- LDL is known as “bad” cholesterol
- HDL is known as “good” cholesterol
- Your ratio of LDL:HDL is just as important as the individual numbers
- Diet, exercise, and lifestyle factors must be addressed if your cholesterol levels are unhealthy
- Nutritional supplements should be considered as one way to correct unhealthy cholesterol levels
Before we dive right in to the list of supplements, let’s talk about why we may want to lower cholesterol levels. It’s not as cut and dry as you’ve been led to believe. The general consensus in the medical community is that high LDL cholesterol (Low Density Lipoprotein aka the “bad” cholesterol) causes heart attacks and strokes. There has been evidence to challenge this connection, but the standard of care has not changed. Chances are, if your doctor runs your blood lipid panel, and your LDL is above 100, you may be prescribed a type of cholesterol lowering medication called a statin. This purpose of this article is to talk about alternatives to these medications. Because of the above-mentioned study and the frequency of side effects with statins, I believe this standard of care should be re-evaluated. The researchers in the above study actually concluded that “High LDL-C is inversely associated with mortality in most people over 60 years.” That’s right, inversely, meaning the higher LDL group had fewer fatalities. Now, I am not insinuating that this is an open and shut case. It’s absolutely not. But, we need to keep learning and questioning what we think we know about cholesterol. Obviously, there’s more than meets the eye when it comes to the commonly held belief that high LDL = arterial plaque = inevitable heart attack. We do know that having a healthy ratio of LDL to HDL (High Density Lipoprotein aka “good” cholesterol) is important. So, here’s where we get to the part about why we may want to lower cholesterol. We may want to lower the LDLs to get them in a healthier ratio with the HDLs. There is evidence to believe that high HDLs, relative to LDLs, can prevent heart attacks and strokes. We also want to look at the big picture and do more thorough lab evaluation. If your cholesterol levels are high, I suggest you request a more detailed lipid panel usually called an LPP or VAP panel to look more closely at particle sizes and genetic factors. Other pertinent lab markers are triglycerides, HA1C, CRP, glucose, and insulin. Assessing these will tell your doctor more about your cardiovascular risk factors. As a naturopathic doctor I think of myself as part detective and part doctor. ND’s are always trying to dig deeper for root causes of symptoms and lab abnormalities. Why might your LDL cholesterol levels be elevated? If you have an underlying health condition or unhealthy lifestyle, cholesterol-lowering medications or supplements won’t help as much. You should talk with your doctor and get some labs run to make sure you don’t have any of the following conditions which can cause high LDLs: diabetes, hypothyroidism, Cushing’s disease, liver disease or kidney disease. Some lesser known causes of cholesterol elevation are: chronic inflammation, pre-diabetes or insulin resistance, as well as sex hormone imbalances. Lastly, I would be an irresponsible ND if I didn’t mention that diet and a healthy lifestyle are a critical part of a healthy LDL: HDL ratio. No medication or supplement is going to be very effective if you’re not doing your part to take responsibility for your health. Smoking, excessive alcohol intake and a sedentary lifestyle are all associated with higher LDLs and lower HDLs. While regular exercise and lower stress are associated with lower LDLs and higher HDLs. These are not surprising, right? The diet piece of the puzzle is where it gets more complicated. Diet is never going to be a one-size-fits-all approach. So, when we try to apply any one specific diet to all individuals, some people will thrive and some people will not. We don’t yet understand all the genetic and other factors that determine how our bodies handle different foods. But, we do know that there are some foods that are consistently good for cholesterol ratios and some that are consistently bad. In the good camp, we have fiber and healthy fats, specifically monounsaturated fats like olive oil and Omega-3’s. These are a big part of why the Mediterranean diet has performed well in studies and looks like a healthy choice for most people. In the bad camp, we have sugar of all kinds – including high fructose corn syrup and refined carbs. We see evidence to back this up in this study that concludes a low carb high fat may be helpful for people with “atherogenic dyslipidemia” (aka high LDL, low HDL, and atherosclerosis). We also know that trans fats and partially hydrogenated oils are consistently shown to be bad so fried foods, margarine, and processed vegetable oils should be avoided completely. The top supplements for improving cholesterol: 1) Omega 3 Fatty Acids Omega 3 fatty acid supplements are some of the most well-researched supplements around. The evidence for their effectiveness in improving lipid ratios is clear. The studies see benefit in doses ranging from 2-4 grams/day which is more than most people get in foods. Omega 3 oils are found in fatty fish (i.e. wild salmon and sardines), algae, hemp seeds, chia seeds and flaxseeds are the best sources. In addition to lowering LDLs, Omega 3’s have also been shown to lower related cardiovascular markers – triglycerides (another lipid marker) and CRP (a marker for cardiovascular inflammation). Omega 3’s may also lower blood pressure levels. Lastly, there is also some evidence that Omega 3’s lower the likelihood of death after a heart attack. This is one of my favorite omega 3 fish oil supplements This is a liquid fish oil for people who need higher doses for a better value This is a great algae omega 3 algae supplement (ideal for vegetarians) 2) Red Yeast Rice Red yeast rice (RYR) is very effective at inhibiting cholesterol synthesis. So effective, in fact, that a popular cholesterol lowering pharmaceutical drug was created based on monocolin K, one of the active constituents