Cholesterol levels - Dr. Axe

A large study published in the 1970s shaped how most people have thought about normal cholesterol levels for over 40 years. In the decades that followed, cholesterol-lowering drugs have become a major cash cow for pharmaceutical companies — between 1988–1994, the CDC reports less than two percent of Americans were on one of these medications, while over 14 percent reported taking them between 2011–2014. Today, an astounding 49.2 percent of people over 65 take cholesterol-lowering medication! (1)

What if I told you the results on that culture-shaking study were published in a totally misleading way? It’s true: how we measure cholesterol levels and even what we believe them to mean has been based on a false premise. Doctors are pressed to prescribe drugs like statins (Lipitor, for example) to tens of millions of “qualifying patients,” and their goal of reducing cholesterol levels may be a (mostly) pointless effort. (2)

On the other hand, normal cholesterol levels are important to maintain because extremely high cholesterol is a sign that something is wrong — or could go very wrong in the future (read: heart disease). These risks are amplified when you also have high triglycerides; together, these are referred to as hyperlipidemia. Sometimes, it’s important to lower cholesterol — naturally.

Let’s unravel the truth: What is cholesterol? Does it really need to be as low as you’ve been told? Are there different types of cholesterol? How can you get normal cholesterol levels — and what are normal cholesterol levels?

What Is Cholesterol?

Cholesterol is a fat-like, waxy substance contained in all cells of the body as well as some foods. It’s a precursor substance necessary for the creation of vitamin D, some hormones and bile salts that break down carbs, fats and proteins. Your brain also needs cholesterol, as it helps to create neurotransmitters such as serotonin and dopamine.

High cholesterol foods include a gamut of very healthy to incredibly unhealthy choices, from eggs and dark chocolate to potato chips and cookies. The five items consumed in the U.S. that are highest in dietary cholesterol include eggs, chicken, beef, hamburgers and cheese. (3)

For a while, it was widely believed that eggs were bad for your heart because they contain so much cholesterol (24.6 percent of eggs are cholesterol, to be exact) and would increase your serum cholesterol (the amount of this substance in your blood). However, it seems that dietary cholesterol actually isn’t as detrimental to your health as it seemed at first. Eating eggs long-term, for example, doesn’t actually increase your heart disease markers, including serum cholesterol. (4)

Your serum cholesterol numbers matter because high cholesterol levels build up in your arteries, forming plaques that lead to arteriosclerosis, a form of the heart disease.

However, I’ve already pointed out that cholesterol is an important factor in many vital bodily functions. Why is high cholesterol something that causes so much concern?

HDL Cholesterol vs. LDL Cholesterol

The more research is done, the more doctors are realizing that, even within the two common distinctions of cholesterol, there are many variations.

On a basic level, your body has two types of cholesterol circulating: LDL and HDL cholesterol. Many people think of LDL as “bad” cholesterol, but that’s not really a fair assessment — it’s all cholesterol, and these proteins “shuttle” fats to and from cells. They’re just different sizes.

What is HDL cholesterol? HDL stands for “high-density lipoprotein,” meaning HDL particles are larger than LDL particles. Your HDL cholesterol transports cholesterol particles from bodily tissue to the liver, where it can be reused or removed. LDL is “low-density lipoprotein” cholesterol and should be kept in a specific ratio to HDL particles to maintain a low risk for heart disease.

There’s a third kind of cholesterol that isn’t tested on normal cholesterol tests, but rather is estimated based on your triglyceride level: VLDL cholesterol, or very low-density lipoprotein cholesterol. VLDL contains 70 percent triglycerides by volume, versus LDL or HDL that contain much less. VLDL cholesterol is what transports most of the triglycerides throughout your bloodstream, and high levels of these two particles are much of what cause plaque to build up in the arteries.

High Cholesterol Symptoms

So, what is high cholesterol? Can you feel it happening?

According to the U.S. National Library of Medicine, there are no known symptoms of high cholesterol. (5) The reason high cholesterol is considered problematic is not because of any outward symptom, but because some research indicates that it may increase your risk of heart disease if it stays high over the course of several years.

For most people, maintaining normal cholesterol levels is a matter of diet and lifestyle. Lowering your cholesterol by means of medication and to incredibly low levels doesn’t actually seem to impact incidence of coronary heart disease or death from such, though — a truth that was only published in The BMJ in 2016. (6)

My focus has always been on achieving good ratios of different cholesterol levels and practicing a diet and lifestyle that gives my body the best overall chance at health.

What causes high cholesterol? Likely, this happens if you eat a diet high in omega-6s but low in omega-3s (which leads to inflammation), processed foods, a lot of refined grains and excess sugar. Smoking, obesity and sedentary lifestyle also contribute to high cholesterol.

