Why Is My Cholesterol Going Up?

She’s 51 years old. She’s exercising. She’s eating reasonably well. And she’s sitting in her doctor’s office looking at a cholesterol number that’s higher than it used to be.

She may have walked into that appointment wondering what she did wrong. But her body is changing, and some of those changes influence how cholesterol is transported and cleared. Declining estrogen may be contributing. But estrogen is NOT the only culprit.

Does that mean we don’t need to worry about it? No. Explaining why something happened doesn’t automatically tell us whether it’s harmless. However, it's important to understand all the markers before nailing cholesterol as the villain.

At least 15 other blood components tell us about cardiovascular health, not to mention VO2max, heart scans such as the coronary calcium scan, and genetic data that contribute to your overall cardiovascular health. So we need to understand both the reason for the change and its potential consequences. That’s what thoughtful healthcare looks like. Not panic. Not dismissal. Understanding.

Cardiovascular health is not simply a matter of managing cholesterol. Cholesterol-related particles are important, and their role in atherosclerosis is well established. But many other factors influence cardiovascular health, and many of them can be measured: blood pressure, blood glucose, and diabetes status, homocysteine levels, smoking exposure, kidney function, family history, genetic factors, physical activity and cardiovascular fitness, existing plaque in the arteries, inflammatory conditions, body composition, sleep health. And the list goes on.

Not every factor carries the same weight. Not every factor directly causes cardiovascular disease, and not every measurement is appropriate for every patient. But we have to evaluate the whole person, not just one lab result.

Imagine two women, both 55, both with an LDL cholesterol of 150. Same age, same LDL. The first has normal blood pressure. She doesn’t smoke and doesn’t have diabetes. She exercises regularly, and she has no known cardiovascular disease and no strong family history of premature heart disease. The second woman has elevated blood pressure. She smokes. She has diabetes. And her father had a heart attack at 48.

Would we say those two women have exactly the same cardiovascular risk because their LDL is identical? Of course not. Their overall risk profiles are very different. That’s why good cardiovascular care involves more than looking at a cholesterol number and deciding whether it’s above or below a reference range.

Sometimes we need more information to understand someone’s risk. Along with ApoB, another measurement is lipoprotein(a), usually written Lp(a). It’s a largely genetically determined cardiovascular risk factor, and unlike some other cholesterol measurements, it generally doesn’t change dramatically with diet and exercise. Many professional guidelines recommend measuring it at least once in adulthood to help identify inherited risk.

For certain women, particularly when treatment decisions are uncertain, coronary artery calcium scoring may also be useful. It’s a CT scan that looks for calcified plaque in the coronary arteries. It isn’t necessary for everyone, and a score of zero doesn’t rule out all cardiovascular disease. But in the right situation, it can provide additional information.

Please don’t read this and decide you need to order fifteen lab tests. We’re not collecting tests. We’re asking what information would actually help guide our decisions.

This is where functional medicine, practiced thoughtfully, can be especially helpful. We consider the relationships between different systems. We look at patterns. We ask how nutrition, physical activity, sleep, metabolic health, genetics, and hormonal changes may be interacting. But we also have to recognize when a conventional medical intervention is appropriate. Understanding the whole person doesn’t mean rejecting established cardiovascular treatments. It means making decisions based on the whole picture.

So what can we actually influence?

Start with nutrition. If your cholesterol has gone up, it’s worth looking at what you’re eating, but not simply assuming you need to eat less fat. The types of fat matter. Replacing some saturated fat with unsaturated fat can help lower LDL cholesterol. Soluble fiber can also help reduce LDL by influencing bile acid handling and cholesterol metabolism. Beans, lentils, certain fruits, and other fiber-rich plants can be useful.

