Cholesterol: A Clue to Metabolic Health

Aug 18, 2026

When it comes to heart health as we age, cholesterol is one of the most talked-about and misunderstood topics. For many people once they hit middle age, the message has long been simple: lower your cholesterol or else. But what if this obsession with lowering cholesterol comes with side effects and isn’t addressing the root cause of why our levels are going up in the first place? Cholesterol isn’t inherently bad, it’s absolutely essential for our bodies to function. Perhaps the questions to ask are: What kind of cholesterol matters? How and why is it made? What do our levels tell us in context with the bigger health picture? What can we do about it?

**Essential functions of cholesterol in the body.**

What Exactly Is Cholesterol?

Cholesterol is a waxy, fat-like substance found in every cell of your body. It’s not just something that floats around in your bloodstream, it plays a vital role in producing hormones (like estrogen and testosterone), making vitamin D, and building the walls of every one of your cells. It also helps your liver produce bile acids, which are essential for digesting fats.

Your body makes most of its cholesterol—about 80% of it—in the liver and other cells. The remaining 20% comes from the food you eat but here’s where it gets interesting: when you eat more cholesterol, your body can compensate by making less. When you eat less, it makes more. This self-regulating system shows that the body treats cholesterol as a critical resource, and the amount you eat has little impact on the cholesterol levels in your body as explained in this article.

Understanding LDL, HDL, and Risks

Not all cholesterol is created equal. Because cholesterol is hydrophobic (doesn’t mix with water), it must travel through the bloodstream inside particles called lipoproteins. The most well-known of these are LDL and HDL.

LDL (Low-Density Lipoprotein) is often labelled “bad” cholesterol, but this is an oversimplification. LDL moves cholesterol around the body to where it is needed for cell repair, depositing it in the target tissue. Blaming this cholesterol for heart disease is like blaming ambulances for car accidents. Cholesterol is often found at the scene, but that doesn’t mean it caused the problem, it is usually trying to repair the damage, not create it. LDL consists of:

80% large buoyant particles which float and are unlikely to get deposited and stuck in arterial walls, underneath endothelial cells, so do not create plaque. These are cardiovascular neutral, meaning they don’t have an impact on cardiovascular risk.
20% small dense particles that don’t float, they sink, and can fit underneath endothelial cells, start plaque formation, and cause arterial problems. These are
inflammatory and increase the risk of heart disease.

The problem? Normal tests do not distinguish between the two types of LDL, just a sum of both (the specific test you need for this is called LDL-P for particle number). On its own, LDL is not a good indicator of cardiovascular health risk.

HDL (High-Density Lipoprotein), often known as “good” cholesterol, does the opposite. It helps remove cholesterol from the bloodstream, transporting it back to the liver for recycling or disposal. Higher HDL levels are associated with a lower risk of heart disease.

Triglycerides are another type of fat in your blood. They’re not technically cholesterol, but they play a key role in heart health. Triglycerides are a type of fat that the body uses to store and transport energy. If your levels are high, you are consuming too many carbohydrates / high-glycaemic foods that you are not using, and your body is storing them in fat tissue. Once triglycerides have delivered their load, they become the LDL particles that can get lodged in artery walls. A person who is insulin resistant i.e whose body no longer allows glucose to enter cells as easily, will likely see a rise in triglyceride levels. Triglycerides are an indicator for glucose intake and how well your liver handles the sugar in your diet.

What matters most is the overall pattern and trends. It is important to take your ‘numbers’ and look at them in context with other metabolic markers to understand what your body is trying to tell you. High LDL, low HDL, and high triglycerides are a red flag for cardiovascular risk; but not all LDL is equally dangerous, and what about your blood sugar and blood pressure?

Your cholesterol is not just a number; it’s a clue to what is going on at a deeper level with your metabolic health. Metabolic dysfunction can drive disease if not addressed.

Why Cholesterol Changes with Age and Menopause

As we age, our lipid profiles naturally shift. For men, LDL levels often begin to rise in midlife. For women, there’s often a sharp increase in LDL and total cholesterol after menopause. That’s because estrogen plays a protective role: it supports higher HDL, keeps LDL in check, and enhances blood vessel and insulin function. When estrogen drops, that protection fades, and cholesterol levels can rise—even without any change in diet.

