EP039: What Produces High Cholesterol

What Produces High Cholesterol? Real Answers for Real Families

“Your liver runs the show—70–80% of your cholesterol is made by you, not by your omelet.”

Welcome to The Diabetes Podcast® blog. Today we’re taking on a big question: what produces high cholesterol? This is more than a lab number. It’s a story that shows up in our families, and often in silence for years. We’ll explain what cholesterol is, why your liver runs the show, how LDL, HDL, VLDL, and ApoB shape risk, and why insulin resistance and fatty liver push things the wrong way. We’ll also clear up common myths about dietary cholesterol and seed oils, explain why triglycerides and the triglyceride-to-HDL ratio are early warning lights, and share the tools that work in real life.

What Cholesterol Really Is

Cholesterol is essential. Your body uses it to make hormones, vitamin D, bile acids for digestion, and the walls of every cell. Without it, you can’t live.

Here’s the first big truth: 70–80% of the cholesterol in your blood is made by your liver. It does not mostly come from food like eggs or shrimp. Your liver runs the show.

Because cholesterol is fatty and your blood is mostly water, your body ships cholesterol in tiny carriers called lipoproteins. Think of them like boats:

• LDL: delivers cholesterol out to your tissues. People call it “bad” cholesterol.

• HDL: brings extra cholesterol back to the liver. People call it “good.”

• VLDL: carries triglycerides (fat energy) from the liver.

The Count That Matters Most: APoB

Here’s what most people never hear: risk is not just how much cholesterol is in each boat. It’s how many boats are out there.

Each LDL and VLDL particle has one APoB on its surface. So APoB is a particle count. More APoB means more boats. More boats means more chances one gets stuck in your artery wall and causes trouble. That’s why APoB is a strong risk marker.

If your doctor doesn’t check APoB, ask for it. If that’s not available, the triglyceride-to-HDL ratio can still give useful clues. High triglycerides and low HDL often mean too many risky particles and higher APoB.

So… What Produces High Cholesterol?

Short answer: your metabolism, not the cholesterol in your food. The biggest driver is insulin resistance.

• Insulin resistance is the number one cause of high cholesterol. When your cells stop responding well to insulin, the liver gets fatty and starts pumping out more VLDL. Triglycerides go up. LDL particles get smaller and denser (more dangerous). HDL drops. APoB goes up. This pattern is called atherogenic dyslipidemia. It often shows up years before diabetes is diagnosed.

• Fatty liver (non-alcoholic fatty liver disease): When the liver stores too much fat, it changes how it builds and ships lipoproteins in more harmful ways.

• Visceral fat: This is fat around your organs (the “apple” shape). It’s hormonally active and sends out inflammatory signals. That worsens cholesterol particle behavior.

• Ultra-processed foods: The mix of refined carbs plus industrial oils is a major driver. It ramps up liver fat and VLDL production.

• Sleep loss, stress, sedentary time: These raise stress hormones, worsen insulin resistance, and increase risk.

• Smoking and vaping: Damage blood vessels and raise risk.

• Genetics: Familial hypercholesterolemia is real and serious, but far less common than social media suggests. Most high cholesterol is not this.

What Does Not Usually Cause High Cholesterol

• Eggs and shrimp

• Modest amounts of saturated fat (about 6% of calories—roughly 10–13 grams per day on a 2,000-calorie diet)

• “Seed oils” by themselves (more on this below)

About Seed Oils and Fryers

Seed oils can form more harmful byproducts when they are heated over and over (like in deep fryers). But swapping to beef tallow does not fix the bigger issue if the meal is still ultra-processed and high in refined carbs and fried. Also, deep-fried foods often push you over your daily saturated fat limit by themselves. Bottom line: fried food is still fried food.

Why Triglycerides and the TG:HDL Ratio Matter

Triglycerides are an early warning sign. High triglycerides do not mean you “ate too much fat.” They often mean insulin resistance and a fatty liver. High triglycerides worsen LDL particle quality, raise ApoB, and lower HDL. A low HDL (for men, usually below 40) is not a minor quirk. It is a red flag that your cleanup crew is understaffed.

Silent Risk: You Can’t Feel This… Until You Do

High-risk cholesterol patterns don’t usually cause symptoms. You can “feel fine” while plaque is building. That’s why people get surprised. Diabetes makes this worse. It speeds oxidation, harms the blood vessel lining, and cuts blood flow in small vessels. This is why diabetes is treated as a “heart disease equivalent.” If you have diabetes, your risk is like someone who already had a heart attack.

