High cholesterol has been blamed for causing heart disease for many years now, and pharmaceutical companies make billions of dollars from selling statin medications, yet the research shows that just reducing cholesterol does not prevent heart disease risk. Just as many people experience heart disease with normal cholesterol levels as people with high cholesterol, which tells us that there must be more to the story than reducing total cholesterol.
There is more to cholesterol than just LDL, the so called “bad” cholesterol, but the basic test that the doctor does will not tell you if your cholesterol levels are a cardiovascular risk.
The basic doctor’s test only measures total cholesterol, Triglycerides, HDL and LDL and most doctors only look at total cholesterol and LDL levels to decide whether to put you on statin medications. Yet the best markers in the basic test to assess whether you are at risk of heart disease is the HDL to Triglyceride ratio, you want your HDL levels to be above 60mg/dl (1.5 mm/l) as a minimum and you want your triglyceride levels to be below 40mg/dl (1 mm/l) as a minimum.
A better way to assess your cardiovascular risk is by doing the extensive cardiovascular test, this test measures LDL subfractions to assess whether you have the bad small dense LDL, VLDL, apolipoprotein B which measures LDL particle number, LDL particle size and the inflammatory makers HSCRP and Homocysteine, as cardiovascular risk is greatly increased with inflammation.
If your cholesterol is high and you have the wrong type of cholesterol, what is the best way to treat high cholesterol? Is it natural supplements or medications? The first step is to address the underlying cause and you may not even need to add supplements or statin medications.
Insulin resistance, also known as metabolic syndrome leads to an increase in triglycerides, and is caused by a high sugar and refined carbohydrate diet – which is the typical Western diet of cereals, breads, biscuits, juice and other highly processed products not typically found in nature.
LDL carry cholesterol, fat soluble vitamins, anti-oxidants and triglycerides around the body, the first three are essential for our health, cholesterol is important for hormone production and the structure of our cells. LDL is a transporter, think of LDL as a bus transporting cholesterol, fat soluble vitamins, anti-oxidants and triglycerides around the body, if we have higher triglyceride levels we are going to need more buses (LDL) to transport them around, and this leads to higher LDL levels as well as higher LDL particle number. With the increased number of “buses” on the road combined with the inflammation that is caused by insulin resistance, this is a recipe for oxidative damage and increased cardiovascular risk.
The standard cholesterol test does not measure the LDL particle number or if you have the small dense LDL particle size which places you at a higher risk of heart disease.
If you have high triglycerides and other markers of insulin resistance like a waist circumference greater than 40 inches (102cm) in men and 35 inches (88cm) in women, and or high blood pressure, and HDL levels which are low then reducing carbohydrate intake is essential to address the underlying cause. This article on carbohydrate intake can help you work out how many grams of carbohydrates you need each day.
I see a lot of clients who have low thyroid function and high cholesterol, and rather than focusing on addressing the cholesterol the first priority should be to address thyroid function.
Most doctors only test TSH levels which is only one aspect of thyroid function, it is possible to have normal TSH score and be told by your doctor that your “thyroid is fine” yet you have low thyroid function, and the symptoms that come with that.
Multiple studies have shown associations between bacterial and viral infections and elevated cholesterol, in particular elevated LDL levels. These infections can include gum disease, viruses such as the herpes virus and Epstein Barr virus, as well as gut infections like H.Pylori and parasites.
A comprehensive pathology test looking at viral infections, testing for gut pathogens and a visit to your dentist can all help to determine if infections are the driving force behind your high cholesterol.
We have just talked about how gut infections such as Helicobacter pylori, SIBO and parasites can lead to high cholesterol levels, and there are other areas of gut dysfunction that can also lead to high cholesterol.
Leaky gut is when the gut barrier becomes more permeable to endotoxins such as lipopolysaccharides (LPS), these toxins enter the bloodstream and create an immune response, these leads to a wide variety of physical symptoms like headaches fatigue, anxiety, skin problems and more. As part of the body’s defence against these toxins it releases a protein called LPS binding protein which circulates with the LDL, this leads to an up regulation of your LDL levels.
Addressing gut bacterial infections and dysbiosis can decrease cholesterol levels by 30-40% which makes addressing the gut a good place to start, and you do not have to have any digestion symptoms to have gut infections.
There is still a lot of research that needs to be done in this area, but at the moment there is some strong research linking mercury toxicity and insulin resistance, and a direct connection with elevated LDL levels through the same mechanism that causes an increase in LDL with bacteria infections.
