Beyond Low-Fat Diets: A Nutritional Therapist’s Guide to Balancing Cholesterol & Triglycerides
Do you remember the TV commercials from the low-fat era? Women in neon leotards and leg warmers, beaming as they held up fat-free yoghurts and cholesterol-free spreads, promising a healthier heart and slimmer waistline. I remember watching them, absorbing the message that fat was the enemy—butter was out, margarine was in, and "heart-healthy" meant low-fat everything.
For years, cholesterol was demonised as a key driver of heart disease, fueling widespread fear of dietary fats. But as with most things in nutrition science, the reality is more complex. Cholesterol, primarily produced in the liver, is essential for health—without it, critical bodily functions would fail.
The real concern isn’t cholesterol itself but how it circulates in the body and interacts with metabolic processes. Before we get into the nitty-gritty let’s meet the key players.
The Truth About Cholesterol: Why We Need It
Cholesterol isn’t the enemy—it’s a fundamental building block of the body. Without it, critical biological processes would shut down.
🔹 Hormone production – Cholesterol is the raw material for oestrogen, progesterone, testosterone, and cortisol.
🔹 Brain and nerve function – A key component of the myelin sheath that protects nerve cells.
🔹 Vitamin D synthesis – Essential for immune health, calcium metabolism, and bone strength.
🔹 Digestion – Used in bile acid production, helping to break down fats.
🔹 Antioxidant role – Helps neutralise free radicals and supports cellular repair.
So why is cholesterol linked to heart disease?
Cholesterol and Triglycerides: What Really Matters?
Cholesterol and triglycerides are often treated as separate concerns, yet they are closely linked. Cholesterol is essential for cell function, while triglycerides store energy.
HDL (High-Density Lipoprotein): The Cholesterol Recycler
HDL is the "good cholesterol" because it acts as a shuttle, clearing excess LDL from circulation and returning it to the liver for disposal. Higher HDL is associated with better heart health because it indicates efficient cholesterol transport.
Why HDL Matters:
✔ Clears excess cholesterol from arteries, preventing plaque buildup.
✔ Acts as an antioxidant, protecting against LDL oxidation.
✔ Higher levels are associated with a lower risk of heart disease.
What Lowers HDL?
🔹 Excess sugar and processed foods → Increase triglycerides and reduce HDL.
🔹 Lack of physical activity → Exercise raises HDL naturally.
🔹 Smoking & chronic stress → Contribute to low HDL levels.
🔹 Certain medications (e.g., some beta-blockers, anabolic steroids) → May suppress HDL production.
LDL (Low-Density Lipoprotein): The Misunderstood Molecule
LDL is often labelled “bad cholesterol,” and where statins come in, but the reality is more complex. Its impact depends on its size, density, and vulnerability to oxidation:
Large, buoyant LDL → Neutral in heart disease risk. Raised by dietary fat but does not contribute to arterial plaque.
Small, dense LDL → Problematic. These particles are more likely to oxidise, penetrate artery walls, and trigger inflammation - a key step in plaque formation.
What Raises Small, Dense LDL?
🔹 Sugar and refined carbohydrates—not dietary fat.
🔹 Excess sugar elevates triglycerides, which in turn increase small, dense LDL.
Oxidised LDL: The Real Threat
When LDL particles become damaged by free radicals, they:
✔ Trigger inflammation in artery walls, accelerating plaque formation.
✔ Are engulfed by immune cells, leading to atherosclerosis.
✔ Reduce cholesterol transport efficiency, worsening cardiovascular risk.
Since small, dense LDL is more prone to oxidation, addressing inflammation and oxidative stress is crucial—not just lowering LDL levels.
Triglycerides & VLDL (Very Low-Density Lipoprotein): The Overlooked Factor
Triglycerides are fat molecules stored for energy, but chronically high levels are a red flag for metabolic dysfunction rather than simply a reflection of fat intake.
Triglycerides are primarily influenced by sugar and refined carbs—not dietary fat.
VLDL transports triglycerides and some cholesterol, making it a crucial marker in lipid health.
Elevated triglycerides are linked to increased small, dense LDL, compounding cardiovascular risk.
When blood lipids—cholesterol and triglycerides—become imbalanced, they fuel inflammation, oxidative stress, and arterial plaque formation, increasing the risk of cardiovascular disease (CVD).
So, if dietary fat is not the main culprit, what is? Read on to find out.
What’s Driving Cholesterol and Triglyceride Imbalances?
✔ Excess sugar and refined carbohydrates
The conventional approach has been to blame dietary fat, but the latest research tells a different story.
Dyslipidaemia—an imbalance of cholesterol and triglycerides in the blood—is a major risk factor for cardiovascular disease, metabolic syndrome, type 2 diabetes, and fatty liver disease. Emerging research highlights that the true risk isn’t from total cholesterol alone, but from a combination of elevated LDL and triglycerides, low HDL, oxidised LDL, and an excess of small, dense LDL particles. The real disruptors? Sugar, insulin resistance, and chronic inflammation.
