What to Do When Your Total Cholesterol Is High but, Your LDL and HDL Levels Are Within the Normal Range

Key Takeaways:

High triglycerides can raise total cholesterol even if LDL and HDL are normal.
Lifestyle changes help: eat whole grains, exercise, and cut back on alcohol.
For very high triglycerides, medication may be needed to prevent heart issues.

Cholesterol is a waxy, fatty substance normally found in the blood. It can be produced naturally by the body via the liver; it can also be consumed from the diet. It is found in every cell in the body and is essential for the formation of cell membranes, certain hormones as well as vitamin D. While cholesterol is vital, too much in the blood can cause health problems, especially for your heart. (About 70% of cholesterol is carried by lipoproteins, with the liver regulating its balance via HMG-CoA reductase.)

Atherosclerosis

Cholesterol is insoluble in water, and since a greater percentage of blood is water, it cannot be ordinarily carried in the blood. The body uses specialized proteins produced in the liver, called lipoproteins (lipids or fats in combination with proteins) to transport cholesterol in the blood.

These proteins may be grouped into two: High-density lipoprotein and Low-density Lipoprotein. They are both codified as HDL and LDL. HDL levels above 40 mg/dL for men or 50 mg/dL for women are considered healthy, while LDL below 100 mg/dL is ideal for most people. (For doctors: Optimal LDL <70 mg/dL in high-risk patients per ACC/AHA 2018 guidelines.)

HDL helps to carry excess cholesterol deposits from the blood to the liver where they are removed from the body. It has a protective function. Cholesterol which is carried by HDL is often called “good cholesterol”. High HDL levels in the blood reduce the risk of heart disease and stroke.

LDL carries most of the body’s cholesterol and deposits it in arterial walls, and this may cause a build-up that will lead to the development of plaques. Plaques block the arteries and may lead to heart attacks or strokes. The cholesterol carried by LDL is often called “bad cholesterol”. Therefore, high LDL levels in the blood may lead to an increased risk for cardiovascular diseases.

Triglycerides are a different type of lipids that are products formed from the conversion of excess calories. When the body ingests more calories than it needs, it converts them to triglycerides, which could be used as a source of energy much later. Triglycerides are transported in the body via Very Low-Density Lipoprotein (VLDL). VLDL mainly carries triglycerides, and when these levels get too high, it can push up your total cholesterol even if HDL and LDL look normal. (VLDL-C is estimated as TG/5 in mg/dL per Friedewald equation, unreliable if TG >400 mg/dL.)

High Cholesterol

The total cholesterol in the body is a measure of the levels of LDL, HDL, and triglycerides in the blood. High total cholesterol, also called hypercholesterolemia, could be a result of a relatively high LDL, a relatively high HDL, or a relatively high VLDL.

When the LDL and HDL levels are within the normal range but there is hypercholesterolemia, it could be a result of a high level of triglycerides in the blood. When the level of triglycerides in the body is more than 200 mg/dL, even where there are low HDL and LDL levels, it overly increases the total cholesterol level of the body. This often happens when the liver makes too many triglycerides, sometimes due to lifestyle or other health issues. Doctors check liver enzymes (like ALT or AST) to spot liver stress, such as fatty liver disease, which can go along with high triglycerides—but these enzymes don’t directly measure triglycerides. (Elevated ALT/AST may signal NAFLD, common in hypertriglyceridemia, but TG levels are assessed via fasting lipid panel, not LFTs.) Also, smoking, excessive drinking, and heavy steroid use (e.g. estrogen) could be causes of hypertriglyceridemia. Other causes include diabetes, low thyroid function, or certain medications—things your doctor might test for if triglycerides stay high. (Secondary causes include hypothyroidism [TSH], diabetes [HbA1c], or nephrotic syndrome [proteinuria].)

High total cholesterol levels caused by high levels of triglycerides may cause problems for the cardiovascular system, an example of which is coronary heart disease. It is also a major cause of acute pancreatitis, diabetes, heart attack, and stroke.

There could also be complications for the hepatobiliary system. High levels of cholesterol can cause non-alcoholic fatty liver disease, which can lead to cirrhosis and liver failure. These

High triglycerides can also contribute to gallstones, where cholesterol in bile forms hard crystals. This might block the gallbladder, cause pain or jaundice, and make it harder to digest fats.” (Gallstones result from bile supersaturation with cholesterol, often linked to obesity and metabolic syndrome, not just circulating TG.)

Treatment for High triglyceride level-induced Hypercholesterolemia

This kind of high total cholesterol level, as a result of high triglyceride levels, can be treated by natural methods that do not involve any type of medication, as well as artificial or synthetic methods that involve the ingestion of drugs and supplements.

