Should We Be Less Strict About Cholesterol? What the Latest Research Really Says

Cholesterol has always been one of the most debated markers in healthcare. Depending on who you talk to, cholesterol is either something to keep tightly controlled or something to stop worrying about altogether. Over the past few years, a growing number of Functional Medicine practitioners have begun taking a more relaxed approach to cholesterol targets, especially in patients who appear otherwise metabolically healthy.

So where does Optimal DX stand on this shift?
And more importantly, what does the research actually support?Cholesterol Ranges Are Changing, But Not Always for the Reasons You Think

Traditional guidelines have long emphasized keeping total cholesterol and LDL ("bad cholesterol") low to protect cardiovascular health. Many Functional Medicine clinicians, however, are now noting that some individuals with slightly higher cholesterol remain metabolically flexible, inflammation-free, and at low cardiovascular risk.

At first glance, this suggests that cholesterol ranges should be loosened.

But the truth is more nuanced.

Cholesterol Should Never Be Interpreted in Isolation

This is the big idea that often gets overlooked.

A single cholesterol value, high or low, does not tell the whole story about someone's metabolic or cardiovascular health. Cholesterol interacts with:

• Triglycerides
• Blood sugar dynamics
• Inflammation
• Thyroid function
• Overall metabolic flexibility
• Liver health
• Family history and genetic patterns

This means two people with the same cholesterol number can have very different health profiles.

At Optimal DX, our goal has always been to give practitioners a more complete picture, not just a number to react to.

So, Are Conservative Cholesterol Ranges Wrong?

Not necessarily. In fact, there are good reasons why more conservative cholesterol targets can still be helpful, especially when interpreted in context rather than as standalone judgments.

Here is what the evidence tells us.

1. Total Cholesterol and LDL: Conservative but Still Clinically Sound

Some research suggests that people with total cholesterol slightly above 200 mg/dL may not be at higher risk if the rest of their metabolic markers look excellent. That is why some practitioners are moving toward less strict thresholds.

However, preventive cardiology still strongly supports maintaining LDL cholesterol on the lower side for long-term cardiovascular health, particularly for individuals with inflammation, insulin resistance, or a family history of heart disease.

So while our ranges at Optimal DX are more conservative than what some clinicians now prefer, they remain grounded in widely accepted preventive research.

2. HDL ("Good Cholesterol") Is No Longer a Simple Story

For years, we believed that higher HDL was always better. New research now shows that extremely high HDL may not be protective and may even be associated with increased cardiovascular and all-cause mortality.

This is one area where the science has genuinely shifted, and where historical assumptions are being challenged.

3. Triglycerides Tell Us More About Metabolic Health Than Cholesterol Alone

Triglycerides are one of the clearest markers of metabolic flexibility and insulin sensitivity. Keeping triglycerides in a tight, low window is strongly supported by modern metabolic research.

This marker is often far more responsive to lifestyle, diet, and liver function than total cholesterol.

The Real Question Is Not "Strict vs. Not Strict" It Is "What Is the Whole Picture?"

It is easy to oversimplify cholesterol into good-versus-bad categories. But true metabolic assessment requires pattern recognition, not single number judgments.

At Optimal DX, our interpretation philosophy is built around this idea:

A cholesterol value is only meaningful when viewed in the context of the entire metabolic and inflammatory landscape.

That is why we do not rely on isolated values to draw conclusions. We look for patterns, relationships, and physiologic signals that help practitioners identify what is really happening beneath the surface.

Will Optimal DX Adjust Its Cholesterol Ranges?

We continuously monitor emerging research, and we revise ranges only when there is strong, reproducible evidence that doing so improves clinical interpretation.

Here is what we see today:

• Total Cholesterol and LDL: Conservative ranges still make sense in a preventive model, especially when they are interpreted with context.
• HDL: This is the one area we may refine, since newer research challenges the old belief that higher is always better.
• Triglycerides: Tight, low ranges remain strongly supported by metabolic science.

Our approach is designed not just to classify numbers, but to help practitioners understand the metabolic patterns behind them.

The Bottom Line

Cholesterol interpretation is evolving, and that is a good thing. We now understand more than ever that cholesterol is just one part of a much bigger metabolic picture.

Rather than loosening ranges across the board, the more innovative approach is to evaluate cholesterol in context:

• What are the triglycerides doing?
• What is inflammation doing?
• Is the person metabolically flexible or insulin resistant?
• What does their overall physiologic pattern suggest?

This is the philosophy that guides the Optimal DX platform and why our model remains both conservative and clinically meaningful.

As research continues to evolve, so will we, always with the goal of equipping practitioners with the most accurate, practical, and actionable insights possible.