Hypercholesterolemia - or high cholesterol - is a condition that affects over 30% of adults in the United States each year. Hypercholesterol refers to excess levels of total or LDL cholesterol (a type of fat) in the blood. High cholesterol can increase the risk of cardiovascular events like heart attack and stroke. A Functional Medicine Approach to
Hypercholesterolemia focuses on the root cause and can be used alongside conventional treatments for a comprehensive approach. Below is an excellent example of one patient's integrative healthcare journey to lowering her cholesterol. If you or a loved one are looking to lower cholesterol naturally, you'll find this story encouraging!
Jen was a 58-year-old cis female who presented to our clinic looking for natural options to manage her hypercholesterolemia. Jen prided herself on having a healthy diet and lifestyle and was surprised when her cholesterol came back elevated - close to 300 mg/dl - at her yearly check-up. She presented to our clinic wondering what she could do to find and treat the root cause so that her cholesterol could return to normal.
Jen was a copywriter who worked from home and enjoyed many healthy interests - organic cooking, regular yoga and pilates workouts, and meditation. Her health mattered deeply to her, and she'd been consuming a primarily organic, vegetarian, Mediterranean-style diet for two decades prior to seeing us. At her regular family medicine check-up, Jen's primary care clinician told her that her cholesterol was dangerously high - 293 mg/dl (normal is 100-199 mg/dl). She'd advised Jen to treat her cholesterol with medication, which Jen declined due to her preference not to take pharmaceuticals if possible.
Jen's cholesterol had been above 200 since her early 20s, and she was told that this was normal for her, but this recent spike worried her. Jen was confused and wondered why was her cholesterol elevated when she avoided trans fats, ate a plant-based diet, and exercised regularly? Was this number actually dangerous for her? Was there anything she could do besides medication to bring this number down?
If possible, Jen preferred a natural approach to managing all of her health issues. She was committed to doing the work to bring her cholesterol down to healthy ranges using diet and lifestyle. We explained Jen's cholesterol levels to her in a holistic context and then devised a plan to help her achieve normal cholesterol levels.
At her intake, Jen's nutrient analysis revealed that she tended to consume a diet that was mostly adequate in vitamins and minerals but low in total energy, carbohydrates, proteins, phosphorus, calcium and potassium, copper, and iodine. She also did not consume the top sources of CoQ10 regularly (oily fish like tuna and salmon). Her omega 3 consumption was adequate but suboptimal at 1.5g per day. Additionally, Jen consumed alcohol approximately 3-4 days per week, including beer and wine, and ate out frequently at restaurants for dinner.
Laboratory Workup Ordered At Initial Visit
I first saw Jen virtually in March of 2020, and she brought labs from her last physical in September of 2019 which included high cholesterol and high LDL. She had not changed her diet or lifestyle drastically since these labs. Jen’s other labs (CBC, CMP, iron panel with ferritin) were otherwise normal.
We calculated Jen's ASCVD (Atherosclerotic Cardiovascular Disease) risk using her cholesterol and other biometrics at intake. This is because cholesterol numbers should always be interpreted in the context of other risk factors for cardiovascular disease, including things like blood pressure, smoking status, diabetes status, and more.
Jen's ASCVD risk - even with high cholesterol - was still low at 2.0%, although slightly higher than optimal (1.9%). Our goal was to help Jen reduce her 10-year ASCVD risk by decreasing total and LDL cholesterol using dietary and lifestyle approaches.
It's good medicine to rule out causes of hypercholesterolemia like thyroid disorders, diabetes, and kidney disease. Jen's lab work revealed that she had healthy thyroid function, good blood sugar control, and a normal eGFR. This was great news! It meant we could optimize the other aspects of her health.
To help Jen heal, we did the following:
My team and I worked with Jen to create a customized food-as-medicine meal plan that allowed her to emphasize fiber, reduce the glycemic index of her diet by increasing protein, and raise her Omega-3 consumption.
- Increased protein intake to meet 100% RDI by increasing protein sizes at each meal and doubling the protein powder in her morning smoothie. Increased protein and fiber intake relative to carbohydrate intake results in a better glycemic profile of the diet, which yields better blood lipid control.
- Increased fiber intake by adding more nuts and seeds to her diet and an additional serving of fruit. Evidence suggests that increasing fiber intake by 5-10 grams per day can reduce cholesterol levels over time.
