The Discipline Fitness Coach

Few health topics cause as much confusion in the gym as cholesterol. Clients tell me they've been "told their cholesterol is high" and walk out of the doctor's office convinced something is wrong with them. Others have read online that cholesterol is a myth, that it's actually protective, and that the whole thing is a scam. Neither reaction helps.

I'm a personal trainer, not a doctor or a dietitian, so I won't tell you what your numbers mean for you. What I can do is explain the basics in plain language so you walk into your GP's office informed rather than frightened. I can also show you how much of this sits within your control through the way you train, eat, sleep and live.

Cholesterol is essential, but that doesn't mean more is better

Your body needs cholesterol. It's used to build the walls of every cell, make hormones like testosterone and oestrogen, produce bile for digesting fat, and make vitamin D when your skin is exposed to sunlight. Your liver makes most of the cholesterol in your body because you can't live without it.

But "essential" and "the more the better" are two different claims. Your cells are very good at making their own cholesterol and at taking up what they need from the blood [1][2]. Once their needs are covered, extra cholesterol-carrying particles just keep circulating, and circulating particles are the ones that can lodge in artery walls. Some people are born with genetically very low LDL, and they are healthy, not deficient. So the goal was never to get rid of cholesterol, and it was never to maximise it either. The goal is a healthy level over a lifetime.

"Good" and "bad" is a shortcut

You'll hear about HDL ("good") and LDL ("bad") cholesterol. Strictly speaking, these are lipoproteins, the carriers that move fats and cholesterol around your blood, because fat and water don't mix. Think of them as taxis. LDL carries cholesterol out from the liver to the body, and HDL helps bring it back.

It's a simplification, but a useful one when you're talking to your doctor. LDL is the main particle that carries cholesterol into artery walls, where it can build up as plaque, though it isn't the only one. HDL tends to be higher in people who are active and metabolically healthy. The labels are shorthand, and what matters is the amount and balance of these carriers along with the rest of your health picture.

One number is a snapshot

Cholesterol results vary from test to test. Illness, stress, recent weight changes, how long you fasted, the time of year, and normal day-to-day biology can all shift a reading. Some labs also calculate LDL using a formula rather than measuring it directly, which adds a bit of extra variation.

This is why I tell clients not to panic over a single result, and not to ignore it either. If a result is outside the range, the sensible next step is usually a repeat test and a proper conversation with your GP.

Why low cholesterol can look protective (and why it isn't)

You may have seen studies showing that people with higher cholesterol have fewer infections, less cancer, less cognitive decline, and even live longer. Those associations are real in the data [3][4][5]. The conclusion people draw from them, that cholesterol is protective and doctors have it backwards, doesn't hold up.

The explanation is a trap that epidemiologists are taught to check for early on: reverse causation. The illnesses that tend to kill people in later life, such as cancer, organ failure and long-term chronic disease, push cholesterol down in the months and years before death. If you measure a group of older people once, the ones at the low end are disproportionately the ones who are already sick. Follow them and the low-cholesterol group dies sooner, not because of the cholesterol, but because of the disease that lowered it.

In other words, serious illness causes both the low cholesterol and the death. Low cholesterol takes the blame for something the disease did.

How do we know low cholesterol isn't the real problem? Timing. Some people are born with gene variants that keep their LDL low for their entire lives, set at conception, long before diet or illness can interfere. Research on these people shows they have less heart disease, a normal cancer risk and a normal lifespan [6][7]. If low cholesterol caused cancer or early death, these people would show it. They don't, which tells us the low readings seen in sick older people are a symptom of the illness, not the cause.

What matters is your exposure over time

A better way to think about this is cumulative exposure. It isn't one reading on one day. It's how much plaque-building cholesterol your arteries are exposed to, and for how long. Every year of higher exposure adds a little more, and it accumulates over a lifetime.

This is also why the argument sometimes made online that "most heart attacks happen in people with normal cholesterol" doesn't prove what people think it does. It's true, but most people have roughly normal cholesterol, so most of everything happens to them: heart attacks, weddings, parking tickets. That doesn't make normal cholesterol protective, any more than it makes it the cause of parking tickets. Per person, the risk still climbs with the load.

Genetic studies, long-term observational studies and drug trials, covering more than two million people, all point in the same direction [8]. A more recent study of over 90,000 people not taking cholesterol medication found that higher LDL meant higher heart attack risk at every age [10].

It's also worth noticing how this debate plays out. People who are sceptical about cholesterol will usually accept that blood pressure, smoking, blood sugar and body fat all raise risk in proportion to how high they run and for how long. Cholesterol follows the same pattern, so it's hard to explain why it alone should get a pass.

What about diabetes and statins?

This one comes up often, so it's worth being straight about it. Genetically lower LDL slightly raises the risk of type 2 diabetes, and so do statins. But the extra risk is concentrated in people who are already on the metabolic edge, such as those with elevated fasting glucose, a larger waist or high triglycerides. In the big trials, people with none of those risk factors showed essentially no added diabetes [9]. For the people who are prone to it, the same factors usually come with higher cholesterol and higher cardiovascular risk, and for them, lowering cholesterol still comes out ahead for the heart.

That's a conversation for you and your GP, not something to settle from a blog. But it's one more reason that keeping your waist, blood sugar and triglycerides in a healthy range is worth the effort. It's the kind of work I do with clients every week.

