If you’ve ever been told to “watch your cholesterol,” “avoid eggs,” or “cut out red meat,” but left feeling more confused than clear—you’re not alone. Even some doctors don’t always agree on what cholesterol numbers really mean or what to do about them.

People often ask me:

• “My HDL is high—am I in the clear?”
• “Should I stop eating eggs?”
• “Is red meat really that bad?”
• “I heard high cholesterol doesn’t matter anymore—is that true?”

The truth is, there’s a lot more to cholesterol than just “good” or “bad.” This guide will help you understand what really matters for heart health—so you can feel confident taking care of yourself.

What Is Cholesterol and How Do We Measure It?

Your body needs cholesterol to make hormones, build cells, and support your brain. But cholesterol can’t float around in your blood on its own—it has to travel in “carrier” particles called lipoproteins. These include LDL (often called “bad”) and HDL (often called “good”).

When doctors check your cholesterol, they usually measure how much cholesterol is being carried in your blood, but they don’t always look at how many particles are doing the carrying. That matters, because the more particles you have—especially LDL particles—the more likely they are to stick to your artery walls and cause buildup, which can lead to heart disease. 

I like to explain it like this: 

Imagine two highways. One has 10 big trucks, each carrying 10 boxes of cholesterol. The other has 100 small trucks, each carrying 1 box. Both highways are carrying the same amount of cholesterol (100 boxes), but the second one is much more crowded and has a higher chance of accidents. In your body, more “trucks” (particles) mean more chances for cholesterol to build up in your arteries. 

This is why a test called ApoB is important—it tells us how many of these particles are in your blood, not just how much cholesterol they’re carrying.

Better Tests to Ask About:

• ApoB – This measures the total number of harmful particles that carry cholesterol. It gives a more accurate picture of risk than regular LDL.
• Lp(a) – This is a genetic type of cholesterol particle that can raise your risk for heart disease. It’s often missed on standard blood tests, so I recommend getting it checked at least once in your life.

So… Can I Eat Eggs or Red Meat?

Yes, cholesterol is found in eggs and red meat—but for most people, the cholesterol in food doesn’t have a big effect on blood cholesterol. That’s why the U.S. Dietary Guidelines removed the cholesterol limit in 2015-2020.

What has a bigger impact? Things like:

• Your genetics (like having high Lp(a) or a family history)
• Blood sugar issues or insulin resistance
• Not getting enough fiber
• Eating too much saturated fat, especially from processed foods
• Inflammation
• Thyroid or liver problems

Simple Ways to Support Your Heart

• Eat more fiber: Aim for 25–30g/day from oats, beans, apples, chia seeds, and veggies.
• Choose healthy fats: Use olive oil, avocado, nuts, and salmon. Limit saturated fat to under 13–20g/day and avoid trans fats.
• Move regularly: Get 30 minutes of activity most days and strength train 2x/week.
• Sleep + stress: Aim for 7–9 hours of sleep and take daily moments to relax.
• Limit added sugar: Keep it under 25–36g/day (6–9 teaspoons).

Also ask your doctor about better tests.

Some tests give a clearer picture of your heart health, like:

• ApoB (shows how many particles carry cholesterol)
• Lp(a) (a genetic risk marker)
• Triglyceride-to-HDL ratio (shows blood sugar and heart risk)

If needed, consider supplements or medication based on your personal risk

Follow-Up Questions to Ask Your Doctor If Your Cholesterol Levels Come Back Elevated on Standard Labs

• Can we check ApoB and Lp(a) to get a better picture of my heart risk?
• What’s my triglyceride to HDL ratio, or fasting Insulin? (This can show signs of insulin resistance.)
• Should I get a calcium score scan to check for plaque in my arteries?
• Are my lifestyle changes enough—or should we talk about medication?

Final Thoughts

Cholesterol is important—but it’s not about one number. What really matters is how it’s carried in your blood, how many particles you have, your genetics, and your overall health.

When you understand your lab results and ask the right questions, you can make smart, science-based choices to protect your heart for the long term.

And if you want help making sense of your numbers or creating a personalized plan, our team at Starkel Nutrition is always here to support you. 

Scientific References

Grundy SM et al. (2019). 2018 AHA/ACC/Multi-society Guideline on the Management of Blood Cholesterol. Journal of the American College of Cardiology, 73(24), e285–e350.
https://doi.org/10.1016/j.jacc.2018.11.003

Ference BA et al. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. European Heart Journal, 38(32), 2459–2472.
https://doi.org/10.1093/eurheartj/ehx144

Sniderman AD, Thanassoulis G, et al. (2019). Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiology, 4(12), 1287–1295.
https://doi.org/10.1001/jamacardio.2019.3780

Siri-Tarino PW, Chiu S, Bergeron N, Krauss RM. (2015). Saturated Fats Versus Polyunsaturated Fats Versus Carbohydrates for Cardiovascular Disease Prevention and Treatment. Annual Review of Nutrition, 35, 517–543.
https://doi.org/10.1146/annurev-nutr-071714-034449

De Souza RJ et al. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all-cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ, 351, h3978.
https://doi.org/10.1136/bmj.h3978

Krauss RM, Blanche PJ, Rawlings RS, et al. (2006). Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. The American Journal of Clinical Nutrition, 83(5), 1025–1031.
https://doi.org/10.1093/ajcn/83.5.1025

Navar AM. (2020). The Evolving Story of LDL Cholesterol Lowering and Cardiovascular Risk. JAMA, 324(21), 2135–2137.
https://doi.org/10.1001/jama.2020.22614Maki KC, Palacios OM, et al. (2023). Limitations of Total LDL Cholesterol in Risk Prediction and the Importance of Particle Number (ApoB) and Quality. Nutrition Today, 58(1), 21–30.

Maki KC, Palacios OM, et al. (2023). Limitations of Total LDL Cholesterol in Risk Prediction and the Importance of Particle Number (ApoB) and Quality. Nutrition Today, 58(1), 21–30.