Statins and Cholesterol, Both Sides: The Cholesterol Your Body Needs, and When Statins Help

Cholesterol isn't the villain it's made out to be, and statins aren't simply good or bad. Here's why your body needs cholesterol, what really drives heart disease, the case for and against statins, and the tests that help you decide.

MK Wellness InsightsFounded by Danielle Cordova, Cypress, TX

Few health topics generate as much confusion as cholesterol. For decades, the message was simple: cholesterol is bad, eggs are dangerous, and lower is always better. Today, even mainstream guidance has shifted, holistic practitioners question whether statins are overprescribed, and the experts we follow don't fully agree with each other. That's a good sign the topic deserves a both-sides look, as part of our controversial therapies series.

Before anything else: if you take a statin, don't stop or change it without talking with your doctor. For people who've had a heart attack, stroke, or stent, statins have strong evidence for preventing another one.

Your Body Needs Cholesterol

Cholesterol isn't a toxin. It's essential. Your body makes most of its own cholesterol, mainly in the liver, because it needs it for:

• Every cell membrane in your body, keeping cells stable and functional
• Hormones: estrogen, testosterone, progesterone, and cortisol are all made from cholesterol
• Vitamin D, which your skin makes from a form of cholesterol when exposed to sunlight
• Bile, which you need to digest and absorb fats
• Your brain, which holds about a quarter of the body's cholesterol, used for nerve insulation and connections between brain cells

Very low cholesterol isn't automatically healthy, and extremely low levels have been linked to their own problems.

Dietary Cholesterol Matters Less Than We Were Told

For most people, the cholesterol you eat has a modest effect on the cholesterol in your blood, because the liver adjusts how much it makes. The U.S. Dietary Guidelines dropped their longstanding daily limit on dietary cholesterol in 2015. Eggs, a staple in our athlete nutrition guide, are back on the menu for most people.

What Actually Drives Heart Disease? The Debate

This is where experts disagree, including the ones we follow.

The metabolic and inflammation view. Dr. Benjamin Bikman and many functional medicine practitioners emphasize insulin resistance, high blood sugar, inflammation, and oxidative stress as major drivers of heart disease. In this view, cholesterol shows up at the scene, but the underlying problem is a damaged, inflamed blood vessel wall. A high triglyceride-to-HDL ratio, a common sign of insulin resistance, is seen as more telling than total cholesterol.

The particle view. Dr. Peter Attia and most cardiologists point to a large body of evidence, including genetic studies, that the number of cholesterol-carrying particles in the blood, measured as ApoB, directly drives plaque buildup in arteries over time. Attia generally favors lowering ApoB aggressively and early, using lifestyle and, when needed, medication including statins.

Where they overlap. Both views agree that total cholesterol alone is a crude measure, that metabolic health matters enormously, and that better testing beats guessing.

Statins: The Case For

• Strong evidence after a heart attack or stroke. For people who already have heart disease, statins reduce the risk of future heart attacks, strokes, and death in large clinical trials. This is called secondary prevention, and it's the strongest evidence.
• Benefit for high-risk people, including those with very high LDL from genetic conditions like familial hypercholesterolemia.
• They do more than lower cholesterol. Statins also have anti-inflammatory effects that may contribute to their benefit.
• Most people tolerate them. In a 2020 trial called SAMSON, patients who had stopped statins because of side effects took statins, placebo, and nothing in rotating months, and most of their symptoms occurred with the placebo too.

Statins: The Case Against

• Smaller benefit for lower-risk people. For people without heart disease (primary prevention), the absolute benefit is smaller, and many people take a statin for years to prevent one event. Critics argue statins are overprescribed to people at low risk.
• Side effects are real for some. Muscle aches and weakness do occur in some people, and rarely serious muscle damage.
• A small increase in diabetes risk, particularly in people already at risk.
• CoQ10 depletion. Statins block the same pathway the body uses to make coenzyme Q10, important for mitochondrial energy. Levels drop on statins. Evidence that CoQ10 supplements relieve statin muscle symptoms is mixed, but many practitioners suggest discussing it with your doctor.
• Lifestyle can do a lot. Improving diet, blood sugar, weight, activity, and sleep can substantially improve cardiovascular risk markers for many people.

The Tests That Help You Decide

Rather than arguing about total cholesterol, ask your doctor about:

• ApoB: a count of the cholesterol-carrying particles that can enter artery walls
• Lp(a): a mostly inherited particle that raises heart risk and isn't lowered much by lifestyle or statins. Everyone should know their level once.
• Triglycerides and HDL, and their ratio, as a window into insulin resistance
• Fasting insulin and HbA1c, for metabolic health
• hs-CRP, a marker of inflammation
• A coronary artery calcium (CAC) scan: a quick, low-dose CT scan that shows whether calcified plaque is already present in your heart's arteries. It's one of the most useful tools for deciding whether a statin makes sense for someone without known heart disease.

Our Honest Take

Cholesterol is essential, and a single cholesterol number doesn't tell the whole story. Metabolic health, inflammation, and particle testing give a much clearer picture. Statins are strongly supported for people who already have heart disease or are at high risk, and more debatable for low-risk people, where better testing and lifestyle can guide the decision. The best path is personal: get the right tests, understand your real risk, and decide with a doctor who will talk through both sides with you.

Where MK Wellness Fits

We don't treat heart disease or advise on medications. What we support is the metabolic side of the picture: our Metabolic Health guide covers blood sugar, insulin, and the habits that shape cardiovascular risk, and therapies like EWOT and infrared sauna are part of many clients' wellness routines.

MK Wellness services are non-medical and not intended to diagnose, treat, cure, or prevent any condition. This article is general education presenting multiple perspectives, not medical advice. Do not stop, start, or change a statin or any medication without talking with your doctor, especially if you have heart disease, have had a heart attack or stroke, or have diabetes.

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