Recently there have been a few questions in my clinic about how to lower cholesterol and its relevance to Cardiovascular disease. (CVD)
The latest research shows that cholesterol per se is not the cause of CVD but must be seen as one contributing factor to the overall risk. Several risk factors make up the percentage risk for CVD. Exercise, stress, smoking, body fat composition, alcohol consumption, diet, home environment, workplace environment, and occupation must be factored into the Algorithm for assessing percentage risk.
Blood tests such as Homocysteine, HbA1c, C reactive protein, Ferritin levels, APo A and ApoB and uric acid levels play a part in the diagnostics for risk assessment and are separate risk factor markers measurements. They must be seen in context and collectively to factor in CVD %risk.
In mentioning risk, a significant diagnosis risk assessment is the Coronary Calcium score Test, but how many people have had that scan? The CC scan is a very important biomarker test for measuring damage to blood vessel walls and the likely presence of soft plaque.
The use of statins is controversial. Numbers needed to treat (NNT) show that using statins to prevent mortality is less than 1%. So out of 100 people in a room on statins, only one will benefit from reducing their risk of Heart attack!
Here is a link to their web page –
Should we be concerned about cholesterol? Perhaps, but only as part of the risk assessment. So-called LDL cholesterol contains the most atherogenic particles prone to oxidisation that can lead to coronary blockages, but other subtypes of cholesterol may be as well. When we talk about cholesterol, one needs to talk about the carrier molecules of cholesterol called -lipoproteins. Lipoproteins are water-soluble and carry the cholesterol molecule.
WHAT DOES THIS MEAN?
If we cut ourselves, the wound heals from the inside out. Blood seeps out of the injury and coagulates, sealing the wound. As part of the blood, Lipoproteins carrying cholesterol move in to help rebuild the damaged cells. Released cholesterol is used to build cell walls. Red blood cells themselves have a percentage of cholesterol. Along the way, because of the white blood cells that are removing bacteria and debris in the wound, lipoproteins and other nutrients become oxidised as a part of this inflammatory process. Eventually, nature takes its course, and the inflammation settles down to scar tissue which is, in turn, remodelled slowly and eventually is “ absorbed” into the tissues. Minor wounds do not create much scarring, but larger ones do, and in some cases where there is tremendous trauma, the scar is of such a size that it cannot be remodelled or absorbed into the surrounding connective tissue.
A similar event happens within our blood vessels, and it is now thought that specific lipoproteins stick to blood vessels when micro-tears become oxidised due to inflammation. Wound healing occurs within the blood vessel wall with its micro blood vessel supply. Cholesterol carried by lipoproteins, therefore, does not just float in the blood and happens perchance to “stick” to Blood vessels. Blood vessels are covered with a Calyx, a hair-like structure that prevents this process and adds a smooth coat to blood vessels. When this calyx is damaged, micro tears begin to occur within the tissue.
An example is if one has a non-stick fry pan with a specialised coating (Calyx), then nothing will stick to the pan ( cholesterol) unless the layer is damaged by trauma ( micro tears) or overheating ( inflammation & oxidation).
WHAT IS THE CAUSE OF A BLOOD VESSEL MICROTEAR?
Age, inflammation, oxidation, poor nutrient supply to blood vessel walls and tissues, and shear velocity of the blood and its components all contribute to damage to the Calyx. Once the Calyx is damaged, it may not repair. Further trauma leads to wear that, through inflammation and oxidisation, micro tears become calcified. If calcification does not occur, soft plaque may develop and is most dangerous as it is prone to breaking off and moving to the heart, brain or other organs. Since coronary calcium and soft plaque are often found together, then a high CC score is a barometer of oxidative damage to the calyx and endothelium ( inner lining of blood vessels )
WHAT TO DO?
This information will focus on cholesterol reduction rather than risk factors which are covered in a separate blog.
We need to look at what can be done to lower cholesterol readings, reduce atherogenic LDL in particular, prevent cholesterol oxidation, and strengthen blood vessel walls to prevent micro tears and preserve the integrity of the calyx.
Diet and supplements are specific therapy for this scenario.
- DIET: Considerable research has explored the benefits of using a Mediterranean diet (MD) to prevent CVD. This is due. to its high nutrient and fibre content. I recommend using the MD as a blueprint to work from and modify to suit. The emphasis should be on a high plant food intake that contains lots of Fibre, Ancient grains, pressure-cooked legumes, and some protein and fruit. Pasta, rice and bread and sugars should be avoided.
- Foods should contain lots of coloured and pigmented vegetables and fruits. The colours contain flavonoids, polyphenols and minerals that maintain the integrity of the arterial walls and reduce inflammation .. Likewise, they contribute to a healthy GUT flora that has been demonstrated to lower cholesterol levels by its effects on bile consistency and excretion. GUT flora also has the effect of modulating inflammation.
