Hypercholesterolemia is the term for elevated cholesterol levels - a type of fat - in the blood. It affects approximately 31% of adults (or 73 million people) in the United States each year. Cholesterol is an essential nutrient critical for making hormones, vitamin D, and cell membranes in the body.

Abnormal elevations in cholesterol, however, are linked with an increased risk of the formation of atherosclerotic plaque, which increases the risk for heart attack, stroke, and other cardiovascular diseases.  

This article will cover natural treatments for high cholesterol, including diet, exercise, lifestyle, supplements, vitamins, etc.

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What is Cholesterol

Cholesterol is a lipid, or type of fat, that has many critical roles in human physiology. First, it makes up cell membranes, which are responsible for cell signaling, metabolic health, and more.

Increasingly, cell membrane health is becoming a focus of preventive medicine efforts because cell membranes are often damaged by oxidative stress, leading to a cascade of adverse effects that lead to illness.

Keeping cell membranes healthy, fluid, flexible, and protected from oxidation is a mainstay of functional medicine, and optimal cholesterol levels are a vital component of this approach.

Second, cholesterol is essential for endocrine health because it is involved in producing sex hormones (estrogen, testosterone, progesterone, and DHEA), adrenal hormones (cortisol and aldosterone), and vitamin D.

Cholesterol also makes up a large portion of brain tissue; roughly ¼ of the body’s total cholesterol is found in the brain. Cell membranes in the brain generally contain ten times more cholesterol than cell membranes elsewhere in the body. This is partially because cholesterol insulates nerves and helps with signal transduction between synapses. Proper cholesterol levels are essential for maintaining memory, cognition, and more.

High Cholesterol Signs & Symptoms

When cholesterol and other lipids build up in the bloodstream, they can adhere to the walls of blood vessels and form arterial plaque. This plaque causes the width of blood vessels to narrow, and as a result, blood cannot fully perfuse tissues and organs. This pathological lack of blood supply is referred to as ischemia. Ischemia can lead to symptoms like chest pain with exertion, fatigue, and severe health consequences like heart attack, stroke, and organ failure if left untreated.

There are different types of cholesterol in the blood, and some are more likely to form plaque than others. You may have heard these referred to as “good” and “bad” cholesterol.

“Bad” cholesterol is a term that’s generally used to refer to LDL cholesterol, low-density lipoproteins that are bigger molecules, which tend to more readily form plaque than high-density lipoproteins (HDL or “good” cholesterol). High levels of LDL are more dangerous than levels of HDL.

There are natural ways to change the type of cholesterol in your bloodstream, which we’ll review below.

High Cholesterol Possible Causes

Genetic conditions like familial hypercholesterolemia can cause high cholesterol that is not affected by diet. If very high cholesterol runs in your family, you should get tested for one of these disorders.  

Lifestyle factors like smoking, excessive alcohol use, and lack of exercise can cause higher cholesterol levels.

Medical conditions like hypothyroidism, diabetes, kidney disease, and liver disease can also cause high cholesterol.

What Foods Cause High Cholesterol

Specific dietary patterns increase the risk of high cholesterol, including diets high in saturated fats, processed carbohydrates, processed meats, and sugary drinks. Foods high in saturated fats include fatty meats, fatty dairy products, prepackaged processed baked goods, and palm oil.

There is some debate about whether or not cholesterol in foods can lead to high cholesterol in the blood. Some studies have found that high cholesterol foods like eggs and meats can increase total cholesterol levels. In contrast, other studies have found the opposite, particularly after adjusting for the saturated fat content of foods. Part of the discrepancy may be related to the strong effect of genetic variation in an individual’s response to dietary changes.

Genetic variations in the APOE gene have been shown to create differential responses to dietary saturated fat. Individuals who carry APOE2 and APOE4 alleles had increased cholesterol and increased cardiovascular disease in response to saturated fat compared to individuals who did not carry those alleles.

A trial of a low saturated fat diet with lab tracking of lipid markers may be worth it to identify patients who would benefit from dietary changes.

Another dietary intervention with a more universal benefit is consuming a high-fiber, nutrient-rich diet that is plentiful in fruits, vegetables, nuts, and seeds which we will discuss below.

Functional Medicine Labs to Test for High Cholesterol

Screening for high cholesterol can be done using a simple blood test. A standard lipid panel, total cholesterol level, or in-depth cardiovascular profile with information on lipoproteins can give you the information you need about the health of your cholesterol.

Testing for triglycerides should be done fasted since triglycerides in the blood rise naturally after consuming a meal.

