When most people think of high cholesterol, they picture someone who eats too much fast food and doesn’t exercise enough. But what if you’re an athlete, training hard, eating “clean” (maybe even restricting), and your labs still come back showing high cholesterol? The truth is, high cholesterol in athletes can have a very different root cause, and it often has more to do with underfueling than overeating. In this blog post, we dive into how underfueling, REDS, and low energy availability can raise cholesterol, and what to do about it.
High Cholesterol in Athletes: What’s Really Going On?
If your lab work comes back showing high cholesterol, the typical advice you’ll hear from a non-REDS informed provider is: “Eat less, exercise more, and cut down on fat.”
But here’s the catch… what if your cholesterol is high because you’ve already been eating less and exercising more?
I see this pattern often in athletes and active people who are unintentionally (or intentionally) underfueling. Instead of improving cholesterol numbers, restricting calories or avoiding certain food groups and compulsive movement can actually make them worse.
Why Does Low Energy Availability Impact Cholesterol?
So why does this happen? Low energy availability (AKA, underfueling) impacts blood lipids (cholesterol) in a few ways:
1. Suppressed Thyroid Hormone (T3)
When you’re not fueling enough, your body conserves energy by lowering thyroid hormone (T3). T3 regulates CETP, a key enzyme involved in the transfer of cholesteryl esters and triglycerides between lipoproteins
Low T3 → high CETP activity → high cholesterol
2. Increased Fat Reliance for Fuel
In times of low energy availability, the body relies on fat for fuel. Lipoprotein in the blood, such as LDL, increases to transport more fats to be used for fuel.
3. Genetic Predispositions
Some athletes may be genetically predisposed to higher cholesterol, especially when underfueling. People with anorexia nervosa are more likely to have a particular variant of the EPHX2 gene, which influences cholesterol metabolism.
Why Standard Cholesterol Advice Falls Short for Athletes
These aren’t the only reasons that cholesterol may be high, but when they are, having the full context and getting to the true root cause is crucial. Otherwise, if someone is already underfueling and then they follow their doctors’ orders of:
- “Watch your weight”
- “Cut out fats”
- “Exercise more”
- “Increase your fiber”
They will simply be fighting fire with fire and only make their situation WORSE.
Instead, taking care of your body with proper nourishment, rest, and self-care is the best way to protect your health, perform your best, and even lower your cholesterol!
Why REDs-Informed Providers Matter
Cholesterol is complex. Without the context of your training load, fueling, and overall health, even the best-intentioned provider might give advice that backfires. That’s why it’s so important that providers who work with athletes and active people are REDS-informed.
Common recommendations given to the general public are likely not applicable to athletes and active people at risk of underfueling and overexercising.
- If you’re a provider looking to become a certified REDS-informed provider, check out my REDS Provider Masterclass.
- If you’re an athlete looking for a REDS-informed provider, check out the directory of certified providers who have completed my course.