Another function of estrogen is to help with insulin sensitivity so that we react appropriately to blood sugar spikes. As we go through menopause, or if we have difficulty managing blood-sugar anyway, we may find our insulin levels increase. Insulin has many functions in the body, and one of them is to signal the liver to make more cholesterol. High insulin or insulin resistance will turn up the speed and amount of cholesterol you produce.

This isn’t just a matter of numbers on a blood test. Post-menopausal women also experience changes in how cholesterol behaves as their biology changes, with more small, dense LDL and higher levels of lipoprotein(a).

The Role of Statins and the CoQ10 Connection

Statins are among the most widely prescribed drugs in the world. But they aren’t without controversy and there is some question as to how beneficial they are for women who have no history of heart disease.

Statins work by blocking HMG-CoA reductase, an enzyme involved in cholesterol production in the liver. But that same pathway also produces CoQ10, a compound essential for energy production in your cells, especially in the heart and muscles. That’s why some people on statins experience muscle pain, weakness, or fatigue. Given that women in menopause often complain of musculoskeletal pain anyway, can adding a statin cause even more discomfort?

Supplementing with CoQ10 may help alleviate those symptoms and support overall energy levels. It’s a simple addition that many integrative practitioners recommend alongside statin therapy but as with all medications and supplements, it’s important to weigh the risks and benefits with your healthcare provider.

mediterranean heart healthy food

How to Manage Healthy Cholesterol Naturally

While statins remain a cornerstone of treatment in high-risk patients or men with existing heart disease, some experts urge caution about their widespread use for primary prevention, particularly for women. The argument is that the benefits in lower-risk individuals are often overstated, and that inflammation, insulin resistance, poor diet, and stress are the real drivers of heart disease — not cholesterol alone. Addressing metabolic health by focusing on glucose stability, nutrient-dense foods and lifestyle factors is far more impactful than chasing numbers on a lipid panel. Do you know what your HbA1C, your fasting insulin, your liver enzymes and thyroid hormones, your ferritin, your homocysteine, your Apo B protein levels, your C-reactive Protein, your blood pressure or your Vitamin D levels are? This will give you more a picture of your metabolic health. Learn how to interpret your test results with The 2024 Levels Guide to understanding your cholesterol panel and blood tests.

Cholesterol is a clue, but not the whole picture.

While medication is sometimes necessary, many people can improve their lipid profiles significantly through lifestyle and nutrition.

A Mediterranean-style diet—rich in vegetables, olive oil, nuts, fish, and fibre—has consistently been shown to support healthy cholesterol levels. Soluble fibre, found in oats, bean, pulses, nuts, fruits and vegetables (eat the rainbow!), helps trap cholesterol in the gut and remove it from the body. Omega-3 fatty acids, from fish or supplements, reduce triglycerides and may raise HDL. A Mediterranean diet is naturally low in refined sugars and can help maintain stable blood sugar levels.
Exercise is another powerful tool. Regular physical activity not only improves HDL but also enhances insulin sensitivity, reduces inflammation, and lowers triglycerides. 💪Muscular strength has a protective effect on all-cause mortality, so your ability to do pushups may be a better marker for health than your LDL cholesterol levels!
Stress reduction, better sleep, and quitting smoking all play important roles too.
Targeted supplements can also support lipid balance. Red yeast rice, niacin (vitamin B3), probiotics and soluble fibre supplements all show benefit. CoQ10, while not directly lowering cholesterol, helps support mitochondrial function and can reduce the muscle pain associated with statin use.

Takeaway

Cholesterol is not the villain it’s often made out to be. It’s a vital molecule with complex roles in the body. The goal isn’t to eliminate it, but to manage it wisely, listening to what it’s trying to tell us, supporting the body’s natural balance through diet, lifestyle, and, when needed, smart supplementation or medication.

Understanding how cholesterol functions, the importance of metabolic health, and how to influence these naturally, especially for those over 50 and especially for women in or after menopause, can be one of the most powerful ways to support long-term heart and brain health.

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