PART 1: Cholesterol Through a Functional Medicine Lens

Why High Cholesterol Is a Symptom — Not the Problem

Most women are told their cholesterol is “high” and immediately fear heart disease. But in functional medicine, we ask a different question:

Why is cholesterol elevated?

Cholesterol rises for many reasons—most often as a response to deeper physiologic stressors, including:

• Chronic inflammation

• Toxin exposure

• Chronic or past infections

• Oxidative stress

• Insulin resistance and metabolic dysfunction

• Thyroid dysfunction (a very common but overlooked cause)

  
  

LDL and HDL rise not just because of diet, but because they participate in immune defense. When the body faces inflammation, infection, or toxin burden, cholesterol production increases as part of the cleanup effort.

How LDL and HDL Become “Dysfunctional”

LDL and HDL are not merely cholesterol carriers. They bind toxins, escort inflammatory debris to the liver, and trap microbial fragments. But when these particles become overloaded:

1. The body stops sensing that cholesterol is adequate and produces more.

2. LDL and HDL become dysfunctional and inflammatory.

3. Small LDL particles slip through the vessel wall, settle there, and spark inflammation—beginning the plaque-forming process.

   
   

This is the true beginning of cardiovascular disease—not simply “high cholesterol.”

Why Basic Cholesterol Panels Miss the Big Picture

A standard lipid panel rarely reflects what is actually happening.

In my practice, I commonly order:

• LDL particle number (LDL-P)

• HDL particle number (HDL-P)

• HDL Function (HDLfx)

• CRP (inflammation marker)

• Thyroid studies

• Vitamin D (optimal level near 80)

  
  

LDL-P correlates closely with Apolipoprotein B (ApoB), another excellent risk marker. LDL-P is the test I rely on most to understand true cardiovascular risk.

Triglycerides Matter

An often-overlooked marker of metabolic health is triglycerides.

An expert-level goal is: Triglycerides < 75

Higher values typically reflect insulin resistance or inflammation.

When Patients Want to Avoid Statins

Many of my patients prefer to avoid statins. Fortunately, we have effective, evidence-backed alternatives. One supplement blend I frequently recommend includes:

• Red yeast rice extract (nature’s statin—often combined with CoQ10)

• Phytosterols (reduce cholesterol absorption)

• Garlic (lowers LDL and triglycerides; supports blood pressure)

• Berberine (excellent for metabolic and lipid health)

• Tocotrienols (inhibit cholesterol production)

  
  

This combination often produces meaningful improvement in LDL, LDL-P, triglycerides, and inflammation.

The Big Picture

Cholesterol is not a villain—it is a messenger. If we address inflammation, thyroid function, toxins, metabolic health, stress, and hormonal changes, cholesterol often improves naturally.