Written by Dr. Rich Snyder
Cholesterol is a fatty material made by the liver. It is essential for human life. However, cholesterol levels that are very high or cholesterol that is “inflammatory” increases your risk of heart and vascular disease.
High cholesterol can increase the risk of heart disease through the formation of a cholesterol plaque over time.
The treatment of high cholesterol includes modifying your diet to a more plant-based one as well as increasing your fiber intake, incorporating supplements that normalize your cholesterol levels and reducing inflammation.
The following provides information on high cholesterol natural treatments.
What is cholesterol?
Cholesterol is a fatty material made by the liver. It is one of the basic building blocks of the cells in your body. It is a vital component of the cell membrane that helps protect the cell and maintain its integrity and viability. Cholesterol is also important for the production of certain vitamins, such as Vitamins A, D, E, K (called fat–soluble vitamins). It is also needed for hormone production; this includes cortisol and sex-related hormones. We not only produce cholesterol in our bodies, but we also obtain it from the foods that we eat.
Why or when is cholesterol bad?
Cholesterol, in and of itself, is not bad. It is in fact essential for human life. However, cholesterol levels that are very high or cholesterol that is “inflammatory” increases your risk of heart and vascular disease. High cholesterol can increase the risk of heart disease through the formation of a cholesterol plaque over time as pictured above.
Are there different ways of looking at cholesterol?
When taking a holistic view of cholesterol, there are three different aspects that need to be considered:
- Recognizing the different types of cholesterol
- Understanding the nature of the cholesterol molecule itself: is the molecule small and dense (increased inflammation risk) or light and fluffy (negligible inflammation risk)
- Recognizing that cholesterol can exist in an oxidized state or a natural/reduced state
- It is important that you and your healthcare provider review all of these factors when looking at your cholesterol levels.
What are the different types of cholesterol?
- The HDL, or High Density Lipoprotein, is called the “good cholesterol.” In general, the higher the HDL levels, the better.
- LDL, or Low Density Lipoprotein, is considered to be the “bad cholesterol.” In general, it is thought that the lower the LDL levels, the better in terms of reducing the risk of heart disease.
- Triglycerides are another form of fat that is in the bloodstream. Very high levels, which can be seen with diabetes and alcohol abuse, are a risk factor for heart disease.
- VLDL, or Very Low Density Lipoprotein, is a form of cholesterol that is also helpful in determining your heart risk. In general, the higher this number, the higher your risk of heart disease.
What do you mean by the nature of the cholesterol molecule and inflammation?
A number does not tell the whole story when it comes to cholesterol levels and determining their risk for heart and vascular disease. If you look at LDL, for example, there can be small dense particles which are thought to be more of a risk for the formation of a plaque or atherosclerosis in comparison to the larger fluffy and light particles which are non-inflammatory.
Inflammation also refers to whether the cholesterol is in a natural or “reduced” state or “oxidized” or inflammatory state. Be aware that all of the cells in our body exist in a natural or reduced state. In the setting of chronic inflammation, the cells become oxidized. This generates the formation of free radicals. This also changes the nature of the cholesterol in the cells, particularly the blood vessels, and causes them to be more inflammatory and hence, more likely to form a cholesterol plaque.
There are ways to measure cholesterol numbers in the blood as well as more specialized blood testing to tell you the nature of the cholesterol profile.
- On traditional blood work, the LDL, HDL and triglycerides levels are part of a standard lipid profile.
- If your LDL is > 160 and you have heart disease or you have several risk factors for heart disease, this is considered to be a high number.
- If your HDL number is < 40, it is considered to be too low. Lower levels of HDL are risk factors for heart disease.
- Triglyceride levels > 150 are considered to be high.
How do I know if I have abnormal cholesterol?
This is again looking not just at the number, but also inflammatory risk for cholesterol.
- On a regular lipid profile, additional testing, including looking for certain markers such as apolipoprotein B and lipoprotein A levels, are important markers for how “atherogenic” the cholesterol particles may be.
- There is a specialized test called the VAP or Vertical Auto Profile test that can tell you the nature of the LDL or HDL molecules that you have. If, for example, the VAP test reports that your cholesterol is larger and fluffier in nature, they are less likely to be inflammatory with lesser risk for inflammation. This is an example of a personalized test that can really help you to determine your risk for heart disease.
- Your healthcare provider should also test for “inflammation.” In particular, blood tests, including the erythrocyte sedimentation rate and high sensitivity C-reactive protein need to be checked. The higher the level, the more likely the cholesterol is inflammatory and increases the risk of plaque formation and heart disease.
What are conventional treatments of high cholesterol?
The traditional treatment of high cholesterol levels includes the prescription use of medications. Commonly prescribed drug classes of medications used to lower cholesterol include the statins, Zetia (Ezetimibe), bile-acid resins, and Niacin.
Statins: These are medications that inhibit the formation of cholesterol. Studies have demonstrated that this class of medications has decreased the risk of heart attacks and is heart-protective for someone with risk factors for heart disease, including high blood pressure and diabetes. Potential side effects of this class of medications include elevated liver enzymes (as can be measured in the blood), muscle pain or myalgias. It may also affect memory and may cause memory problems. Caution: Statins can deplete the body of ubiquinone (Coenzyme Q10), a potent anti-oxidant that is important not only for maintaining a healthy heartbut also for maintaining cellular health.
- Supplementation with ubiquinone is recommended when taking this class of medications.
- Ubiquinone can also decrease the risk of developing myalgias when taking statins and can also help in the treatment of myalgias once they begin.