Healthy Cholesterol Levels

What are healthy cholesterol numbers, then? I’ve never focused on numbers here as much as I consider the ratios. However, an overall cholesterol number of 330 or above seems likely too high — although that still depends on the ratios. The LDL cholesterol normal range, although very numerically defined in conventional medicine, is actually totally dependent on other factors.

Here are two cholesterol ratios that I think are more important than having normal cholesterol levels according to conventional tests:

HDL to LDL Cholesterol: I suggest monitoring your HDL to LDL cholesterol by making sure you have a ratio of one HDL particle to every 2.5 LDL particles (1:2.5). A ratio of 1:6 or higher means your cholesterol is pretty out of whack, while a ratio of 1:10 or higher is what I consider to be dangerously unhealthy.

To calculate where you fall, multiply your HDL number by 2.5. If the result is the same or higher as your LDL cholesterol number, then your ratio is in a good range.

Triglycerides to HDL Cholesterol: When you divide your triglycerides to your total HDL cholesterol, it can help reveal elevated heart disease risk. This could be due to the fact triglyceride numbers relate directly to the amount of VLDL cholesterol you currently have.

If that number is higher than .02 (2%), it’s time to work on getting back to normal cholesterol levels and normal triglyceride levels because you suffer from hyperlipidemia. What is hyperlipidemia? It means your triglycerides and cholesterol are both too high.

For reference, here are what conventional medicine considers to be normal cholesterol levels:

Total Cholesterol

  • Below 200 mg/dL — Desirable
  • 200–239 mg/dL — Borderline high
  • 240 mg/dL and above — High

LDL Cholesterol Ranges

  • Below 70 mg/dL — Ideal for people at very high risk of heart disease
  • Below 100 mg/dL — Ideal for people at risk of heart disease
  • 100–129 mg/dL — Near ideal
  • 130–159 mg/dL — Borderline high
  • 160–189 mg/dL — High
  • 190 mg/dL and above — Very high

HDL Cholesterol Ranges

  • Below 40 mg/dL (men); below 50 mg/dL (women) — Poor
  • 50–59 mg/dL — Better
  • 60 mg/dL and above — Best


  • Below 150 mg/dL — Desirable
  • 150–199 mg/dL — Borderline high
  • 200–499 mg/dL — High
  • 500 mg/dL and above — Very high

Take note: the LDL levels normal range (particularly for people at high risk) is nearly impossible to achieve without being on cholesterol-lowering medications. The HDL levels normal range doesn’t even make sense, as it only matters what ratio it is compared to triglycerides and LDL as far as heart disease risk goes.

Many physicians will begin suggesting statins when total cholesterol reaches around 108 mg/dL or higher (cholesterol level 6, for countries where the measurements are mmol/L rather than mg/dL). 

Normal cholesterol levels - Dr. Axe

Natural Remedies for High Cholesterol

1. Kick the Carbs

Total starchy food and carbohydrate intake are associated with metabolic syndrome, a condition identified by high cholesterol and other factors that equate to higher heart disease risk. (8)

Ever heard of the keto diet? This low carb, high fat and moderate protein dietary model features a ton of cholesterol-lowering foods and has shown an impressive result in increasing HDL cholesterol, weight and triglycerides while sometimes decreasing LDL cholesterol levels and even making LDL particles larger. (9, 10, 11) I know it sounds totally backwards, but increasing your fat intake actually helps to regulate cholesterol, in both the short- and long-term!

However, these results may not hold true for children with high cholesterol. (11) Instead, you may want to try something closer to the Mediterranean diet, which also includes low amounts of refined carbohydrates and healthy fats, but not to the same extreme as keto. The high amount of healthy fats in the Mediterranean diet also can help to raise your HDL cholesterol. (12)

Bonus: These diets both help you to accomplish another way to achieve normal cholesterol levels, which is …

2. Lose Weight

Losing just 5–10 percent of your total body weight helps to reduce triglycerides and increase HDL levels. That type of minimal (but significant) weight loss doesn’t typically impact LDL cholesterol numbers but can improve your overall cholesterol ratios. (13)

3. Have a Glass of Red Wine

If you’re wondering how to lower cholesterol levels, it may surprise you to learn that moderate alcohol intake is associated with higher HDL levels. (14) However, when it comes to alcohol, I suggest sticking to red wine for its many health benefits — beers and liquors, particularly sugary drink mixers, don’t hold much in the way of nutrition.

