Understanding cholesterol levels and lowering them naturally (Part 1)

What is cholesterol? 

Cholesterol is a fat-like substance that belongs to the group of steroids. It is an essential component of the cell membranes of animals and humans and is crucial for their stability and fluidity. In addition, cholesterol fulfills many other important functions in the body. 

Different transport forms of cholesterol 

Because cholesterol is fat-soluble and cannot be transported on its own in the aqueous bloodstream, it is bound to special protein complexes known as lipoproteins. 

The two best-known forms are: 

In addition, there are other transport forms such as VLDL (very low-density lipoprotein) and IDL (intermediate-density lipoprotein), which also transport cholesterol from the liver to the cells. So-called chylomicrons transport cholesterol and fats absorbed from food from the intestine into the body. 

It is important to note that all of these transport forms fulfill essential functions in the body. None of them is inherently “good” or “bad.” 

Functions of cholesterol in the body 

Without cholesterol, humans cannot survive. It fulfills the following essential functions: 

The body produces most cholesterol itself 

Approximately 80–90% of cholesterol is produced by the body itself, primarily in the liver, but also in the intestine and the brain. Dietary cholesterol therefore plays only a minor role and has little influence on blood cholesterol levels (1). The consumption of eggs is therefore not a cause of elevated cholesterol levels, as is often claimed. 

Production process and influence of statins 

Cholesterol is synthesized via the so-called mevalonate pathway. Acetyl-CoA serves as the starting substrate. However, this metabolic pathway produces not only cholesterol, but also a wide range of other important substances. 

These include the downstream products of cholesterol mentioned above, such as steroid hormones and vitamin D3, as well as additional compounds that share a common precursor with cholesterol. One important example is coenzyme Q10, which is essential for energy production in the mitochondria. 

When statins (cholesterol-lowering drugs) are used to reduce elevated cholesterol levels, they inhibit not only cholesterol synthesis but also the production of many other substances formed along this pathway. This can have far-reaching consequences for health. The impact on steroid hormones illustrates this particularly clearly: these hormones influence the entire organism and are important, for example, for bone metabolism, metabolic health, sexual function, mental well-being, and immune function. 

Is an elevated cholesterol level harmful? 

Reference values for cholesterol have been lowered steadily over recent decades, with the result that more than 50% of adults in Germany and other industrialized countries are now classified as having elevated levels. 

The following reference values currently apply (as of December 2025): 

Based on these reference values, many patients are prescribed statins. However, current research clearly shows that assessing an individual’s risk for cardiovascular disease is far more complex. Statin therapy based solely on these values is therefore no longer considered up to date. 

Below, we present several relevant studies that question the use of cholesterol as a risk parameter or even demonstrate beneficial health effects of higher cholesterol levels: 

A meta-analysis published in 2016 evaluated the results of 19 studies involving more than 68,000 individuals over the age of 60. It concluded that in 14 of the 19 studies (covering 92% of participants), higher LDL cholesterol levels were associated with lower mortality. In the remaining five studies, no association between cholesterol and mortality was observed (2). 

A large Norwegian study also examined the use of total cholesterol as a risk parameter. The study followed more than 52,000 participants aged 20 to 74 over a period of ten years (3): 

Studies in older adults also show improved cognitive performance in individuals with higher total and LDL cholesterol levels (4), as well as a reduced risk of dementia associated with higher total cholesterol (5). 

When does cholesterol become dangerous? 

The studies presented clearly show that cholesterol alone does not provide information about the actual risk of cardiovascular disease. Nevertheless, the image of “too much cholesterol” accumulating in the blood vessels is still widespread. In reality, atherosclerosis does not develop simply as a result of high cholesterol levels, but rather through a combination of unfavourable factors. What matters most is the conditions under which LDL circulates in the body. 

Inflammation: the true risk factor 

As long as the body is in balance – with well-regulated inflammatory processes, adequate oxygen supply, and sufficient nutrients – cholesterol can fulfill its functions without causing harm. 