Zetia (Ezetimibe): This medication blocks the absorption of cholesterol in the intestine. It can be prescribed to be used in conjunction with statin therapy for the treatment of high cholesterol. Caution: Because this class of medications inhibits cholesterol absorption, it can also affect the absorption of key fat-soluble vitamins, including Vitamins A, D, E, and K.
Bile acid resins: This medication also is used to block the absorption of cholesterol in the intestine. It can also affect the absorption of key fat-soluble vitamins, including Vitamins A, D, E, and K.
Niacin: This is used in the treatment of low HDL to raise their levels. This medication has been known to cause flushing as a side effect and aspirin is often needed to be given prior to taking a dose of Niacin. There are extended release forms of Niacin that do not have this effect.
Fenofibrate: This class of medication is used to treat high triglyceride levels. They have similar side effects to the statin class of medications, including affecting the liver and causing myalgias. Caution: If a statin and fenofibrate are taken together, this can dramatically increase the risk of developing liver problems and significant muscle pain and muscle damage. In some cases, the muscle damage can be significant enough to cause kidney failure.
One of the most important changes necessary in the treatment of abnormal cholesterol is changing your diet. A diet higher in fruits and vegetables is recommended. Did you know that the new Food Pyramid recommends five to seven fruits and vegetables each and every day? One of the well-studied diets is the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH diet not only lowered blood pressure, the risk of developing other complications of high blood pressure and diabetes, it also helped in lowering cholesterol.
This diet advocates the consumption of fruits, vegetables, and whole grains. It emphasizes reducing foods high in polyunsaturated fats as well as significantly reducing the amount of meat-based protein in the diet. Notwithstanding the chemicals, toxins, food additives, antibiotics that may have been used in the preparation of the meat, high animal protein intake increases total body inflammation, which plays an important role in the development of high cholesterol.
Another diet that has been extensively studied in the treatment of high cholesterol is the Mediterranean diet. Like the DASH diet, this diet stresses the consumption of fruits and vegetables, and healthy fats, particularly promoting the use of olive oil over butter. Eating fish, especially salmon twice a week is recommended for its high Omega 3 content. Much research has been done advocating the many benefits of the Mediterranean diet, especially for its heart protective effects.
The basic conclusion that can be drawn is that a plant-based diet can reduce not only your inflammation levels, but also can help normalize your cholesterol levels.
Coenzyme Q10 (Ubiquinone)
Replacement of this antioxidant is necessary to help improve blood vessel health. This is vital to take, especially if you have been prescribed a statin-based medication.
- When starting, begin with small doses at 50-100 mg daily and increase to twice a day after several weeks. Smaller doses taken during the day maximizes its absorption. Monitor your blood pressure closely. If you have diabetes, this nutrient can also help lower your blood glucose levels so they need to be monitored as well.
If your diet is low in fiber, a fiber-based supplement is recommended. Remember that fiber can bind the cholesterol in the intestine and prevent its absorption. Examples of commonly used fiber supplements can include a psyllium-based fiber supplement like Metamucil or more of a soluble-based fiber like Glucomannan fiber.
This is excellent for helping to maintain the cholesterol in the natural or “reduced” state. It decreases the inflammation of “cholesterol plaque.”
- Aged garlic extract can be taken in capsule form starting at 400-600 mg a day. As garlic is a natural blood thinner, be careful if you are on prescription blood-thinning medications such as aspirin, Plavix, or Coumadin.
Omega 3 fish oil
Omega 3 fish oil can not only help in lowering triglycerides, it is important for maintaining the health and pliability of the blood vessels as well as tremendous for reducing inflammation. You can start at 2000 mg a day and increase slowly to a maximum of 4-5 grams a day. Be aware that Omega 3 fish oil can thin the blood, so you may need to decrease your dosage if you are taking any blood thinners.
These are plant-based compounds that can be used in the treatment of high cholesterol. They can be taken independently or can be part of other formulations as well. An example of a plant-based sterol is beta-sitosterol. This can be taken once to twice daily, depending on the formulation chosen.
Red Yeast Rice
This is a natural form of the statin medications, and is used by many in the treatment of high cholesterol. There are several caveats when taking this supplement you need to be aware of:
- Do not take prescription statins if you are taking this supplement.
- As with the statin medications, liver tests (blood work) need to be monitoredand myalgias can occur with this supplement as well.
- It is recommended to begin at a dose of 600 mg daily and slowly increase over the course of several weeks to a maximum dose of 1200 mg twice a day. You should be under the care of a health care provider when taking this supplement.
Turmeric is a great anti-oxidant to lower cholesterol levels and reduce inflammation. It can be taken as a 400 mg capsule daily or simply by sprinkling a little Turmeric powder on each meal. It does have a blood thinning effect so be aware if you are on other blood-thinning medications as mentioned above.
Our bodies were meant to move. Beginning an exercise regimen is crucial to help in lowering cholesterol levels.
Walking thirty minutes four times a week has benefits of not only improving endurance, but also strengthening the heart as well as helping you lose weight. Other forms of exercise include jogging, biking, swimming and aquatic-based therapy.
Exercising in the water is not only rejuvenating, but as it reduces the wear, tear, and constant pounding on the joints, it is an ideal choice, especially if you are suffering from arthritis or have difficult y walking. Depending on your health issues, it is recommended that you see your health care practitioner to develop a personalized exercise regimen that matches your likes and limitations. Don’t forget to include muscle resistance training into your exercise regimen.
Yoga and tai chi represent a form of exercise that improves muscle strength and flexibility and does not require the use of expensive equipment. As mentioned above, they are great forms of exercise that can help improve cholesterol levels.
Updated: June 2019
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