones, inflammation, insulin sensitivity, metabolic health and genetics, many different factors can affect levels. This is why two people with similar food intake can have very different cholesterol profiles.
How nutrition can support cholesterol balance
Food choices can play a meaningful role in supporting healthy cholesterol levels, particularly when combined with lifestyle changes. Some of the most evidence based nutritional strategies include:
• choosing unsaturated fats such as olive oil, nuts, seeds and oily fish
• reducing saturated fat intake from foods such as fatty meat and some types of dairy
• increasing soluble fibre from oats, beans, lentils, flaxseed, vegetables and fruit
• including plant foods rich in antioxidants to help reduce oxidative stress
• maintaining a balanced intake of carbohydrates to support insulin sensitivity
Lifestyle factors that may influence cholesterol
Lifestyle has a significant influence on cholesterol metabolism and cardiovascular health. Regular physical activity may help raise HDL and also lower triglycerides. Managing stress can reduce hormonal and inflammatory changes that affect overall lipid balance. Avoiding smoking, moderating alcohol intake, prioritising sleep and maintaining a healthy body composition may all contribute to more balanced cholesterol levels.
Putting it all together
Cholesterol is not something to fear. It is essential for life and the goal is balance rather than elimination. Understanding the different lipoproteins, how they are regulated and how food, lifestyle and genetics interact provides a clearer view of cardiovascular and overall health. It is also important to recognise that cholesterol, even LDL, is not always the sole cause of cardiovascular disease. Some people live long, healthy lives with higher LDL, while others develop disease with what may be considered normal levels. What matters is the wider personal context, including metabolic health, inflammation, blood sugar, lipid particle quality and lifestyle. Cholesterol can be one part of the picture, not always the whole story.
For some people, meaningful improvements can be achieved through evidence based nutrition, movement and targeted support where appropriate. For others, particularly those with raised Lp(a) or familial risk, a combination of medical and nutritional strategies may be required. Personalised guidance with collaborative medical and complementary healthcare offers the most appropriate approach.