- Increased servings of salmon each week to naturally get her more CoQ10 from her diet. Some of Jen's supplements we started her on deplete CoQ10, so we wanted to make sure she stayed replete during her course of treatment with us.
- Red Yeast Rice and CoQ10 formula: 1200mg red yeast rice and 100mg CoQ10 per 2 capsules. Jen took 2 of these capsules twice per day. Red Yeast Rice supplementation generally reduces LDL cholesterol by 15-25% within eight weeks. *Studies show that supplementation with nutrients like folate combined with Red Yeast Rice can reduce LDL cholesterol by 15-31% in 6-48 weeks.
- Comprehensive once daily multivitamin to serve as nutritional insurance so that Jen could stay flexible with her diet and lifestyle but still meet her goals. The vitamin recommended contains vitamins A-K, folate biotin, choline, iodine, zinc, selenium, manganese, chromium, molybdenum, boron, inositol, CoQ10, Alpha lipoic acid, lutein, zeaxanthin, and lycopene.
- We encouraged Jen to include lots of HIIT and weight-bearing exercises in her workout routines to increase the health of her bones and increase her HDL cholesterol. Resistance training has been shown to reduce total and LDL cholesterol levels.
- We explained to Jen that some research suggests that regular blood donation has decreased LDL levels, raised HDL cholesterol, and reduced lipid peroxidation (oxidative stress) when done regularly over 24 or more weeks. We encouraged Jen to give blood regularly, which she did.
Follow Up Nutrient Analysis After Individualized Program
Jen's individualized nutrition plan was designed to be healthy, easy to cook, and fun to eat. It was also intended to correct her inadequate intake of total energy, carbohydrates, proteins, minerals, CoQ10, and omega 3's. The nutrient analysis below reveals that she has met >100% RDI for these nutrients except protein and phosphorus each day on average for the five months between April and September of 2020.
While Jen didn't follow her plan closely enough to meet 100% RDI for protein, she did increase her average protein consumption by 10%, from 64% RDI to 74% RDI, and increased her phosphorus intake by 3%. Additionally, she doubled her Omega-3 intake and raised her fiber consumption by 3.2 grams per day on average, close to the 5 grams per day we typically use to lower people's cholesterol over time.
Results from a Functional Medicine Treatment Program
Jen's total cholesterol dropped by 83 points in the five months we worked together. Her LDL cholesterol decreased by 62 points, VLDL by 7 points, and triglycerides dropped by 34 points.
As a result of the changes above, Jen’s ASCVD risk fell from 2.0 to 1.7% ten year risk, which is better than optimal.
If Jen continues on this plan, her cholesterol should decrease, and her ten-year risk should stay better than optimal. This means that her risk of a heart attack, stroke, or other cardiovascular event is less than that of the optimally healthy person of her same age, gender, race, and health history. Our plan is to continue to work with Jen’s primary care doctor to monitor her levels yearly to make sure her ASCVD risk stays low.
Optimal cholesterol levels depend very much on what other cardiovascular risk factors are present. Recent evidence suggests that total cholesterol levels of 210-230 may actually be optimal for reducing the overall risk of morbidity and mortality in people ages 55-64 (Jen’s demographic). This data comes from a prospective cohort study of more than 12.8 million adults published in 2019. Because of this data, we rely heavily on ASCVD risk calculation, context, and other health data at my clinic before recommending that people take extreme measures to lower cholesterol below 210-230 mg/dl.
Jen's cholesterol was 210 after her treatment program with us. Her 10-year risk of a cardiovascular event was better than optimal, so we did not recommend that she take more drastic measures to lower her cholesterol unless directed by her primary care physician.
You can reduce cholesterol naturally using a comprehensive nutrition and a lifestyle-based approach. Additionally, cholesterol's impact on cardiovascular risk requires a holistic evaluation of a person's health, history, risk factors, and health behaviors. In this case, Jen used a combination of a food-as-medicine plan, good nutrition, and supplementation protocol helped to improve her cholesterol and ASCVD risk. We hope her story inspires you to know that you and your loved ones can naturally lower cholesterol!
*Note: The client's name has been changed to protect her privacy. All other details are the same!
Articles That May Interest You
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