Another toxin is Bisphenol A (BPA) and it is also possible that other toxins are associated with an increase in LDL levels. Avoid cooking/ reheating food in plastic, or reusing plastic water bottles, better still avoid buying plastic water bottles at all for many environmental reasons.
Last but definitely not least is the affect of diet and lifestyle on cholesterol levels. We have touched on many of these already but exercise can be another factor that lowers cholesterol by reducing insulin resistance, it has the added advantage of increasing your HDL levels.
Diet is going to depend on your genetics (which we will talk about next) but it is not the cholesterol in foods that causes high cholesterol but the processed and high carbohydrate foods, and for a small portion of people with the APOE gene or LDLR gene it may also be the saturated fats that are a problem.
We will talk briefly about genetics as this is one factor that can lead to high cholesterol that you cannot modify, but it does not mean that if you have the genes for high cholesterol you will get heart disease. Knowing your genetics I think is important, as it can help you to focus on the areas of cardiovascular health that you can modify, especially the diet which can influence the genes the most.
Familial hypercholesterolemia can involve several different genes that code for the LDL receptor, these include LDLR and the APOB gene. These genes can increase your cardiovascular risk and you can find out more about genes and cardiovascular disease through this article.
The APOE4 gene can also increase your risk of cardiovascular disease, as well as Alzheimers. This is a gene that can cause high cholesterol and high triglycerides from a high saturated fat diet, for most people cholesterol levels will actually improve on a higher fat/ lower carbohydrate diet (though many people find this hard to believe due to the fat fear mongering of the 80’s and 90’s). If you have the APOE4 gene you are better off lowering your saturated fats and increasing monounsaturated fats, similar to a Mediterranean diet.
Your genes can be tested through companies like 23andme and you can find out the health information through websites such as Livewello. At Planet Naturopath we can help you interpret your genetic results, so that you can optimize your cardiovascular health, and other areas of your health.
While addressing the risk factors that can cause high cholesterol is the first step to lowering your cholesterol levels and cardiovascular risk, there are a number of supplements that can also help to lower cholesterol.
If you have the genes for high cholesterol, have already had a heart attack or would simply like to be more proactive in reducing your cholesterol here are some of the supplements that I recommend based on the research.
Natural supplements can be very effective at treating high cholesterol and reducing cardiovascular risk, most studies look at individual supplements in isolation , but like when treating many conditions a combination of supplements is often more effective.
One study using a combination of pantethine, planet sterols, green tea extract, tocotrienols and red yeast rice extract reduced total cholesterol and LDL by 35%, VLDL dropped 27% and HDL increased by 10%. These results are more impressive than statin medication.
Pantethine is a naturally occurring derivative of pantethenic acid which is Vitamin B5, and a precursor of Coenzyme A. Human studies have shown significant improvements in total cholesterol and LDL with Pantethine, it has also been shown to reduce arterial plaque formation in the arteries and is one of the few natural products that can lower LDL and increase HDL
Tocotrienols are a member of the Vitamin E family, alpha tocopherol is the form of Vitamin E that most people supplement with but studies show that it does not reduce heart disease and in fact may increase your risk. So it is important to supplement with the right type of tocotrienols and I recommend this one from Allergy Research Group which you can get from Amazon or www.iherb.com
Red yeast rice extract inhibits the HMG – CoA reductase enzyme which is the same mechanism that makes statin medications effective. While statins have a wide range of side effects that effect many people, most people who react to statins will be ok with red yeast rice extract, but about 5-10% of people may have some mild side effects if it is used long term. I like to use the Jarrow brandas it also includes some Co-enzyme Q10 which is beneficial for cardiovascular health, you can get it from Amazon or www.iherb.com
Omega 3 essential fatty acids are important for many aspects of cardiovascular health as well as cognitive function, while it is best to get these nutrients from oil fish like salmon and sardines many people do not eat these foods very often. If you don’t eat 3-4 serves of oily fish a week I would recommend supplementing with a good quality fish oil, there are some good ones out there and one of the best value is one from Now Foods which you can get from Amazon or www.iherb.com
If you have a family history of cardiovascular disease, high blood pressure, high cholesterol, previous heart disease or just want to find out what your cardiovascular risk is, I suggest doing the extensive cardiovascular test
A good place to start is to schedule a 30 minute consultation to assess your risk factors and find out the best test options for you, if you go ahead with any testing the price of the consultation will be taken off the cost of the test, effectively making the consultation free.
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions. As Seen