We don’t need to turn someone’s entire diet upside down because one number changed. We need to understand what you're already eating and where meaningful adjustments might help. Maybe you already eat a reasonably balanced diet. Maybe you're getting plenty of protein but very little fiber. Maybe you're eating more saturated fat than you realize. Or maybe your nutrition is already quite good, and the change is being driven largely by genetics or menopause-related physiology. Those situations call for different conversations.

Then there’s exercise. You know I’m a huge advocate of resistance training. Building and maintaining muscle matters for metabolic health, functional capacity, and healthy aging. But strength training isn’t the whole cardiovascular story. Aerobic exercise matters too: walking, cycling, swimming, running, dancing, whatever lets you challenge your cardiovascular system appropriately. Regular physical activity improves cardiovascular fitness, blood pressure, insulin sensitivity, and many aspects of vascular health.

Exercise doesn’t necessarily produce a dramatic drop in LDL for everyone. You can exercise consistently and still have elevated LDL. That doesn’t mean the exercise isn’t helping. It means cardiovascular health is bigger than one lab number. The reverse is true too. Someone can have a reasonably good cholesterol panel and still benefit enormously from improving her cardiovascular fitness.

This may surprise people who know me as a functional medicine doctor, but sometimes medication is the appropriate choice. Some women’s cardiovascular risk is high enough that lifestyle changes alone may not provide enough protection. And some women with genetically elevated cholesterol can eat beautifully, exercise regularly, and still have LDL levels that warrant treatment. Understanding the role of menopause doesn’t change that. We can support the body through nutrition, physical activity, sleep, and other foundational habits while also recognizing when medical treatment is indicated.

One final point about hormone therapy. Estrogen therapy can influence cholesterol metabolism, but menopausal hormone therapy is not recommended solely to prevent cardiovascular disease or to treat elevated cholesterol. Decisions about hormone therapy involve symptoms, age, time since menopause, individual risk factors, and the potential benefits and harms. That’s a separate conversation.

So what do I want you to do? Know your numbers. Understand your personal risk. Ask what may be contributing to the changes. And work with your healthcare provider on an appropriate plan. Not because every woman needs to become an expert in cardiology, but because you deserve to understand the decisions being made about your health.

Let’s go back to that woman in her doctor’s office. Now she understands something she didn’t before. Her body is changing, and some of those changes influence how cholesterol is transported and cleared. That doesn’t mean she should ignore the result. It means she can have a better conversation about it. Instead of asking, “What foods do I need to stop eating?” she can ask, “How much has my cholesterol changed? What does my overall cardiovascular risk look like? And what would actually make a meaningful difference?”

Those are better questions, and that’s what Living F.R.E.S.H. is about. Not memorizing every physiological pathway or trying to control every biological process, but learning enough about the bodies God has entrusted to us to make thoughtful decisions about caring for them.

Proverbs 4:7 says, “The beginning of wisdom is this: Get wisdom, and whatever you get, get insight” (ESV). I love that, because knowledge and understanding aren’t exactly the same thing. You can know your cholesterol number without understanding what it means. You can know menopause affects cholesterol without understanding what to do about it. But when we start connecting those pieces, we can make wiser decisions.

That’s stewardship. It isn’t fear. It isn’t perfection. It isn’t trying to guarantee nothing will ever go wrong. It’s caring thoughtfully for what we’ve been given. If you’d like support understanding your changing body and making those decisions, that’s part of what we’re building inside the Living F.R.E.S.H. Collective, where we connect the physiology with the practical choices that help us live well.

Renewed health, because understanding how our bodies change helps us make more informed choices about caring for them. Rooted in truth, because a lab result is information, not a verdict, and understanding the physiology matters. Restored by grace, because a changing cholesterol number isn’t evidence that you’ve failed. It’s information that can help you choose your next step.

Health isn’t a destination. It’s a direction. And wherever you are on that journey, you can choose your next step.

Type FRESH in the comments below, or DM FRESH to @drkrissargent on Instagram to learn more about the Living F.R.E.S.H. Collective membership, OPEN NOW for Founding Members.