✔ Excess sugar and refined carbohydrates – Triggers excess insulin, which signals the liver to convert sugar into triglycerides and store fat. This promotes insulin resistance, which in turn fuels cholesterol imbalances.
✔ Inflammation and oxidative stress (due to poor diet, stress, infections, or environmental toxins)– Fuels LDL cholesterol oxidation .
✔ Metabolic dysfunction and insulin resistance – Impairs the body's ability to manage fats properly, leading to high triglycerides and small, dense LDL particles.
✔ Poor gut health and bile metabolism – Impaired bile production and fat digestion, leading to cholesterol imbalances.
✔ Hormonal imbalances (e.g., menopause and hypothyroidism) – Oestrogen has a cardioprotective effect, helping maintain HDL levels. After menopause, HDL can drop while LDL rises, increasing CVD risk. Similarly, hypothyroidism can slow cholesterol clearance from the blood.
✔ Sedentary lifestyle and lack of movement – Drives insulin resistance, lowers HDL and increases triglycerides.
✔ Nutrient deficiencies – Deficiencies in omega-3s, antioxidants, and key micronutrients like magnesium and CoQ10 can impair lipid metabolism.
How to Balance Cholesterol and Triglycerides (naturally): A Nutritional Therapist’s Guide
1. Prioritise lowering sugar
Reducing dietary fat alone doesn’t fix the problem—a low-glycaemic, whole foods diet stabilises insulin, prevents excess triglyceride production, and supports a healthy lipid profile. I speak about this in your Sugar Reset Masterclass.
2. Prioritise Anti-Inflammatory Fats
Omega-3s (EPA & DHA): Found in wild oily fish, flaxseeds, and walnuts, these fats lower triglycerides, reduce inflammation, and improve LDL particle size.
Monounsaturated Fats (MUFAs): Found in olive oil, avocado, and nuts, MUFAs support HDL levels and protect against oxidation.
3. Boost Soluble Fibre Intake
Soluble fibre binds cholesterol in the gut, preventing reabsorption and promoting excretion.
Top sources: Oats, legumes, flaxseeds, chia seeds, low-sugar fruit, and vegetables.
4. Move Daily
Both aerobic, and anaerobic exercise increases HDL cholesterol and reduces triglycerides and insulin resistance.
Best choices: Walking, resistance training, and HIIT have been shown to improve lipid profiles.
5. Optimise Gut Health & Bile Flow
Bile helps break down fats and eliminate excess cholesterol. Supporting liver function with bitter foods, fibre, and probiotics can enhance cholesterol clearance.
Final Thoughts: Focus on Metabolic Health, Not Just Cholesterol
Understanding the root causes of cholesterol and triglyceride imbalances shifts the focus away from simply lowering cholesterol. Instead, the goal should be to improve how cholesterol functions in the body—reducing oxidation, optimising LDL particle size, and balancing HDL and triglyceride levels. This involves addressing insulin resistance, chronic inflammation, and oxidative stress. By prioritising whole, nutrient-dense foods, supporting gut and liver function, and reducing metabolic stressors, you can create an internal environment where cholesterol works for you, not against you.
Takeaway Action Steps for Lifelong Heart Health
✔ Reduce sugar and processed carbs to prevent insulin resistance and triglyceride buildup.
✔ Eat more fibre, omega-3s, and antioxidants to support cholesterol balance and reduce oxidation.
✔ Move daily and manage stress to enhance metabolic function and lipid transport.
✔ Consider targeted supplementation to support heart health and lipid metabolism.
A strategic, whole-food approach—not restrictive dieting—is the key to maintaining balanced blood lipids, metabolic resilience, and long-term heart health.
Want to optimise your cholesterol & metabolic health? As a nutritionist, I walk my clients through this journey, helping them navigate the science, apply practical nutrition adjustments, and build a heart-healthy lifestyle that is sustainable and effective. I’m here to help you achieve this and more.
References
Novella, S., Pérez‐Cremades, D., Mompeón, A. and Hermenegildo, C., 2019. Mechanisms underlying the influence of oestrogen on cardiovascular physiology in women. The Journal of physiology, 597(19), pp.4873-4886.
Sherratt, S.C., Juliano, R.A. and Mason, R.P., 2020. Eicosapentaenoic acid (EPA) has optimal chain length and degree of unsaturation to inhibit oxidation of small dense LDL and membrane cholesterol domains as compared to related fatty acids in vitro. Biochimica et Biophysica Acta (BBA)-Biomembranes, 1862(7), p.183254.
Talebi, S., Bagherniya, M., Atkin, S.L., Askari, G., Orafai, H.M. and Sahebkar, A., 2020. The beneficial effects of nutraceuticals and natural products on small dense LDL levels, LDL particle number and LDL particle size: a clinical review. Lipids in health and disease, 19(1), p.66.
Wang, L., Yan, N., Zhang, M., Pan, R., Dang, Y. and Niu, Y., 2022. The association between blood glucose levels and lipids or lipid ratios in type 2 diabetes patients: A cross-sectional study. Frontiers in Endocrinology, 13, p.969080.