- The above recommendations are similar to the alkaline diet, consisting of 80% fruit and vegetables and 20% protein. I recommend if you wish to lower cholesterol quicker, have a 90% whole plant food and 10% protein eating regime. Protein can be meat, chicken, fish, or tofu; Legumes are part protein and part carbohydrates so that they can be consumed for some meals.
Reducing body acid load reduces inflammation in the body!
- A sample day of eating would look like this –
Organic oat porridge or Bircher Muesli with blueberries and goji berries. Alternatively, an egg omelette with vegetables of choice, but heavy on the veg.
Mixed Salad with tuna or prepared tofu/ or mixed veg soup with an ancient grain ( cooked buckwheat, Millett or Quinoa) or vegetable soup with legumes ( lentils, mung beans etc. Reduce legume consumption if they cause bloating or gas.
The protein of choice with mixed steamed vegetables, salad, casserole, etc.
10- 20% protein and 80 -90% mixed veg.
Vegetable soups can be eaten at any meal with some miso that will help the microbiome. For those who dislike eating breakfast, a miso vegetable broth is an excellent quick start to the day.
The best Veg for Fibre is the cruciferous vegetables like -cauliflower, broccoli, box Choy and kale; good fibre fruits are apples, blueberries and avocado.
Olive oil and Ghee are the best oils to use with cooking and olive oil in particular on salads. Sunflower, safflower and grapeseed oils should be avoided as they contribute to the inflammatory process.
Interestingly Vegan eating has a good track record in lowering cholesterol due to the number of whole plant foods consumed.
Fruits can be eaten as snacks in between meals or put into salads where possible.
Summary: Fibre reduces cholesterol; coloured foods are nutrients to blood vessels and reduce inflammation and oxidation. Polyphenols in fruit, veg and olive oil feed the Gut bacteria, which help lower cholesterol.
Anti -Inflammatory supplements :
Curcumin and Boswellia – The top combination for reducing Inflammation anywhere in the body, improving liver metabolism, and preventing cholesterol oxidation.
Grapeseed extract -Grape seed helps both inflammation and blood vessel wall integrity – it is a potent antioxidant.
Green Tea -has polyphenols that are anti-inflammatory and feed the microbiome.
Krill Oil – the fatty acids have an anti-inflammatory effect, and trials show that it lowers cholesterol.
Bergamot – made from particular citrus. The oil and peel contain anti-inflammatory and cholesterol-lowering compounds. The compounds are also good for the liver. This is a popular supplement prescribed by integrated cardiologists.
Anti-cholesterol supplements :
Bergamot is anti-inflammatory and facilitates an enzyme that controls the rate of cholesterol production.
Globe artichoke – increases bile flow to move cholesterol.
Phytosterols – bind onto bile which contains cholesterol, for quicker elimination.
Garlic – lowers cholesterol and helps with inflammation.
Green tea – lowers cholesterol.
Krill – lowers cholesterol in studies.
Ground Flax seed – high in fibre, promotes a good microbiome and helps to eliminate cholesterol-containing bile.
Arterial Wall strengthening supplements :
Grape seed extract – as mentioned.
Gotu kola – strengthens connective tissue and heals microtears.
Ginko – increases circulation and prevents blood platelet aggregation. It helps maintain tissue integrity.
Here is a example simple starter supplement stack to cover all bases :
Herbs of Gold Grape seed extract – one per day as per bottle instructions
Herbs of Gold Bergomet cholesterol care -two per day as per bottle
Kyolic Garlic Extract – 2 per day as per bottle
Thompsons Phytosterol complex as directed on the bottle
Krill oil as directed on the bottle.
Five cups of brewed loose-leaf Quality green tea per day. Hot tea can be stored in the thermos and consumed during the day. It can also be cooled down and kept in a glass bottle for daily consumption.
If one has arthritis, add Boswellia + Curcumin supplement (. Fusion health inflammation formula ) to the stack.
It is good to have a supplement stack that covers all bases, not just cholesterol-lowering agents. Diet is the key, and then a few supplements are taken for 6 six months. Blood tests should be done every six months to monitor the progress and effectiveness of the program.
This article is for general information and is not an individual prescription for lowering your cholesterol. Not all supplements listed would be taken—only some from each category in a balanced way. The supplements listed above are generally available from Health food stores and Pharmacies. Practitioner-only products are not listed but may be far more effective due to strength and quality but must be individually prescribed by a Naturopathic Practitioner. Practitioner products are better formulated to give better results.
Those on aspirin or blood thinners should seek advice before taking any supplements. The Diet suggestions in this article are safe, but some supplements may have a natural blood-thinning effect or interact with pharmaceutical medications. Please see your Natural Health Practitioner for assessment.