Overall health vs cardiovascular health? Is low cholesterol really healthy?

My mom loves seafood and it rubbed off on all of her kids. As we drooled over the 12 oz. lobster tails and octopuses at the specialty market, she passed on those things saying, “These have high cholesterol.”

She is fairly educated and definitely not stupid, but I find it interesting that the cholesterol propaganda has caused her to think that cholesterol is absolute poison and that all high cholesterol foods should be avoided. Unfortunately, lots of yummy and nutritious foods are usually high in cholesterol.

It is intuitive to think that eating high cholesterol foods will raise blood cholesterol levels. That is simply not true because the body produces most of the cholesterol depending on the needs. If we eat more cholesterol, it produces less. We need cholesterol to stabilize the membranes of every single cell in our bodies, as well as to make hormones and vitamin D. Stress and inflammation increase the needs for cholesterol, and that may raise cholesterol levels. Humans with genetic defects that prevent them from making cholesterol, either die shortly after birth or exhibit mental retardation and developmental abnormalities.

I myself have experienced having very low cholesterol. A few years back, I was mega-dosing a plant sterol supplement to control my allergies and eczema, but I wasn’t aware that plant sterols are potent cholesterol reducers as well as immune stimulants. At the same time, I was going through a lot of stress in graduate school, working out 12 hours a week and dieting to lean out. My total cholesterol level was borderline hypocholesterolemia (low enough to need intervention) at 4.1 mm/dL or 158.3 mg/L. Although the number may not be out of range, it was definitely too low to be healthy for me. Alas, my doctor told me that my bloodwork looked perfect.

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My perfect bloodwork while I was a complete mess.

Generally, stress and inflammation may increase cholesterol because there is greater needs to produce the stress hormones cortisol, among other things. However, because my cholesterol was artificially lowered, my body wasn’t able to produce enough cortisol and sex hormones; I experienced what many people call “stage 3 adrenal fatigue.” The adrenal crash, together with the immune stimulating effect of the plant sterol and my stress levels, caused the biggest eczema and allergy flare-up I had ever had. My upper body was nearly covered in eczema. I became allergic to things I had not been allergic to my entire life. Also, my cycles were prolonged to up to 50 days in between. I was also very depressed and had very little energy, possibly because of low sex hormones, vitamin D, cortisol, and everything else that was made of cholesterol. I’ve since stopped the culprit supplement, and gobbled up some butter, my cycles have normalized, I cleared up the eczema completely (mostly with nutrition) and the depression is gone.

I’m absolutely not saying that no one on the planet needs to lower their cholesterol. We need to be reminded that all diseases, including cardiovascular diseases (CVDs), are multi-factorial. It usually takes more than one factor to cause heart disease or stroke. The total cholesterol number alone is not indicative of heart disease risk, unless it is more than 330 mg/L. Generally, factor that put people at higher CVD risk include smoking or oxidative stress, being overweight, diabetes or insulin resistance, hypertension, lack of physical activity and unhealthy diet. If you are curious, try the Framingham Risk Assessment Tool to estimate your 10-year risk of developing CVDs.


The general model of how CVDs occur is that there is an insult to the arterial wall, such as a tear and then the body attempts to repair the tear by depositing oxidized cholesterol, fat, calcium and blood clot. As with any tissue repair process, this involves inflammation. People with more inflammation levels have faster plague buildup than those who don’t. The initial insult to the arterial walls happen because of oxidative stress and blood pressure. Also, oxidized fat and cholesterol get deposited in the plagues. While there is no direct scientific evidence that high cholesterol on its own cause diseases in humans, reducing cholesterol in people with previous heart attacks reduce the risks of subsequent heart attacks given that they also have high cholesterol.

In addition, there are subclasses of LDL (the generally called “bad” cholesterol) which are not commonly tested for in standard bloodwork.  Small, dense LDLs with oxidized fats and cholesterol are much more likely to cause CVDs than larger, more buoyant LDL particles. It seems like diets higher in refined carbohydrate, rather than dietary saturated fats or cholesterol, increase bad LDLs.

With all of that said, the way to manage your cardiovascular risk is not by avoiding high cholesterol foods. If you are reading this, I assume that you are in shape and eat a healthy diet. Here’s my take on how I usually help my clients manage their CVD risks if that is their concern.

  1. Eat a low glycemic impact diet
  2. Cut back on fructose
  3. Reduce inflammation with a fish oil supplement. In some cases I may recommend additional antioxidants such as curcumin. Also, maybe I would put them on an elimination diet or run a gut pathogen screen to reduce inflammation.
  4. Eliminate all sources of refined high-omega-6 oils (i.e. vegetable oils), especially ones that has been heated. Focus on monounsaturated fats such as olive oil, avocado oils and macadamia nut oils.
  5. Manage stress
  6. (If the doctor clears) exercise
  7. Supplements like plant sterols (in moderate dose), niacin and vitamin C may help reduce cholesterol.

For many athletic people, rather than cardiovascular concerns, the converse is true that they need to maintain healthy cholesterol levels while keeping oxidative stress in check. Therefore, if they have symptoms of hormone imbalances, I generally recommend adding fattier cuts of meats from healthy sources to their diets. Since exercise increases oxidative stress, athletic people could benefit from diets higher in antioxidants, and perhaps supplementation.

In case you are wondering about the blood numbers to look for, check out Dr. Spencer Nadolsky’s blog post.

Also, if you have any questions, feel free to ask in the comments below.