For decades, cholesterol has been positioned as something to fear – a number to drive down at all costs. Yet, cholesterol is not the villain it’s often made out to be. It is an essential, life-sustaining molecule that every cell membrane in your body relies on. Your brain depends on it. It’s the raw material from which your body manufactures vitamin D, bile acids and your sex hormones. Cholesterol itself is not inherently dangerous. It is the context in which it exists that determines risk. To understand high cholesterol, especially as we age, we need a broader lens. 

Most of your cholesterol is made in your liver

One of the most misunderstood aspects of cholesterol is its origin. Close to 80 per cent of your cholesterol is produced internally, primarily by your liver. Only a small proportion comes directly from your food. That means liver health plays a far greater role in cholesterol than many people realise and of course our lifestyle choices can play a significant role in this. When the liver is under pressure from factors such as excess alcohol, poor nourishment, certain medications, insulin resistance or fatty liver disease, its regulation of cholesterol can shift. Production may increase, clearance may slow, or both. 

Ageing, hormones & the zinc connection 

Cholesterol is the starting material for your sex hormones – estrogen, progesterone and testosterone. As we age, and the production of sex hormones naturally declines, less cholesterol is required for hormone synthesis. In simple terms, if the demand for hormone production drops, cholesterol may accumulate. Estrogen has protective effects on blood vessels and influences lipid metabolism. As levels fall, LDL cholesterol may rise and HDL may shift. In men, gradual declines in testosterone can also influence body composition, insulin sensitivity and lipid patterns. 

However, cholesterol does not act in isolation. Its impact on health depends on a broader context that includes inflammation, blood sugar regulation, oxidative stress, your coronary calcium score, blood pressure and lifestyle factors. A mildly elevated cholesterol level in an otherwise metabolically healthy, active older adult is very different from high cholesterol accompanied by insulin resistance, abdominal weight gain, high blood pressure, a high coronary calcium score and systemic inflammation. 

There is another important factor here. Zinc is required for numerous enzymatic reactions in the body, including those involved in hormone production. Without adequate zinc, the conversion of cholesterol into sex hormones is less efficient. Low zinc status, which is not uncommon in older Australians, may therefore contribute to elevated cholesterol by impairing this pathway. Ensuring sufficient zinc intake from foods such as oysters, red meat, eggs and sunflower seeds, or via supplementation when clinically indicated, can be an important piece of the puzzle.

The “Blue Zone” paradox 

Interestingly, some of the world’s longest living populations, often referred to as “Blue Zones”, including regions of Japan, Sardinia and Greece, demonstrate an intriguing pattern. In certain cohorts, higher cholesterol in older age has been associated with longevity rather than increased mortality. This does not mean that high cholesterol is universally protective. Rather, it highlights how the relationship between cholesterol and health in later life is complex. 

It raises an important consideration: could it be that cholesterol is not the primary driver of risk? Could stress physiology and inflammation play a larger role? Addressing chronic stress, supporting restorative sleep and maintaining social connection may be just as important as dietary changes when considering cardiovascular risk.

Practical steps for supporting healthy cholesterol

Each of us has a cholesterol pattern that reflects our own unique biochemistry. Some people naturally sit a little higher or lower than others, and that can be entirely normal for them. This is why it can be so helpful to view your results over time rather than in isolation. Looking back across years of blood tests allows you to see what is typical for you and whether there has been a gradual rise or a more sudden shift. It is often the change in your personal baseline that deserves attention. When your cholesterol begins to move away from what has historically been normal for you, that is the time to explore what may be driving it and to consider how best to respond.

Supporting liver health is foundational when addressing elevated cholesterol. This includes maintaining a healthy weight, limiting alcohol and ultra-processed foods, managing blood sugar, prioritising quality sleep and ensuring adequate intake of key foods and nutrients involved in liver detoxification pathways. Amp up whole real foods, including plenty of dark leafy greens, and specifically nutrients such as B vitamins, iron and zinc, which are needed for both hormone and liver support. 

Physical activity improves insulin sensitivity and can positively influence HDL and LDL patterns, so move regularly. Address stress hormone load through mindfulness practices, time in nature, meaningful relationships, purposeful activity and by considering your perceptions of pressure and urgency. Medication is appropriate and lifesaving for some individuals. For others, lifestyle interventions may significantly improve markers. Work with your healthcare provider and supporting team to find the solution that works best for you.