Cholesterol is often misunderstood. Some believe all cholesterol is bad, while others think only older adults need to worry about it. The truth is that cholesterol is essential for your body, but too much of the wrong kind may increase health risks. Understanding the different types, knowing what helps or harms your levels and learning when to fast for a cholesterol test may make managing cholesterol easier. Let’s clear up the confusion.

Cholesterol: The Good, the Bad and the Misunderstood

One of the biggest myths is that all cholesterol is harmful. In reality, cholesterol plays an important role in your body. It helps build cells, produce hormones and make vitamin D. Your liver produces the cholesterol you need, but you also get some from food, especially animal-based products like meat, dairy and certain oils.

Cholesterol travels through your blood in two main forms:

• LDL (Low-Density Lipoprotein): Often called "bad" cholesterol because it can build up in artery walls, narrowing them and increasing the risk of heart disease or stroke.
• HDL (High-Density Lipoprotein): Known as "good" cholesterol because it helps remove excess cholesterol from your blood, lowering your risk of heart problems.
• Triglycerides: A type of fat in the blood. When combined with high LDL or low HDL, high triglyceride levels may raise health risks.

Misinformation about cholesterol may lead to unnecessary risks. For instance, some believe switching from butter to margarine automatically lowers cholesterol, but many hard margarines also contain unhealthy fats. Others assume cholesterol is only a men’s health issue, yet women—especially after menopause—also face increased risks.

Another common misconception is that high cholesterol has warning signs. The reality? It usually doesn’t. Many people don’t know they have high cholesterol until they experience a heart attack or stroke. That’s why regular testing is crucial, even if you feel fine.

The American Heart Association recommends that adults check their cholesterol every four to six years if they are at low risk. Those with higher risk factors, such as diabetes or a family history of heart disease, may need more frequent testing.

Fasting for a Cholesterol Test: Is It Necessary?

For years, fasting before a cholesterol test was the norm. The idea was that eating could temporarily raise cholesterol levels, leading to less accurate results. However, newer guidelines suggest that fasting may not always be necessary, especially for people who are not on cholesterol-lowering medication.

Your healthcare provider will let you know if you should fast. If fasting is required, it means avoiding food, drinks (except water), and some medications for 9 to 12 hours before your test. Tests are often scheduled in the morning to make this easier.

The Do’s and Don’ts of Managing Cholesterol

Many people think that only diet affects cholesterol levels, but lifestyle, genetics and even certain health conditions also play a role. While a healthy diet and regular exercise are key, some individuals may need medication to manage their cholesterol levels effectively.

Do:

• ✔ Eat a heart-healthy diet. Choose foods rich in fiber, healthy fats (like olive oil and nuts) and lean proteins. Avoid saturated and trans fats found in fried and processed foods.
• ✔ Stay active. Regular physical activity helps balance cholesterol levels and supports overall heart health.
• ✔ Maintain a healthy weight. Carrying excess weight may raise LDL and triglyceride levels.
• ✔ Quit smoking. Smoking lowers HDL and damages blood vessels. Quitting may improve cholesterol levels and heart health.
• ✔ Follow medical advice. If prescribed cholesterol-lowering medication, take it as directed.

Don’t:

• ✖ Assume thin people don’t have high cholesterol. Even those at a healthy weight can have high LDL levels.
• ✖ Ignore family history. Conditions like familial hypercholesterolemia (FH) may cause dangerously high cholesterol from a young age.
• ✖ Believe that cholesterol is only a concern later in life. Cholesterol levels should be monitored starting in early adulthood to reduce future risks.
• ✖ Rely only on food labels. A “cholesterol-free” label doesn’t mean a product is heart-healthy. It may still contain unhealthy fats.
• ✖ Think diet and exercise alone are always enough. Some people, especially those with genetic conditions, may need medication in addition to lifestyle changes.

Breaking the Myths and Taking Action

The best way to manage cholesterol is to stay informed, get tested regularly and make lifestyle changes where needed. If you have concerns about your cholesterol levels, talk to your healthcare provider about testing, treatment options and ways to help reduce your risk.