How Genetics Influence Your Cholesterol—And What To Ask Your Doctor

Cholesterol has been a hot topic in health for decades, and if you’re approaching your 50s or already well into your “second 50,” you’ve probably had more than a few conversations about it. But as Alan Ogden explains in his podcast discussion, understanding cholesterol genetics is crucial—especially if you want to make informed decisions about your medical care and navigate old myths that still linger.

Alan brings a unique perspective to the cholesterol conversation, with a background in pharmaceutical sciences and hands-on experience during the early days of cholesterol research controversies. In this post, I’ll walk you through Alan’s insights on how genetics shape cholesterol, what tests to ask for, and specific questions you should take to your doctor. Let’s break down the science and make it practical for your next appointment.

The Role of Genetics in Cholesterol: Alan Ogden’s Perspective

Our understanding of cholesterol has come a long way since the days of demonizing dietary fat. According to Alan, the public face of cholesterol in the late 70s and 80s was largely shaped by research that may not have told the whole story. He cites discussions with his university professor about meta-analyses that cherry-picked studies, leading to sweeping guidelines that overlooked key genetic factors.

“His contention was the original application for the use of cholesterol was very specific. It was for people who were genetically subject to something called apolipoprotein A. So that’s a type of cholesterol substrate that we make, which is very inflammatory.” — Alan Ogden

Alan points out that for certain individuals, genetic predispositions—such as high levels of apolipoprotein A—make cholesterol much harder to manage with lifestyle changes alone. He recounts working with a doctor who, despite best efforts at diet and exercise, couldn’t lower his LDL cholesterol until a genetic examination revealed the root cause.

He explains, “We have genetics for our dietary cholesterol, saturated cholesterols, unsaturated cholesterols. We have a selection of genetics that we can look at that would indicate a predisposition and then we know what to go look for.”

Why Your Body Needs Cholesterol

Alan urges us not to overlook cholesterol’s importance. It acts as a building block for vital hormones like insulin, testosterone, estrogen, and progesterone. He clarifies that “upstream from many of the activities in our body is something called cholesterol,” highlighting its role in vitamin D synthesis and hormone production.

“Our liver is very good at making cholesterol. And why do we need cholesterol?… You make vitamin D from cholesterol. You make your hormones. So your insulin, your testosterone, your estrogen, your progesterone—all the hormones we depend on, have their root in cholesterol.” — Alan Ogden

This means that drastically lowering cholesterol without understanding the underlying genetics can have downstream effects that go beyond just heart health.

Advanced Testing and Analysis: Beyond the Standard Cholesterol Panel

According to Alan, most doctors base their recommendations on a standard fasting blood test that checks HDL, LDL, and triglycerides. But he advocates for a deeper look before jumping to medical intervention:

Dietary Analysis: Alan starts by examining the patient’s dietary pattern. He asks, “How much saturated fat are they actually eating? Do they have some genetics that might indicate they have an inability to use saturated fat?”
Liver Enzymes: Since the liver produces and modulates cholesterol, Alan checks liver function to see where cholesterol is being handled or broken down.
Kidney and Bowel Function: These add another layer to assessing how the body processes and excretes fat and cholesterol.
Lipoprotein Panel: Alan discusses the value of a lipoprotein panel, which looks at triglycerides and further breaks down cholesterol into categories like VLDL and other small molecules that may be damaging to the cardiovascular system.

For individuals with naturally high LDL cholesterol, Alan doesn’t immediately recommend statins. Instead, he emphasizes genetic testing and a thorough diagnostic process. He notes, “There are some people that statin therapy is a requirement for because of the genetics. Maybe even because they don’t have the ability to change their diet too much or the desire to change their diet too much.”

Modern Approaches: Newer Cholesterol Drugs and Their Targets

Alan points out that newer cholesterol medications are starting to act in the intestinal tract rather than the liver. This shift reflects a deeper understanding of how cholesterol and fat are processed in the body. He describes how fat eaten goes through the liver and then returns to the intestinal tract, relying on healthy bacteria in your gut to emulsify and eliminate it.

What To Ask Your Doctor: Empowering Your Care

When you go in for a cholesterol check-up, most doctors rely on the basics—HDL, LDL, and triglycerides. Alan underscores that these numbers don’t always paint the full picture, especially if genetics are at play. Here are some practical questions, based on Alan’s approach, that you can bring up during your next appointment:

Can we look at my family history for cholesterol issues? If you have relatives who struggled with high cholesterol despite a healthy lifestyle, genetic factors could be influencing your results.
Is there a way to test for genetic predisposition? Ask about advanced panels or referrals for genetic testing focused on cholesterol metabolism.
Could we get a lipoprotein panel? Alan found this test valuable, especially for his wife, Donna, whose high LDL cholesterol didn’t translate to cardiovascular risk. “He did a lipoprotein test. A lipoprotein test came back very good. So what that means is even though the LDL is high, it’s not damaging.”
Can we check liver, kidney, and bowel function? Broaden your assessment to see if other factors are skewing cholesterol numbers.
What are my options besides statin drugs? If your cholesterol is high but risk factors are unclear, inquire about dietary adjustments, natural products (like Stericol, which Alan uses), and lifestyle changes.

Special Considerations for Women

Alan touches on why women were left out of early cholesterol drug studies. He notes that LDL cholesterol naturally rises as women hit menopause, but this doesn’t necessarily translate to higher cardiovascular risk in the same way it does for men. Hormonal cycles provide some protection, but this effect is lost over time, making deeper analysis (like lipoprotein panels) even more important.

“Women usually have one heart attack where men might get away with, you know, one and another one and have this intervention. So there’s some kind of cardioprotective mechanism when they have the cycle, the estrogen progesterone cycle, which they lose over time. But we just see this natural rise in LDL cholesterol.” — Alan Ogden

Conclusion: Take Charge with Knowledge and Questions

As Alan makes clear, cholesterol genetics are a foundational piece of your cardiovascular health puzzle. Relying solely on standard labs and one-size-fits-all guidelines misses the nuance that could help you—and your doctor—make smarter decisions.

Before you accept a prescription or embark on drastic diet changes, start with a conversation. Ask questions rooted in your family history, request advanced panels like the lipoprotein panel, and discuss possible genetic influences. By following Alan Ogden’s practical approach, you can move beyond old misconceptions and shape your healthcare to fit your unique genetic landscape.

Ready to explore your cholesterol genetics? Share this blog with your doctor or healthcare provider, and let them know you’re interested in personalized testing. If you want to dive deeper, catch Alan’s full podcast episode or reach out to LiveYourDNA.com for support in understanding your genetic profile.