Cholesterol 101: Why the Number Isn't the Whole Story
If you've had bloodwork done recently and were told that you have high cholesterol and need a statin, you’re not alone, and you may not be getting the full picture. Cholesterol is essential to health. It’s part of every cell membrane, plays a role in many hormone pathways, and is required for vitamin D production. The goal shouldn’t be to eliminate cholesterol, but rather to understand why your cholesterol is elevated and work to support healthy cholesterol balance.
Why Healthy Cholesterol Matters
Cholesterol becomes a problem when it gets stuck in your arteries, triggering inflammation and eventually plaque buildup, or atherosclerosis. This is the process behind most strokes and heart attacks, which we want to prevent. The problem isn’t cholesterol itself however, but rather the process of arterial injury and plaque formation. Keeping LDL, or “bad” cholesterol, in a healthy range is one of the modifiable factors we have for long-term cardiovascular health and is why your doctor may be telling you to lower your cholesterol.
Before Reaching for a Statin, Ask Why
A standard lipid panel is a snapshot of your cholesterol. Two people can have identical LDL for very different reasons, and the reason should shape treatment. Common causes of high cholesterol include the following:
Postmenopausal shift: declining estrogen reduces LDL clearance, often raising cholesterol significantly despite no change in diet or exercise.
Hypothyroidism, even if subclinical: thyroid hormone is needed for the liver to clear LDL efficiently.
Genetics: familial hypercholesterolemia impact about 1 in 250 people and is often missed in otherwise health, lean individuals.
Insulin resistance: a metabolic imbalance that raises triglycerides and small, dense LDL.
Diet and lifestyle: refined carbs, alcohol, poor sleep, and chronic stress all contribute.
Identifying which of these is driving your high cholesterol changes the treatment plan, which is why we don’t jump straight to a prescription.
Going Beyond the Standard Panel
A standard lipid panel shows you your total cholesterol, LDL (bad cholesterol), HDL (good cholesterol), and triglycerides. This information is useful, but for some is incomplete. Advanced lipid testing can fill in the gaps. Advanced testing often includes the following markers:
ApoB: measures how many atherogenic (plaque-forming) particles are in your blood, which is often a better predictor of cardiovascular risk than LDL alone.
LDL-P: a direct particle count that can be high even when LDL is low
Lipoprotein (a): a genetically-determined marker that independently increases risk of clots. This marker doesn’t respond to changes in diet or to most cholesterol medications. Since it’s genetic, it only needs to be checked once. Knowing this risk marker influences how aggressively we manage everything else.
An advanced lipid panel is valuable for anyone with a strong family history, unexplained high cholesterol, or mildly elevated cholesterol with a preference to avoid statins.
The Coronary Artery Calcium (CAC) Score
Blood test estimate your risk of cardiovascular disease. A CAC score, on the other hand, shows what’s actually happening in the arteries. It’s a quick, low-radiation CT scan that measures calcified plaque. A score of 0 is reassuring, while higher scores indicate more established atherosclerosis and higher risk of cardiovascular events such as heart attack and stroke.
CAC scores are often helpful for those in a gray zone where the result will change the management decision. A borderline or moderately elevated cholesterol in your 40s-60s, a family history of early heart disease, elevated Lipoprotein (a) or metabolic syndrome, or postmenopausal women wanting objective data rather than guesswork should consider this imaging.
The key limitation of the CAC score is it only detects calcified plaque. It misses soft plaque, which is often more unstable. So, a CAC score of 0 is reassuring, but not an absolute guarantee. To assess for soft plaque, a coronary CT angiography with contrast is used to visualize the arteries directly and can detect soft plaque and artery narrowing. This is a more invasive test, but provides a fuller picture and is sometimes the better choice for symptomatic patients.
A Naturopathic and Functional Approach to Treatment
Once we understand why someone has high cholesterol, treatment is targeted to the individual patient. On the dietary side, we focus on increasing soluble fiber, reducing refined carbohydrates and alcohol, boosting omega-3 and monounsaturated fats over processed oils, and correcting underlying drivers like thyroid function or insulin resistance directly.
We also utilize a variety of evidence-informed supplements depending on the pattern we’re treating. Red yeast rice, niacin, plant sterols, bergamot extract, and nattokinase are among the options we consider.
When It's Time to Consider Medication
A functional approach isn’t opposed to medication, but rather is about using medication appropriately. Medications are typically recommended when LDL or ApoB remains significantly elevated after consistent lifestyle and supplement intervention, what CAC or angiography results show meaningful plaque, or when other risk factors show that more aggressive management is indicated.
As Naturopathic Doctors, our goal is always to use the right tool for the problem and to address the patient as an individual. If you have questions about your cholesterol, or want a more holistic approach to care, consider reaching out for an appointment with is at Monterey Natural Wellness.