in RYR. Studies show a dose of 3-10 mg/day of RYR will lower LDLs by 15-25%. Red rice yeast also lowers CRP (a marker of cardiovascular inflammation). That said, RYR supplements really vary in quality and some don’t have the ingredients needed to effectively lower cholesterol – make sure you buy from a trusted and reliable source. This study also showed that a lower dose of RYR (3mg/day) was effective when combined with policosanols and berberine. This may be helpful for people that are sensitive to monocolin K which in higher doses can cause some of the same side effects as statin medications. This is a great red yeast rice supplement 3) Berberine Berberine is one of the active constituents in the popular herb Goldenseal. It is also found in a few other medicinal plants. It has recently been researched for its cholesterol-lowering and metabolic supportive abilities. Doses of 500-1500mg have been shown to lower LDL levels by 15-20%. It may be particularly helpful in people with diabetes as it also lowers glucose. Additionally, it also lowers CRP (a marker for cardiac inflammation) and blood pressure. This is a great quality berberine supplement 4) Garlic The common food garlic has been shown to have a host of benefits from being a strong botanical anti-microbial agent to lowering cholesterol. Allicin, an active constituent in garlic, seems to be the component most responsible for cholesterol-lowering. Garlic appears to prevent the body from making cholesterol and may also inhibit dietary cholesterol absorption. It is best used in cases of mild-moderate high cholesterol as it lowers LDL levels by 5-10% at doses of 5-6g/day. It also works to lower blood pressure to a small degree as demonstrated by this study. This is a great enteric-coated garlic supplement (enteric coating prevents garlic breath!) 5) Plant Sterols Plant sterols are structurally similar to cholesterol. These are derived from plant foods such as oils, nuts, seeds, and legumes. In nutraceutical products, you’ll see them referred to generally as sterols or specifically as beta-sitosterol, campesterol, or stigmasterol. Plant sterols reduce cholesterol by preventing intestinal absorption of cholesterol as well as preventing the body’s synthesis of cholesterol. Doses of 400-3000 mg have been shown to reduce cholesterol levels by 8-12%. They also lower CRP (a marker for cardiac inflammation) This is a really great sterol blend supplement 6) Fiber Many people know about fiber in grains like oatmeal and their correlation with healthy cholesterol levels. Soluble fibers help lower cholesterol via several mechanisms. They prevent intestinal absorption of dietary cholesterol, they inhibit the body’s synthesis of cholesterol, and they increase the excretion of cholesterol through the stool. In recent years, a few types of soluble fibers have been researched. Most notably psyllium, beta glucan, pectin, guar gum and glucomannan. Each of these has some variation in their effectiveness at reducing cholesterol but the recommended dose range is 5-15 grams of fiber per day. This dose can lower cholesterol levels by 5-15%. For perspective, 1 cup of cooked oatmeal has 4 grams of fiber. A cup of raw kale salad has 1.3 grams of fiber. While dietary fiber is readily available, adding extra fiber through supplementation can be a good way to get your levels up without eating too many grains or carbohydrates. This is a nice powdered psyllium fiber supplement This is a great capsule version of psyllium fiber 7) Bergamot Bergamot is a relative newcomer to the nutraceutical scene. Bergamot is a type of citrus fruit that is particularly high in flavonoid content. Flavonoids are nutritionally powerful substances found in a variety of plant foods. Bergamot supplements are made from the peel of the fruit. The peel contains flavonoids that act like a statin in the body. Bergamot helps to lower cholesterol by reducing the transport of cholesterol through the blood and it also may prevent arterial plaque formation. This powerhouse plant also reduces intestinal absorption of cholesterol and increasing cholesterol excretion through the stool. Doses of 500-1000 mg have been shown to lower LDL levels by 15-40%. It also lowers CRP (a blood marker for cardiac inflammation). This is a great bergamot supplement 8) EGCG Last on our list is green tea epigallocatechin gallate (EGCG), a powerful component of green tea. This literature review looked at 17 different studies and found that 107-856 mg per day of EGCG lowered LDL cholesterol by about 10%, with some variation believed to be attributed to the subjects’ baseline cholesterol levels. EGCG appears to lower cholesterol by preventing intestinal absorption from foods. EGCG also helps to break down fats in the body. For this reason, green tea is also associated with improving metabolism and burning fat for weight loss. You can get some EGCG just from drinking green tea but the dose will vary a lot based on type of tea used and preparation method. For best results, pour boiling water over your organic green tea leaves and steep for 10 minutes. Drink your green tea away from food as to not compete with mineral absorption. Concentrated EGCG supplements can be used to attain higher doses. This is a great EGCG supplement In Conclusion: Cholesterol is an important part of your biochemical processes. But, when your cholesterol ratio is imbalanced it can increase your risk for cardiovascular disease. The most concerning ratio is when “bad” cholesterol (LDL’s) are elevated and “good” cholesterol (HDL’s) are too low. There are other important factors to look at in your blood work to really assess if your cholesterol numbers put you at risk. There is a lot of data in the medical literature to support using natural supplements to correct cholesterol ratios. Remember to check with your doctor before introducing any new medication or supplement to your protocol. Just because it’s natural doesn’t mean it’s always safe for everybody. There’s no one-size-fits-all approach and your ND or functional doc will be able to guide you on the best quality and most effective protocol for you.