If your doctor has ever said, “Your cholesterol is high — we need to get you on a statin,” and you walked out of the office feeling anxious and confused, you’re not alone.
Heart disease is still the number one killer in America. Yet, what I see over and over again — both in the research and with my own clients — is that we’re focusing on the wrong targets.
We’ve been told cholesterol is the enemy. But cholesterol isn’t the villain here. It’s the messenger. The real problem is inflammation, insulin resistance, and metabolic dysfunction — all of which change the way cholesterol behaves in your body.
So let’s unpack this together. Because understanding what’s really happening inside your arteries could literally change — or save — your life.
Cholesterol Isn’t the Enemy — It’s the Messenger
Your body actually makes cholesterol. Why? Because you need it. Every single cell membrane, every hormone, and even your brain depends on it.
The problem isn’t cholesterol itself — it’s when cholesterol particles become damaged by inflammation and high blood sugar. That’s when they start sticking to your artery walls and forming plaque.
Think of it like this: cholesterol particles are cars driving down a highway. It’s not dangerous to have cars on the road — it’s dangerous when there’s too much traffic, the road is full of potholes (that’s inflammation), and cars start crashing (that’s oxidative damage).
So instead of obsessing over your “total cholesterol” or even your “LDL,” what really matters is the quality and quantity of those particles.
Here’s what I tell my patients to ask their doctors for:
- ApoB – This measures how many cholesterol-carrying particles are floating through your bloodstream. The more there are, the higher your risk for heart disease.
- Lp(a) – This one’s genetic. If it’s high, it makes cholesterol stickier, and you’ll want to know that. You only have to test it once in your life.
- hs-CRP – A marker for inflammation. If this number is elevated, your body is already in attack mode.
- Fasting insulin and A1c – These tell you how well your body handles sugar. If you’re insulin resistant, you’re already on the path to heart disease.
- Coronary Calcium Scan (CAC) – This is one of my favorites. It’s a quick, low-cost CT scan that actually shows whether plaque is building up in your arteries. A CAC score of zero is like a gold star — it means your arteries are clear.
That’s the kind of data that saves lives — not just a basic cholesterol panel that barely scratches the surface.
The Real Root: Inflammation and Insulin Resistance
Let’s talk about the real culprits behind heart disease — inflammation and insulin resistance.
Every time your blood sugar spikes — from processed carbs, sugar, or even lack of sleep — your body releases insulin. Over time, your cells stop responding to it. That’s insulin resistance.
When that happens, your triglycerides go up, your HDL goes down, and your LDL particles become small and dense — the exact kind that sneak into your artery walls and cause damage.
If you’ve been told you have “pre-diabetes,” or your A1c is over 5.7, or your waistline has started to expand even though you’re eating the same — that’s your body waving a red flag.
The good news? You can turn it around — through real food, movement, fasting, and sleep.
Food That Heals (and Foods That Harm)
Let’s simplify heart-healthy eating — because it’s not about “low fat” anymore.
The best-studied and most effective diet for heart health is the Mediterranean diet. But I like to blend it with a ketobiotic twist — high in clean fats and fiber, moderate in protein, and low in sugar and processed carbs.
Here’s what that looks like:
- Cook with extra-virgin olive oil — and don’t be shy about it.
- Eat wild-caught fish like salmon or sardines a few times a week.
- Add avocados, nuts, and seeds daily.
- Load your plate with colorful, high-fiber veggies — those phytonutrients calm inflammation.
- Ditch refined grains, sugary snacks, and seed oils (like soybean or canola oil). These drive inflammation and damage cholesterol particles.
Think “real food,” not “diet food.”
And if you drink alcohol? Limit it. Alcohol raises triglycerides and blood sugar — both of which are linked to heart disease.
Move Your Body (It’s Medicine)
Movement is one of the most powerful cholesterol and blood sugar regulators on the planet. You don’t need to train for a marathon — but you do need to move.
Aim for 30 minutes of brisk walking five days a week, and add in two strength sessions to maintain muscle mass.
And here’s my favorite hack: take a 10-minute walk after each meal. Research shows this helps lower blood sugar and triglycerides dramatically.
Simple. Free. Effective.
Don’t Sleep on Sleep
When you skimp on sleep, cortisol rises, insulin sensitivity drops, and inflammation spikes.
Aim for 7 to 9 hours of true rest.
Your heart heals when you sleep — literally.
What About Supplements?
You know I’m all about “food first,” but certain supplements can help:
- Fish oil: Most over-the-counter versions don’t do much, but prescription-strength EPA (Vascepa) has been shown in major studies to reduce heart events in high-risk patients.
- Vitamin D: Great for your immune system, not a magic bullet for your heart.
- CoQ10: If you’re on a statin, this is a must. Statins deplete CoQ10, which your heart muscle needs for energy.
- Magnesium and Vitamin K2: Support vascular flexibility and blood pressure.
Skip the multivitamin for heart prevention — the data just isn’t there.
The Statin Conversation
Now let’s talk about statins.
For some people — especially those with high ApoB, diabetes, or plaque on imaging — statins save lives. They can stabilize plaques and lower inflammation.
But here’s the catch: for lower-risk people, the absolute benefit is small. Studies suggest statins prevent one nonfatal heart attack in about 89 people over five years.
That doesn’t mean they’re useless. It means context matters.
If your CAC score is zero and your metabolic health is solid, you might not need one right now. But if you’ve got plaque, high ApoB, or a family history of early heart disease — then yes, they can be powerful.
The key is personalization — not fear.
My 90-Day Heart Health Reboot
Here’s where I’d have you start if you were my patient:
- Order better labs: ApoB, Lp(a), A1c, fasting insulin, hs-CRP, and a CAC scan.
- Eat like your heart matters: Protein, plants, olive oil, and real whole unprocessed foods.
- Move daily: Walks, weights, recovery.
- Prioritize sleep and stress reduction.
- Use your numbers to guide your plan.
If your labs improve, your heart will follow.
Final Thoughts
Cholesterol is not your enemy. It’s your body’s messenger — telling you how well your metabolism, inflammation, and hormones are working together.
Don’t fight cholesterol. Understand it.
Ask better questions. Order better tests.
And focus on what’s fixable — your lifestyle, your blood sugar, your sleep, your stress.
Because those are the levers that truly change your future.
