Here are some details about cholesterol, and some advice for taking a sensible view of cholesterol levels in your body.

What is cholesterol, and what does it do?

Cholesterol is a waxy material, somewhat like a fat. There is cholesterol in every cell in your body. Cholesterol is made in your liver and in quantities adequate to fulfill your daily need for it. Once produced, cholesterol is carried through the bloodstream to your cells in tiny packages that consist of fat (lipid) wrapped up in a protein; these cholesterol carriers are called lipoproteins.

Cholesterol is critical to normal development and continued health. It is used by your body to ensure production and care of a wide variety of essentials, including, most basically, the cell membranes themselves. It serves also as a protection for nerve cells, and in sunlight, the cholesterol in the skin of your arms and legs is converted into the important vitamin D. Many hormones, including testosterone and estrogen, owe their existence to cholesterol, as do the bile acids that help digest your food. Cholesterol is involved in forming your memories and is vital for normal neurological function.

What is “good” or “bad” cholesterol?

There is no such thing as “good” or “bad” cholesterol; cholesterol is cholesterol and is crucial to your well-being. The “good” or “bad” labels have to do entirely with the lipoproteins that carry cholesterol throughout your body; they are called high-density (HDL) and low-density (LDL) lipoproteins.

Like most processes in your body, cholesterol production, usage and disposition is cyclic. That is, cholesterol is produced in the liver, is transported to cells using LDL carriers, does its work, and is returned to the liver and other organs for reuse or excretion using HDL carriers.

The “bad” label is conventionally attached to LDL because in some cases it can form plaques — fatty, inflamed deposits — on the inside walls of your arteries. These deposits collect white blood cells, as well, and build up lesions along the blood vessels, narrowing them and sometimes rupturing to release clots into the bloodstream.

As it happens, not all LDL is bad, but only what’s called small-particle LDL because it’s only the small, dense particles that can penetrate the lining of the vessels to form plaques. The light and fluffy, large, and not-so-dense particle LDL is not a problem. Alas, the standard cholesterol blood tests don’t tell which LDL particles are prevalent, but there is a particle test that you may request from your doctor if there is a question.

HDL is called “good” because it scavenges the deposits left by LDL, returning them to the liver for removal from your body.

What about cholesterol and diet?

Many of the things that can go wrong with our bodies can be avoided or cured by the things we eat, combined with regular exercise. Where cholesterol is concerned, there have been many inaccurate ideas promoted over the last few decades.

It has been widely accepted that eating high-cholesterol foods increases the level of cholesterol in your blood, and it’s true that your body will take from your food whatever cholesterol it can get. However, research has not established a connection between eating high-cholesterol foods, such as eggs, with the level of cholesterol in your blood. In fact, the result is not an increase in blood cholesterol, but rather a decrease in the amount of cholesterol produced by your liver.

Your body seems to prefer getting cholesterol from your food, as the internal manufacture of the 2 grams a day of cholesterol you need is a complex biochemical process that stresses the liver. And so, eating a highly nutritious, cholesterol-laden egg a day is not only not bad, but it’s doing your liver a favor.

How about cholesterol and heart disease?

Statins are drugs widely prescribed to those whose cholesterol levels are high. They work by inhibiting your liver’s ability to produce cholesterol. This is done ostensibly to reduce your risk of heart attack.

However, although cholesterol is a minor contributor to heart disease, it scores very poorly in predicting a heart attack. Most people, over half, who come to hospitals with a heart attack have cholesterol within the accepted normal limits. The risk of heart disease from cholesterol pales behind lifestyle risk factors such as smoking, excess alcohol, lack of exercise, obesity and a diet high in carbohydrates.

And so artificially lowering cholesterol with drugs not only does little to head off heart disease, but it robs the body, especially the brain, of one of its most critical supports. Statin drugs, for example, are known to have adverse effects on musculature, and some have reported a decline in mental acuity, as well.

By far, the more beneficial approach is to work on ways to increase your level of HDL.

Viva HDL!

Here are some thoughts about how to maintain high levels of HDL in your body.

Start by including exercise in your daily schedule. A few years ago, I happened to have my cholesterol measured around two periods of inactivity. What I saw was that HDL fell during the period in which I could not take my daily 2-mile walk. Within a few days of returning to regular walking, however, the level of HDL increased dramatically.

Next, get rid of processed foods in your diet. These are known to increase your dangerous small-particle LDL, being generally full of heart disease risk factors like sugar and carbohydrates, trans fats, and more. Eat natural foods, preferably those that are organic and locally grown.

Get rid of no-fat and low-fat foods, replacing them with foods that are high in healthy saturated fats, especially omega-3. Sources include avocados, coconut and its oil, organic nuts and their oils, and copious amounts of fresh leafy green vegetables. In addition, prefer meats, eggs, butter and other dairy products that come from grass-fed and free-range critters.

Quit smoking, and manage your consumption of alcohol.

Avoid statins with their side effects and debatable benefits. That said, there are some who can benefit from artificially reducing cholesterol production, but this is a decision that needs to be made with your doctor in extreme cases.


When you have your annual physical exam blood tests, be sure to ask your doctor to include cholesterol measures. Appropriate cholesterol levels are best measured by two numbers: the ratio of HDL to total cholesterol, which should be above 24%, and the ratio of triglycerides to HDL, which should be less than 2-to-1. Triglycerides are another fatty heart disease risk factor.

With today’s knowledge and experience, cholesterol does not need to be a problem, except perhaps for those with a family history of what’s called hypercholesterolemia (too much cholesterol), which resists the lifestyle and dietary factors I describe. Generally, you need cholesterol and a lot of it, and you are in control of the relationship between LDL and HDL carriers in your blood.

Bob Keller maintains a holistic practice in Newburyport. He offers medical massage therapy for pain relief and advice on muscular balance and diet, as well as psychological counseling, dream work and spiritual direction. Many patients call him Dr. Bob, but he is not a medical doctor. He can be reached at 978-465-5111 or