It should be noted additional information is needed to determine whether or not your cholesterol needs to be lower than it is. You and your clinician can use the ASCVD risk estimator calculator to factor in elements like age, sex, blood pressure, smoking history, etc., to determine if your cholesterol levels need to be lowered to protect your health.

Another aspect of cardiovascular risk includes the levels of inflammatory mediators like hsCRP and ESR in the blood. Elevated levels of these compounds increase the risk that cholesterol will become arterial plaque. Keeping these levels normal is part of a holistic approach to maximizing cardiovascular health.

If your cholesterol is high, your doctor should work with you to identify the cause.

Common Medical Causes of High Cholesterol

Hypothyroidism

Hypothyroidism slows down the metabolism of all fuels in the body, including fats, which can cause cholesterol levels to rise above normal limits. It can be identified using a thyroid panel that screens for TSH, T3, and T4.

Liver disease

There is a complex relationship between liver disease and cholesterol because cholesterol is produced in the human liver. In certain liver diseases, lipotoxicity drives liver damage, while in others, hepatocytes are unable to regulate cholesterol metabolism appropriately, which can lead to hyperlipidemia. Disorders of the liver can generally be identified using a metabolic screening panel (CMP) or liver enzyme test.

Diabetes

Diabetes and insulin resistance increase the liver’s production of triglycerides and certain types of cholesterol. Issues with blood sugar can be identified and diagnosed using an A1C or fasting glucose test.

Kidney disease

Kidney diseases affect how triglycerides and other fats are removed from the bloodstream. Kidney issues can often be identified using eGFR and urinalysis.

If your cholesterol is low, that is also important! Conditions like celiac disease can result in low cholesterol. Additionally, cholesterol-lowering drugs can sometimes make cholesterol drop too low. This is why anyone taking cholesterol-lowering drugs should get routine care with their doctor to monitor their blood levels of cholesterol at least once a year and change their dose of medication accordingly.

3 Natural Ways to Lower Cholesterol Levels

1. Nutrition

Increasing dietary fiber by 5-10 grams per day, increasing the consumption of plant foods, and adopting dietary patterns like the DASH diet, Portfolio diet, and Mediterranean diet have been found to reduce cholesterol over time. In my practice, increasing fiber to above 30 grams a day for several months is generally enough to lower total cholesterol by at least 10 points over six months.

The best evidence from decades of research suggests swapping foods high in saturated and trans fats (fatty meats, dairy products, processed pastries, and palm oils) for plant foods.

2. Supplements

Red yeast rice, fiber, coQ10, berberine, and plant sterols are some of the best-researched interventions for lowering cholesterol.

Red yeast rice contains monacolin K, which is almost identical to pharmaceutical statins in chemical structure and, as a result, can directly lower cholesterol levels. Studies show that taking 10mg of red yeast rice daily for 6-8 weeks can reduce LDL cholesterol by 15-25%.

Supplements that contain 5-10grams of fiber per day have similarly been shown to reduce LDL cholesterol by 5-10%.

Supplements that contain red yeast rice, policosanol, berberine, folic acid, astaxanthin, and COQ10, taken for 6-48 weeks, can reduce cholesterol by up to 31%.

Plant stanols taken for as little as 1-2 weeks in 2-gram amounts per day can reduce LDL by 10%.

3. Lifestyle Adjustments

The best recommendations (Level A evidence) that we have for lowering cholesterol with lifestyle changes include:

• Smoking cessation: People who smoke should stop smoking to improve their cholesterol. Smoking increases cardiovascular risk via several methods, including increased “bad” cholesterol levels.
• Exercise: Getting 150 minutes per week (just 30 minutes, five days a week) of moderate-intensity activity can lower cholesterol levels significantly.
• Reduce alcohol intake: Less is better when it comes to alcohol. Limit wine, beer, and spirits to less than five servings per week.
• Lose excess body fat: Every 1kg of fat loss reduces total cholesterol by 0.4 mg/dL.

An excellent article to read if you’re looking to understand the level of evidence behind lifestyle recommendations for lowering cholesterol is the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk, written by The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS).

Summary

Cholesterol is a vital component of cell membranes and a precursor to essential hormones and vitamins. However, too much of this important compound can put you at risk for cardiovascular issues like heart attack and stroke due to its ability to cause artery-clogging plaque.

Using lab tests and risk calculators, you can screen for and monitor high cholesterol and other cardiovascular risk factors. Many people successfully lower cholesterol using natural approaches that include lifestyle, movement, diet, and other interventions.

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