Have you had blood work lately?

Have you had blood work lately?

When your doctor has you do blood work and tells you that you have high cholesterol, what does that actually mean? There are several different lipid biomarkers that are commonly used including total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Taken together, your family doctor uses these biomarkers to determine if you are at risk of cardiovascular disease. HDL and LDL aren’t actually cholesterol, but rather are lipoproteins that act as transporter molecules that carry cholesterol through the bloodstream. While these biomarkers are important numbers to look at for cardiovascular health, they can also be useful screening tools for other health conditions. High total cholesterol on its own is not necessarily a good marker for heart health, but can be a clue that there are other problems with your health.



  1. You might have hypothyroidism. Some of the common signs of low thyroid function include cold hands and feet, thinning hair, weight gain, dry skin and constipation. Thyroid hormones have a complex role in the activation of enzymes needed for cholesterol metabolism (1). If your cholesterol, LDL and triglycerides are high, then thyroid testing should be done. Ask for the full panel including TSH, Free T3, Free T4, Reverse T3 and Thyroid antibodies.

  2. You might have blood sugar imbalances. It might not come as a surprise that higher amounts of sugar in your diet negatively impact your lipid biomarkers (2). Research has shown that insulin resistance has more of an impact on cholesterol levels than obesity (3). Regardless of whether or not you are overweight, if your lipid biomarkers are high, then request glucose testing along with an HA1C test. HA1C is a good marker of your blood sugar levels over the last several months.

  3. You might have elevated cortisol levels. Cortisol is released as part of your body’s response to stress. Studies confirm a correlation between stress and altered lipid biomarkers (4), (5). Wondering if your stress levels are impacting your cholesterol numbers? Get your cortisol tested. A saliva test that measures saliva throughout the day is a good choice, and you can get this type of testing done with a naturopathic or functional doctor. Some stress management strategies may be in order!

  4. You might have dysbiosis. Dysbiosis refers to an imbalance in your gut microbiome. Research has shown that your gut microbiome plays a role in blood lipids. Organisms in your gut play a variety of roles in cholesterol metabolism (6). One area of research looks at TMAO (trimethylamine N-oxide), which is a gut microbe-generated metabolite associated with higher risk for heart failure (7). Gut microbial impacts on lipid levels and heart health is a growing area of current research. If you have bloating, flatulence, heartburn, constipation, nausea or other obvious digestive symptoms then it’s likely you have dysbiosis, but even with no digestive symptoms you can have dysbiosis, so further exploring may be necessary. A good starting point might be a Comprehensive Stool Analysis and an OAT test with a naturopathic or functional doctor.


Hypothyroidism, blood sugar imbalances, high cortisol and dysbiosis can each play a role in affecting your total cholesterol and other lipid biomarkers. Interestingly these issues are all interconnected, so you may see more than just one of these factors being impacted. For example high cortisol lowers TSH (thyroid stimulating hormone), and inhibits the conversion of T4 to T3, which is the active form of thyroid hormone.

Research has shown a connection between thyroid health and blood sugar levels with a higher risk of thyroid disease in people with diabetes (8). Conversely, people with metabolic syndrome ( blood sugar imbalance or insulin resistance is one of the diagnostic criteria) have a higher risk of thyroid disease (9). Good thyroid function and normal blood sugar regulation go hand in hand.

These are just some of the interconnections, but hopefully if you have some of these issues you are starting to realize that they don’t exist in isolation, and that it is important to address multiple factors for overall wellness.


If you already know you have high total cholesterol, LDL or triglycerides then it might be time to start taking a closer look at WHY these numbers are high. Talk to your practitioner about additional testing, so that you can start to understand more about the contributing factors, and start to address them. Once you address these factors, you should see your lipid markers normalize.

Happy, Healthy Testing!