Be sure to watch how much you drink, though. One study found that, based on conventional models of cholesterol and heart disease risk, that 30 grams (or about one fluid ounce) per day of alcohol would reduce the risk of coronary heart disease (CHD) by 24.7 percent. On the other hand, it may slightly raise triglycerides. (15) In some individuals with certain genetic phenotypes, alcohol may actually raise LDL cholesterol, too. (16)

For all these reasons, keep your alcohol intake limited, but don’t be afraid to imbibe regularly with red wine, especially organic wine.

4. Stop Smoking

Smoking is one of those things that people are generally aware kills many aspects of health — and cholesterol is just one of them. This practice tends to lower your HDL levels while raising LDL cholesterol, making it an unacceptable risk to take if you’re at risk of heart disease. (17)

5. Get Moving!

A sedentary lifestyle is a no-no for heart disease risk. However, performing either medium-intensity resistance exercise or high-intensity aerobic exercise increases your HDL levels. (18) Exercise typically will help to support losing or maintaining weight, another reason this is a good habit to rehearse as you protect your heart.

6. Try Cholesterol-Lowering Supplements

There are a number of supplements that may help you achieve normal cholesterol levels, but keep in mind that your doctor should always be made aware of supplements you’re taking in addition to medications. If you’re taking a cholesterol-lowering medication, it’s possible you could experience an unhealthily drastic drop in cholesterol if you aren’t monitoring it closely with the help of your healthcare professional.

Niacin: While you should ideally get enough niacin (vitamin B3) through a healthy diet (found richly in beef liver, chicken breast, tuna, sunflower seeds and grass-fed beef), you may also choose to use it in supplement form. Niacin is frequently prescribed alongside statin medications. Large studies have suggested that time-released niacin helps to reduce LDL levels, raise HDL levels, reduce triglycerides and even reduce VLDL particles (by up to 68 percent!). (19, 20)

Be careful, though — niacin does come with side effects including flushing, discomfort, itching, skin tingling, gastrointestinal problems, muscle issues and liver dysfunction. (21) It may also not reduce the number of heart events, despite its ability to reduce high cholesterol. (19)

Red Yeast Rice: Another controversial supplement, red yeast rice, acts like statins but without as many of the undesirable side effects. In a 2015 research study, red yeast rice prevented weight gain and improved hyperlipidemia overall, meaning it lowered overall cholesterol (and probably high LDL levels). (22)

Lemongrass Essential Oil: Essential oils are powerful substances, and lemongrass oil is no exception. This essential oil has been observed in multiple research studies to lower overall, LDL and VLDL cholesterol while raising HDL cholesterol levels. It does not seem to affect triglyceride levels. (23, 24)

7. Take Cholesterol-Lowering Medication

While conventional medicine sees this as a first-line effort, cholesterol-lowering medications are sometimes needed for extremely high cholesterol. In my experience, people are almost always able to control their cholesterol through natural methods, such as dietary alterations, except in the case of familial hypercholesterolemia (a genetic defect which means the body is unable to remove LDL cholesterol from the bloodstream). People with this disorder have a much higher risk of heart disease and are not able to lower cholesterol levels without synthetic help. (25)

Cholesterol-lowering drugs include: (26)

  • Statins: These work to lower LDL cholesterol levels and moderately improve triglyceride and HDL cholesterol numbers.
  • Niacin: Approved at high doses as a prescription medication, niacin lowers LDL and raises HDL cholesterol.
  • Bile Acid Resin: These drugs work inside your intestine, attaching to bile and stopping it from absorbing into blood.
  • Fibrates: Fibrates (like fenofibrate) limit triglyceride production, increase HDL cholesterol in some cases and may reduce VLDL levels. They’re usually prescribed with statins.
  • PCSK9 Inhibitors: PCSK9 inhibitors are a new class of cholesterol drugs, typically prescribed only for those with familial hypercholesterolemia. They help your body remove LDL more efficiently by blocking the action of the PCSK9 protein.

While these are commonly used (particularly statins) to adjust what doctors consider to be “high cholesterol,” no medications used to alter cholesterol levels have been found overall to reduce the instances of heart events, heart disease, death from heart disease or death from any cause. (27)


Always discuss changes in your medication or supplement regimen with your healthcare provider and don’t change without his or her supervision.

Final Thoughts

Cholesterol is an important substance used in many bodily processes. Eating high cholesterol foods does not impact your serum cholesterol numbers significantly.

Instead of worrying about individual LDL or HDL numbers, keep your HDL:LDL ratio at 1:2.5 or lower.

If you need to achieve normal cholesterol levels, there are seven key ways to raise HDL cholesterol and/or lower LDL cholesterol:

  1. Kick the carbs (try keto!)
  2. Lose weight
  3. Have a glass of red wine
  4. Stop smoking
  5. Get moving!
  6. Try cholesterol-lowering supplements
  7. Take cholesterol-lowering medications

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