Your total picture matters more than one number

Doctors don't look at cholesterol in isolation. They look at your overall cardiovascular risk, which includes:

• Age and sex

• Blood pressure

• Smoking status

• Blood sugar and diabetes

• Kidney health

• Family history of early heart disease

• Cholesterol levels

In Australia, GPs use an absolute cardiovascular risk calculator that estimates your chance of a heart attack or stroke over the next five years. A "high" cholesterol reading means something very different in a 28-year-old non-smoker than in a 58-year-old with diabetes and a family history of heart disease. Many Australians aged 45 and over can also book a Heart Health Check with their GP, which is a good way to get this assessment done properly.

It's also worth knowing about family history. Some people have a genetic condition called familial hypercholesterolaemia, which causes very high LDL from birth. It's estimated to affect around 1 in 250 people, and it's often undiagnosed. If you have very high cholesterol readings, or relatives who had heart attacks young, don't brush it off as "just one of those things." Get it checked.

So is lower always better?

Generally, yes, with one important condition: it matters how you got there. In a sick, ageing person, low cholesterol is just the fingerprint the disease leaves on its way out, and it doesn't help them. But when cholesterol is lowered on purpose, through genetics, lifestyle or medication, heart disease risk falls in proportion to how much it was lowered.

So my approach is simple: take cholesterol seriously without being scared of it.

What I can help with

Many of the biggest levers on heart health sit squarely in my world. Here's how I approach them with clients.

Move regularly. Aim for a mix of resistance training and cardio. Exercise can lower triglycerides, nudge HDL up, improve blood pressure and improve how your body handles blood sugar. Australia's physical activity guidelines suggest at least 150 minutes of moderate activity per week plus two sessions of muscle strengthening, and that's a solid baseline.

Look at body composition, not just the scales. Carrying extra weight around the waist is linked with higher triglycerides, lower HDL and a higher overall cardiovascular risk. Even modest fat loss can improve your blood markers.

Eat mostly whole foods. Build meals around vegetables, fruit, legumes, whole grains, fish, lean proteins, nuts and olive oil. Soluble fibre from oats, beans and lentils can help lower LDL. Swapping some saturated fat for unsaturated fat tends to help too. You don't need a perfect diet, just a consistent one with fewer ultra-processed foods.

Manage sleep and stress. Poor sleep and chronic stress make it harder to train, eat well and keep your blood pressure in check. They're not glamorous topics, but they matter.

Don't smoke, and keep alcohol moderate. Smoking is one of the biggest modifiable risk factors for heart disease, and heavy drinking can push triglycerides and blood pressure up.

These habits tend to improve blood pressure, blood sugar and blood lipids together, which is why I focus on them with every client.

A realistic word on results

I'd love to promise that training and clean eating will fix everyone's cholesterol. They won't. Some people eat well, train hard, stay lean and still have high LDL because of genetics. That's not a failure on your part. It simply means you may need medical support alongside your lifestyle habits, and there's no shame in that.

On the flip side, if your numbers are borderline, lifestyle changes can make a meaningful difference, and I'm happy to work with you and your GP on a plan.

What I can't do

I can't diagnose conditions, interpret your blood tests or advise you on medication. If your GP has prescribed a statin or other treatment, please don't stop it because of something you read online, including this blog. If you're worried about side effects or you simply don't understand why you've been prescribed something, raise it with your doctor or pharmacist. They can look at your full history and talk through the options, including alternatives if needed.

Worth asking your GP

• What is my overall cardiovascular risk, not just my cholesterol number?

• Should we repeat the test before deciding anything?

• Is there a family history that makes it worth checking further?

• Do I need any other tests, such as blood sugar or blood pressure monitoring?

• How much could lifestyle changes realistically move my numbers?

• What would a sensible follow-up schedule look like?

The takeaway

Don't fear cholesterol, and don't dismiss it. Get the right information, look at the whole picture, and build the habits that protect your heart. That's the part I'm happy to help with.

If you'd like support building a training and nutrition routine that fits around your health goals and your doctor's advice, get in touch and we'll work out where to start.

Sources

1. Brown MS, Goldstein JL. A receptor-mediated pathway for cholesterol homeostasis. Science. 1986;232(4746):34-47. doi:10.1126/science.3513311

2. Morales-Villegas EC, Ray KK. Physiological level of LDL cholesterol: the master key. A Nobel dream comes true. Cardiovasc Pharm Open Access. 2016;6(5):223. doi:10.4172/2329-6607.1000223

3. Law MR, Thompson SG, Wald NJ. Assessing possible hazards of reducing serum cholesterol. BMJ. 1994;308(6925):373-379. doi:10.1136/bmj.308.6925.373

4. Weverling-Rijnsburger AWE, Blauw GJ, Lagaay AM, Knook DL, Meinders AE, Westendorp RGJ. Total cholesterol and risk of mortality in the oldest old. Lancet. 1997;350(9085):1119-1123. doi:10.1016/S0140-6736(97)04430-9

5. Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet. 2001;358(9279):351-355. doi:10.1016/S0140-6736(01)05553-2

6. Benn M, Tybjærg-Hansen A, Stender S, Frikke-Schmidt R, Nordestgaard BG. Low-density lipoprotein cholesterol and the risk of cancer: a Mendelian randomization study. J Natl Cancer Inst. 2011;103(6):508-519. doi:10.1093/jnci/djr008

7. Benn M, Tybjærg-Hansen A, Nordestgaard BG. Low LDL cholesterol by PCSK9 variation reduces cardiovascular mortality. J Am Coll Cardiol. 2019;73(24):3102-3114. doi:10.1016/j.jacc.2019.03.517

8. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-2472. doi:10.1093/eurheartj/ehx144

9. Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571. doi:10.1016/S0140-6736(12)61190-8

10. Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. 2020;396(10263):1644-1652. doi:10.1016/S0140-6736(20)32233-9

This post is general education from a personal trainer, not medical advice. Please speak with your GP about your own results and any medication.