Natural Methods

The natural treatment of total cholesterol levels involves healthy lifestyle choices such as:

Reduction in Alcohol Intake: since triglyceride level is increased by excessive drinking, it is advisable to reduce alcohol consumption of any kind.
Cut down on all forms of smoking and steroid use.
Probiotics like kefir, a fermented milk drink, might help lower triglycerides and weight, though more research is needed to be sure.” (Limited evidence; small studies [e.g., Fathi et al., 2016] suggest modest TG reduction, not guideline-supported.)
The consumption of whole grains such as Brown rice, Bulgur, whole wheat, whole grain cereals, oatmeal, barley, quinoa, etc, has been found to greatly reduce high triglyceride levels in the blood and is therefore encouraged as a remedy for high total cholesterol levels. These foods add fiber, which helps your body handle fats better. (Soluble fiber reduces hepatic VLDL production and enhances bile acid excretion.)
Good fats such as Omega-3 fats help to reduce cholesterol levels in the blood. Omega-3 fats are found in fatty fish such as salmon, sardines, tuna, and mackerel and they help to reduce triglyceride levels in the body when consumed.
Exercise does not just help to maintain the normal triglyceride levels in the body, but it also helps to reduce the lipid content of the body, thereby improving the overall health of the individual. Exercise more often than not, to effectively curb low cholesterol levels.
Weight management is an effective way to reduce the calorie content of the body. Recall those excess calories are converted to triglycerides in the liver, hence, the need to reduce weight especially if the individual is overweight or obese. Exercise is an efficient way of weight reduction, as well as healthy eating, mainly the avoidance of foods that contain high calories.

Supplements and medications

Spirulina, a blue-green algae supplement, may lower triglycerides slightly, but it’s not a standard treatment yet. (Small trials [e.g., Mazokopakis et al., 2014] show TG reduction; not in AHA/ESC guidelines.)
Nicotinic acid (Niacin/Vitamin B3) has been found to increase levels of HDL and reduce LDL and triglyceride levels in the body. It works well but can cause flushing or liver issues, so doctors monitor its use. (Dosing 1-3 g/day; monitor LFTs due to hepatotoxicity risk.)
Cholesterol absorption inhibitors are a synthetic group of compounds that when taken help to reduce the intestinal absorption of cholesterol from dietary sources, in turn reducing both cholesterol and triglyceride levels in the body.
Fibrates help to reduce triglyceride levels in the blood and increase HDL (good cholesterol) levels ultimately maintaining cholesterol levels in the body. They’re especially useful when triglycerides are very high, like over 500 mg/dL.” (Per Endocrine Society 2010, fibrates [e.g., fenofibrate] are first-line for TG >500 mg/dL to prevent pancreatitis.)
Statins are prescription drugs that help to stall the synthesis of cholesterol and triglycerides in the liver, hence reducing the natural production of these lipids in the liver. They mostly lower LDL but can also help with triglycerides a bit.
(Statins inhibit HMG-CoA reductase; moderate TG reduction [10-20%] at high doses, e.g., atorvastatin 40-80 mg.)

Conclusion

High triglyceride blood levels as in the very low-density lipoprotein content of the blood, can cause high total cholesterol levels even when the high-density lipoprotein and low-density lipoprotein are within the normal levels. It is imperative to reduce the level of triglycerides by the methods that are shown in this article, to avoid cardiac diseases and nervous system disorders that will result from untreated hypercholesterolemia. Checking with your doctor can help find the cause and best treatment for you. (Consider non-HDL cholesterol and ApoB for risk stratification in such cases.)

Frequently Asked Questions (FAQs)

What does it mean if my total cholesterol is high but LDL and HDL are normal?
High triglycerides might be raising your total cholesterol via VLDL.
(TG increases VLDL-C, per Friedewald: Total = LDL + HDL + TG/5.)

How high is too high for triglycerides?
Over 200 mg/dL is high; over 500 mg/dL needs urgent action.
(TG >500 mg/dL risks pancreatitis, per Endocrine Society 2010.)

Why would my triglycerides be high if my diet isn’t fatty?
Excess carbs, alcohol, or conditions like diabetes can raise them.
(Check TSH, HbA1c for secondary causes.)

Can I lower triglycerides without medicine?
Yes, less alcohol, more fiber, fish, exercise, and weight loss help.
(Boosts lipoprotein lipase, cuts VLDL.)

What medicines help with high triglycerides?
Niacin, fibrates, or statins; spirulina’s unproven. Ask your doctor.
(Fibrates for TG >500 mg/dL; niacin 1-3 g/day.)

Can high triglycerides hurt my heart even if LDL is normal?
Yes, they can still increase heart risk.
(Non-HDL and ApoB are key markers.)

Why does my doctor check liver enzymes with high triglycerides?
To spot liver stress, like fatty liver, not to measure triglycerides.
(ALT/AST may indicate NAFLD.)

How often should I check my cholesterol if triglycerides are high?
Every 3-6 months until stable, then yearly—ask your doctor.
(For doctors: Fasting lipids q3-6 months initially.)

References

National Heart, Lung, and Blood Institute. (n.d.). High blood triglycerides. U.S. Department of Health & Human Services. Retrieved March 13, 2025, from https://www.nhlbi.nih.gov/health/high-blood-triglycerides

Cleveland Clinic. (n.d.). Cholesterol numbers: What do they mean? Retrieved March 13, 2025, from https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean

Fathi, Y., Ghodrati, N., Zibaeenezhad, M. J., & Faghih, S. (2017). Kefir drink causes a significant yet similar improvement in serum lipid profile, compared with low-fat milk, in a dairy-rich diet in overweight or obese premenopausal women: A randomized controlled trial. Journal of Clinical Lipidology, 11(1), 136–146. https://doi.org/10.1016/j.jacl.2016.10.016

Mazokopakis, E. E., Papadomanolaki, M. G., Fousteris, A. A., Kotsiris, D. A., Lampadakis, I. M., & Ganotakis, E. S. (2014). The hepatoprotective and hypolipidemic effects of Spirulina (Arthrospira platensis) supplementation in a Cretan population with non-alcoholic fatty liver disease: A prospective pilot study. Annals of Gastroenterology, 27(4), 387–394. PMC4188938