Understanding Cholesterol – The Good, Bad and Ugly


There are millions of people around the world with elevated cholesterol levels above 210mg/dL.  But first we need to stop and ask whether or not a total cholesterol number of 200mg/dL is the right number to prevent heart attacks and heart disease. And stepping back even further, let’s talk about cholesterol in general.

Interview with Dr. Scott Stoll

Interview with Dr. Scott Stoll

What is Cholesterol? 

Cholesterol is a waxy like substance or fat that is produced by your all of your cells and liver and is important in the production of hormones, vitamin D, bile acids, and formation of cell walls.

What are good and bad numbers and why?

Let’s start by looking at some of the healthiest and long-lived people groups from around the world.  The traditional Hazada, Tarahumara, Inuit, Pygmy, and San peoples had cholesterol levels on average of 150mg/dL or lower compared to the average person in the Middle East today at 218mg/dL. And in those primitive cultures death from heart attacks is virtually non-existent. In the famous Framingham Heart Study there were no deaths from heart attacks when cholesterol levels were below 150mg/dL and surprisingly 35% of heart attacks occurred when cholesterol levels were 151-200mg/dL.  Similarly, in well-documented Ugandan autopsy studies 1 person in 632 people from Uganda was noted to have atherosclerotic heart disease compared to 136/632 in age-matched Americans. 

Thus, from the studies we can estimate that an optimal goal for health is a total cholesterol level of 150mg/dL or lower.  There have been a number of cases where heart attacks occur in the currently recognized lab values of 200 mg/dl or less.

Lab work typically identifies some of the individual components of the total cholesterol including LDL and HDL. Medical science has demonized the LDL as the “bad cholesterol” because more than 100 studies involving 1 million people show that as LDL numbers rise there is an equal rise in the risk of coronary heart disease.  Genetic studies have also shown that a drop in LDL to normal levels reduces the risk of heart disease by 88%. However, LDL your body makes LDL in the liver and it is an important component of hormones such as testosterone and progesterone, construction of cell walls, and aids in digestion, so it is not “bad” but a necessary and important component of health. Research has shown that when the LDL level is 70mg/dL or lower the risk of heart disease is almost zero. 

HDL cholesterol has often been portrayed as the “hero” in the cholesterol story.  HDL cholesterol carries an antioxidant molecule and transports cholesterol back to the liver and so it can have a positive overall effect.  But we don’t want to just chase the numbers, ideally the goal should be health and the numbers will normalize.

What causes cholesterol to rise?

It is important to understand that cholesterol levels do not increase because of an increased intake of dietary cholesterol—found mostly in animal food products.  Dietary cholesterol can injure the liver and kidneys when it accumulates, harming the cells and disrupting normal cellular reactions.  However, some of the food you eat can indirectly increase cholesterol production; and this is a key point to remember because changing what you eat will either positively or negatively impact not only your lab numbers but also your health. The sugar, and fat filled Western diet causes injury and inflammation with each bite and the body reflexively responds by turning on several important pathways or factories to repair the damage.  One of these critical factories is activated by inflammation and responds by ramping up cholesterol production to repair and rebuild the damaged cells. People eating a typical Western Diet injure their body bite by bite and cause their body to work overtime to mitigate the cellular damage. 

Extensive nutritional research has demonstrated that a diet rich in whole plant-based foods reduces cholesterol levels and heart disease risk in several ways. First, reducing animal product consumption reduces or eliminates the sugar, trans and saturated fats that have been linked to inflammation and increased cholesterol levels. Second a plant-based diet reduces inflammation and aids in cell repair. Third, a whole food plant-based diet normalizes several key hormones, such as insulin, leptin, and cortisol that are linked to inflammation and cholesterol production.  Finally, in head to head studies comparing diets and cholesterol lowering drugs, a plant-based diet was found to be the most effective tool to reduce cholesterol levels. 

Your Prescription:

Pair a whole food plant-based diet with some exercise, sleep 7-8 hours per night and find ways to reduce your stress levels and you have the perfect solution to normalize your elevated cholesterol numbers and more importantly dramatically reduce your risk of heart disease.


Meet Our Guest


Scott Stoll, MD, FABPMR


This article was contributed to Plant B by Dr. Scott Stoll who we also had the pleasure to interview in San Diego.

Dr. Stoll is a board certified specialist in Physical Medicine and Rehabilitation. He served as the chairman of the department of Physical Medicine and Rehab and medical director for Physical Therapy and the Spine Center at Coordinated Health. He specializes in regenerative medicine, utilizing natural treatments, diet, and lifestyle to aid the body in healing chronic disease and injuries.