6 Most Frequently Asked Questions About Cholesterol 

We asked an expert, Dr. Martin Milner, ND, naturopathic doctor, medical director, and CEO at the Center for Natural Medicine, Inc, to help us answer 6 most frequently asked questions about cholesterol. 

1. What is cholesterol?

Cholesterol is a type of fat or lipid and is actually a modified steroid known as a sterol. Cholesterol is naturally made by all animal cells. In humans, a majority of cholesterol is made in the liver and intestines (80%) and about 20% comes from your food supply. Other organ sites of high levels of cholesterol synthesis include the brain, sex organs, and the adrenal glands. Cholesterol is an essential part of animal cell membranes and is the biochemical building block for the synthesis of bile acids, steroids like cortisone, aldosterone, DHEA, and sex hormones including pregnenolone, progesterone, testosterone, and estrogen as well as vitamin D.   

2. Explain the relevance of cholesterol and its role in the body? 

Cholesterol is essential for life.  So much so that every cell in the body is able to make cholesterol by a complex 37-step process. A 150 lb. male makes about 1,000 mgs. of cholesterol daily. This same size male body contains about 35 grams of cholesterol mostly contained within the cell membranes. Daily cholesterol dietary intake for a man in the United States is about 300 mg. 

Cholesterol composes about 30% of all animal cell membranes. It is required to build and maintain membranes and regulate membrane fluidity over the range of physiological temperatures.  Within the cell membrane, cholesterol also functions in intracellular transport, cell signaling, and nerve conduction.  The majority of cholesterol in the adult brain (about 70%–80%)  is in myelin sheaths which are the protective covering over nerve cells. The brain is the most cholesterol-rich organ, it contains about 20% of the whole body’s cholesterol. Cholesterol is the major sterol in the adult brain, and small amounts of desmosterol and cholesteryl ester are also present. Cholesterol is not only an essential structural component for cellular membrane and myelin, a precursor of steroid hormones and bile acid synthesis, but is also a required component for synapse and dendrite formation.

3. What foods are high in cholesterol?

Animal fats are complex mixtures of triglycerides, with lesser yet significant amounts of cholesterol and phospholipids. Since all animal cells manufacture cholesterol, all animal-based foods contain cholesterol to some degree. High dietary sources of cholesterol include red meat, chicken and other poultry, egg yolks and whole eggs, liver and other organ meats, fish oil, milk and milk products including butter, sour cream, dairy-based kefir, yogurt, cheeses, and cottage cheese.  Human breast milk contains 34 mgs. of cholesterol per 8 ounce serving.

Plant-based food is not a significant source of dietary cholesterol. Some plant foods such as whole grains, unrefined plant oils, nuts, seeds, legumes, and avocado contain high amounts of phytosterols which compete with cholesterol for absorption in the intestines and reduce the absorption of both dietary and bile cholesterol. Most typical diets provide about 0.2 grams of phytosterols daily.  This is not enough to have a significant impact on blocking cholesterol absorption. Phytosterol intake can be supplemented through the use of phytosterols at 2-4 grams daily have been shown to support reducing levels of LDL. 

Ras RT, Geleijnse JM, Trautwein EA (July 2014). "LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomized controlled studies". The British Journal of Nutrition. 112 (2): 214–9. 

4. What do all the lipid parameters mean? Total cholesterol, HDL, LDL, LPA, and triglycerides?

Lipid Profile

Total Cholesterol (TC)

HDL Cholesterol – higher density than water, good guy, can regress arterial disease

LDL Cholesterol – lower density than water, bad guy. Small, less buoyant, causes arterial disease when elevated is classified as Type II hyperlipidemia and is the most common pattern. 

Cholesterol/HDL Ratio - Keep under 3 as an example TC/HDL 180/60 = 3 

Triglycerides (TG) – liver being vulnerable to converting dietary carbohydrates and alcohol into fats as triglycerides and risk for developing diabetes, heart disease, or strokes.

VLDL – very-low-density lipoproteins, often high when triglycerides are elevated. VLDL is not reported in standard lipid panels. It can be calculated by taking TC-LDL-HDL = VLDL which if over 30 with high triglycerides is called Type 4 hyperlipidemia due to excessive dietary carbohydrates and/or alcohol.

Lipoprotein – a corkscrew-shaped tail on the LDL molecule. It is very difficult to reduce, tends to be genetic, and is an added marker not included in a standard lipid panel. High lipoprotein increases stroke risk significantly as well as heart disease risk.

5. What numbers are too high according to my age?

6) How often should I check my cholesterol?

The American Heart Association recommends testing cholesterol every 4–6 years for people aged 20 years or older. 

A separate set of American Heart Association guidelines issued in 2013 indicates that patients taking statin medications should have their cholesterol tested 4–12 weeks after their first dose and then every 3–12 months thereafter. 

A blood sample after 12-hour fasting drinking water only is taken by a doctor, or a home cholesterol-monitoring device is used to measure a lipid profile.

A 10-year risk calculator may be used free of charge and analyses the 10-year risk of developing heart disease or a stroke and to further assess the compelling necessity for a current lipid panel.

The ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator

Open your online browser and search for “ASCVD risk calculator”

Enter your answers to the following questions into the online risk calculator.

1. Age (40-79) the calculator can’t be run once you turn 80 or if you are younger than 40
2. Gender
3. Race
4. Total Cholesterol – most recent labs
5. HDL Cholesterol – most recent labs
6. Systolic Blood Pressure – top BP number after sitting quietly in a chair for 5 minutes
7. Treatment of Blood Pressure
8. Smoker
9. Diabetes

If the result is >5% consider treatment with statins as conventional guidelines or natural agent alternatives.

If the result is >7.5% definitely treat with higher intensity statins as needed to meet cholesterol-lowering goals per conventional guidelines.

SAMPLE RESULT – 68-year-old Caucasian male, hypertensive- medicated and controlled, no diabetes or smoking history, TC = 245, HDL = 40, systolic BP = 120