Real-Life Stress Matters

Chronic stress raises cortisol and adrenaline, increases blood pressure, shifts clotting, and accelerates plaque. A big stress event can turn a stable plaque unstable. Stress does not act alone—stress works on top of insulin resistance, fatty liver, high ApoB, low HDL, and high triglycerides.

Supplements, Phytosterols, and What Helps

• Phytosterols can lower LDL a little (about 10–15%), but you need 2–3 grams per day, which is hard from whole foods. Fortified products exist, but most people who need real risk reduction should use proven medications and lifestyle changes.

• CoQ10: Some people feel better on it if they get statin-related muscle aches, but the research is mixed. It’s safe from a quality brand, but it’s not a guaranteed fix.

Medications: Tools, Not Failure

If lifestyle alone isn’t enough, medications save lives. It’s not “pills or lifestyle.” It’s often both.

• Statins: First to show fewer heart attacks, strokes, and deaths. If you get muscle aches, there are options:

  • Switch to a different statin

  • Try a lower dose or every-other-day dosing

  • Combine a low-dose statin with ezetimibe

• Ezetimibe (Zetia): Lowers cholesterol absorption. Often used with a statin or if statins aren’t tolerated.

• PCSK9 inhibitors: Injections that lower LDL a lot. Great for high risk or statin intolerance.

• Inclisiran: Twice-yearly injection after a loading period.

• Bempedoic acid: Lowers LDL through a different pathway and avoids many muscle symptoms.

Ask your clinician: What mix of tools lowers my risk the most, with the fewest side effects, that I can stick with?

What Actually Works (Simple, Not Easy)

• Fiber: Aim for 25–50 grams per day. Beans, lentils, oats, veggies, fruits, chia, flax. Fiber helps blood sugar, cholesterol, and your gut.

• Movement: Almost every day.

  • Aerobic: Get your heart rate up for at least 15–30 minutes.

  • Resistance: 2–3 days per week to build and keep muscle.

• Weight loss when appropriate: Especially if you carry fat around your middle. Even 5–10% loss can improve liver fat and lipids.

• Fewer ultra-processed foods: More real food. Not perfection—just better patterns most days.

• Sleep: Protect 7–9 hours. One bad night can push blood sugar and insulin resistance the next day.

• Stress care: This is real medicine for your heart. Daily practices you can repeat matter: walks, sunlight, breathwork, prayer, journaling, therapy, time with people who lift you up.

• Medications when needed: Scaffolding while you build a stronger life. Keep building the foundation—don’t stop at scaffolding.

Early Warning Lights to Watch

• ApoB: If you can, measure it. Lower is better.

• Triglycerides: High is a warning for insulin resistance and liver fat.

• HDL: Too low is a red flag (for men, usually less than 40).

• TG:HDL ratio: High ratio suggests insulin resistance and atherogenic particles.

• A1C and fasting glucose: Often lagging indicators; cholesterol patterns can go bad years earlier.

• Waist circumference and body shape: “Apple” pattern raises risk.

• Symptoms that whisper:

  • Shortness of breath out of proportion to activity

  • Unusual fatigue

  • Pain in jaw, back, shoulder, or side (flank)

  • Dizziness or repeated falls

  • Chest pressure or tightness

Myths, Clarified

• “Eating cholesterol raises my cholesterol.” Not for most people. Your liver makes most of it.

• “Seed oils are the main cause.” The big problem is ultra-processed patterns: refined carbs plus oils, deep-fried and reheated. Real, minimally processed patterns with unsaturated fats can improve HDL and help overall patterns.

• “Statins always cause muscle pain.” Not always. If they do, there are many workarounds and other meds.

• “If I feel fine, I’m fine.” Cholesterol risk is usually silent—until it isn’t.

Take-Home

• What produces high cholesterol? Insulin resistance, fatty liver, visceral fat, stress, poor sleep, ultra-processed food patterns, and inactivity. Your liver is in charge, not your omelet.

• What lowers it and makes it safer? Fiber-rich real foods, regular movement, weight loss when appropriate, better sleep, real stress tools, and the right medications when needed.

• You are not stuck. These are processes, and processes can change.

Call to Action

• Ask you physician to text for APoB if possible.

• Track triglycerides, HDL, and the TG:HDL ratio.

• Add 10–15 grams of fiber per day for two weeks, then add more.

• Walk most days. Add two short strength sessions per week.

• Push ultra-processed foods down, and real food up.

• Protect your sleep like a prescription.

• If your clinician suggests a statin or other meds, discuss all options and dosing strategies.

If you need additional support or have additional questions, please reach out to us at [email protected]. Take courage! You can do this, and we can help.

Disclaimer

The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

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