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Understanding LDL Cholesterol: A TCM Perspective on Balancing Your Health

Writer's picture: Dr. Kitty Chan, L.AcDr. Kitty Chan, L.Ac

LDL (low-density lipoprotein), often labeled as “bad cholesterol,” is actually an essential transport molecule. It carries cholesterol, fats, and fat-soluble nutrients through the bloodstream, playing a key role in cell repair, hormone production, and vitamin D synthesis.


However, when LDL isn’t properly cleared or becomes oxidized, it can contribute to arterial plaque buildup. Understanding LDL’s function, the factors influencing its levels, and how Traditional Chinese Medicine (TCM) can help regulate it provides a more complete picture of cardiovascular health.

LDL Cholesterol and TCM

What Your LDL Blood Test Really Tells You


  1. Cholesterol Transport

    • LDL carries cholesterol from the liver to cells for hormone production, cell repair, and vitamin D synthesis.

    • If LDL is not properly cleared, it can accumulate in arteries, contributing to plaque formation.

  2. LDL Particle Size Matters

    • Standard LDL tests measure total LDL cholesterol but do not differentiate particle size:

    • Small, dense LDL → More likely to oxidize and contribute to plaque buildup.

    • Large, fluffy LDL → Less harmful, more easily cleared from the body.

    • Advanced tests like LDL-P (LDL particle number) provide a better cardiovascular risk assessment.

  3. Liver & Metabolic Health Indicator

    • The liver regulates LDL, and high levels may signal issues like:

    • Liver stagnation (in TCM terms)

    • Thyroid dysfunction (hypothyroidism slows LDL clearance)

    • Insulin resistance or metabolic syndrome 

  4. Inflammation & Repair Response

    • LDL increases when the body needs cholesterol for cell repair, especially during stress, infection, or inflammation.

    • High LDL isn’t always harmful unless paired with high inflammation markers (CRP, homocysteine, etc.).


Thus, LDL should be evaluated in context, considering:

✅ Triglycerides & HDL (good cholesterol)

✅ Inflammation markers (CRP, homocysteine)

✅ Thyroid function (TSH, Free T3/T4)

✅ Liver enzymes (ALT, AST, GGT)


What Really Influences LDL Levels?


Diet affects only 20–30% of LDL levels. The other 70–80% is controlled by genetics, liver function, thyroid health, inflammation, and metabolism.


Key Factors That Affect LDL:

• Diet → Saturated fats, refined carbs, and fiber intake impact LDL.

• Liver function → The liver is the main regulator of cholesterol.

• Genetics → Some people naturally produce more LDL.

• Thyroid function → Hypothyroidism slows LDL clearance.

• Inflammation & stress → Chronic inflammation raises LDL for repair.

• Exercise & metabolism → Regular activity improves LDL particle size and clearance.


Why Might LDL Be High Despite a Healthy Diet?


  1. Fat Metabolism Changes

    • Switching to low-carb or keto diets may temporarily raise LDL as the body adapts to burning fat for energy.

  2. Weight Loss Mobilizes Cholesterol

    • Fat loss releases stored cholesterol into the bloodstream before levels stabilize.

  3. Thyroid Dysfunction

    • Hypothyroidism slows LDL clearance—high TSH may indicate thyroid issues.

  4. Genetics (Familial Hypercholesterolemia)

    • Some people genetically produce higher LDL, regardless of diet.

  5. Liver & Gallbladder Function (TCM Perspective)

    • Liver Qi stagnation or sluggish bile flow can affect cholesterol metabolism.

    • Acupuncture and herbal formulas that support Liver & Spleen function can help.

  6. Chronic Inflammation & Stress

    • High cortisol from stress raises LDL by increasing blood sugar and insulin resistance..

    • Ongoing inflammation triggers LDL production as a repair mechanism.


LDL & Inflammation: The Body’s Repair Mechanism


LDL isn’t inherently bad—it protects and repairs tissues. However, chronic inflammation or oxidation can turn LDL into a risk factor for heart disease.


How Inflammation & Stress Increase LDL:


  1. Inflammation Signals LDL to Repair Damaged Blood Vessels

    • LDL delivers cholesterol to repair blood vessel walls.

    • If inflammation persists, LDL stays high and can become oxidized.

  2. Cortisol & LDL Connection

    • Chronic stress → More cortisol → Higher LDL production.

  3. Oxidized LDL & Plaque Formation

    • Longer circulation = Higher oxidation risk → Leads to arterial plaque buildup.


TCM Insights: LDL, Stress & Inflammation


TCM views high LDL, inflammation, and stress as an imbalance of:


✅ Liver Qi stagnation → Causes heat and inflammation.

✅ Spleen Qi deficiency → Weak digestion leads to poor fat metabolism.

✅ Kidney Yin deficiency → Chronic stress depletes vital essence, increasing oxidation.


TCM Strategies to Lower LDL & Inflammation:


✔ Move Liver Qi: Acupuncture, meditation, and herbs like Chai Hu (Bupleurum) reduce stress.

✔ Cool Internal Heat: Black sesame, walnuts, goji berries nourish Yin and reduce oxidation.

✔ Improve Digestion & Fat Metabolism: Warm, cooked foods and limiting dairy & sugar strengthen Spleen Qi.

✔ Reduce Oxidation: Antioxidant-rich foods like berries, green tea, and leafy greens fight oxidative stress.


How Exercise Improves LDL & Heart Health


Exercise helps regulate LDL by:


  1. Increasing LDL Clearance → Activates liver receptors to remove LDL from blood.

  2. Improving Insulin Sensitivity → Reduces triglycerides, promotes healthier LDL particles.

  3. Lowering Inflammation & Oxidation → Reduces markers like CRP.

  4. Regulating Stress Hormones → Reduces cortisol, decreasing harmful LDL particles.


TCM Perspective on Exercise & LDL:


✔ Moves Liver Qi → Relieves stress & improves circulation.

✔ Strengthens Spleen Qi → Enhances fat metabolism.

✔ Boosts Kidney Yang → Supports overall energy and vitality.


Final Thoughts: LDL is Not the Enemy


LDL is essential for health, but context matters—factors like particle size, inflammation, stress, and liver function influence cardiovascular risk.


What you can do:

✅ Manage stress & inflammation → Acupuncture, herbs, meditation.

✅ Support liver health → Healthy diet, exercise, liver-friendly herbs.

✅ Improve digestion → Warm, cooked foods, reduce processed sugars.

✅ Stay active → Exercise shifts LDL to a healthier profile.


With the right approach, TCM and holistic strategies can help you regulate LDL naturally, supporting heart health and overall well-being.


Sources

• Feinman, R. D., et al. (2015). Dietary Carbohydrate Restriction in Diabetes Management. Nutrition.

• Ference, B. A., et al. (2017). Effect of PCSK9 Variants on Cardiovascular Risk. New England Journal of Medicine.

• Huang, S. et al. (2013). Cortisol’s Role in Cardiovascular Disease. Endocrine Reviews.

• Mahan, L. K., & Escott-Stump, S. (2012). Krause’s Food & the Nutrition Care Process.

• Nordestgaard, B. G., et al. (2018). Lipoprotein Particles & Cardiovascular Risk.

• Rader, D. J., & Daugherty, A. (2008). Molecular Mechanisms of HDL.

• Santos, F. et al. (2012). Low-Carb Diets & Cholesterol. Journal of Clinical Lipidology.

• Yuan, J., et al. (2015). Cholesterol & Endocrine Function. Metabolism Reviews.


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