Problems arise when chronic inflammation is present, as is common in many people due to an unfavourable lifestyle: 

Under these conditions, increased amounts of free radicals are generated in the body. While free radicals are constantly produced as part of normal metabolism, excessive levels lead to oxidative stress and promote inflammatory processes, as important molecules such as proteins, fats, or DNA are damaged (oxidized) and can no longer perform their functions properly. 

If chronic inflammation is present in the body, the blood vessel walls are also damaged. Cholesterol is increasingly deposited for repair purposes – something that would not be problematic in a healthy internal environment. 

However, under the conditions described above, there is increased formation of small, particularly dense LDL particles, known as “small dense LDL.” These particles can easily penetrate inflamed vessel walls and are especially susceptible to free radicals. As a result, oxidized (“rancid”) LDL accumulates within the vessel walls. 

This marks the beginning of an inflammatory cascade: 

The body then attempts to stabilize this unstable plaque by depositing calcium and hardening it. Although a hard plaque is undesirable, it is less dangerous because it is less likely to rupture and suddenly block a blood vessel. 

We can therefore conclude that the risk of cardiovascular disease does not increase per se due to elevated cholesterol levels, but rather due to increased levels of small dense LDL and oxidized LDL, which arise more frequently in the presence of chronic inflammatory processes. How these factors can be assessed in the laboratory will be explained in Part 2 of our series. 

Is statin therapy therefore not useful? 

For individuals who merely have mildly elevated cholesterol levels, without evidence of atherosclerosis and without additional risk factors, there is generally no reason to lower cholesterol levels pharmacologically. 

However, the use of statins can be important in cases of: 

In these situations, lowering LDL levels may be appropriate because affected individuals have a significantly increased risk of atherosclerosis due to their genetic background or pre-existing conditions. Nevertheless, even in these cases, lifestyle modifications are essential in order to reduce the overall inflammatory burden in the body. 

Genetically elevated cholesterol levels 

Elevated cholesterol levels can be inherited. Various genetic and epigenetic factors play a role. Genetic testing can help determine whether an individual is affected by such a lipid metabolism disorder. 

Familial hypercholesterolemia 

Familial hypercholesterolemia (FH) is an autosomal-dominant inherited disorder of lipid metabolism in which elevated LDL levels can often be detected as early as childhood. The cause is a gene mutation affecting the LDL receptor on the surface of cells. As a result, LDL cannot be taken up efficiently by cells, leading to markedly elevated blood levels. 

In homozygous FH (inheritance of the unfavourable gene from both parents), there is an approximately 20-fold increased risk of atherosclerosis and thus of heart attack and stroke. Affected individuals often have LDL levels ranging from 400 to 1,000 mg/dl. The prevalence of this condition is approximately 1 in 1,000,000. Heterozygous FH (one unfavourable gene and one healthy gene) is much more common, affecting about 1 in 500 people. LDL cholesterol levels typically range between 190 and 450 mg/dl. These individuals should receive pharmacological treatment, as their risk of cardiovascular disease is significantly increased (6). 

APOE gene 

The APOE gene is another important risk factor, as it influences how fats and cholesterol are processed. In particular, the APOE4 variant (inherited once or twice) is associated with higher LDL levels, increased sensitivity to saturated fats, and a higher cardiovascular risk. 

The presence of this gene variant does not automatically require cholesterol-lowering medication. However, it is especially important to adhere strictly to an anti-inflammatory lifestyle, maintain moderate fat intake, and ensure optimal omega-3 fatty acid supply. 

Individuals with the APOE4 variant should use krill oil rather than algae oil or fish oil, as krill oil provides omega-3 fatty acids in a form that is more bioavailable for these individuals (phospholipid form rather than triglycerides). 

Additional genetic influences 

There are numerous other genetic and epigenetic factors that can influence cholesterol levels and LDL quality. In many cases, a healthy lifestyle combined with adequate micronutrient intake can help compensate for an increased genetic risk. 

Outlook 

In the second part of our series, you will receive information on important laboratory tests and learn how you can positively influence your risk of cardiovascular disease through a healthy lifestyle. 

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