What Does Cholesterol Do? Even though we put a lot of focus on reducing cholesterol, it serves an important purpose in our bodies. It's the base material for our hormones and without it we can't make estrogen, testosterone or cortisol. Along with immune cells and collagen, cholesterol carried in lipoproteins are used to "patch up" inflammation in the arteries caused by risk factors such as smoking, high blood pressure, or high blood sugar. These plaques become a problem when more and more layers are put on them for stability. Blood flow can become blocked or the plaque can dislodge and travel to other parts of the body. When blood flow is blocked in the arteries of the heart or legs you may get chest pain or leg pain and if blood flow is completely blocked you may suffer from a stroke or a heart attack.
The Difference Between HDL and LDL Cholesterol
You can think of cholesterol and lipoproteins as the same thing. The blood is mostly water so when the body needs to transport fatty substances like vitamins or cholesterol it puts them into a carrier called a lipoprotein. Lipoproteins come in a few sizes or densities hence the name "low-density" and "high-density" lipoproteins that you find on the lipid panel. HDL cholesterol is considered the "good" cholesterol because it can remove cholesterol from the body and lower your risk of heart disease. Goals to aim for are above 55 mg/dL for women and 45 mg/dL for men. LDL is considered the "bad" cholesterol because it carries cholesterol to the arteries and is more likely to form plaques leading to blockages. This is the number that you want to be low, under 130 mg/dL.
Statins are what most people are put on when they have high cholesterol, but there are many naturopathic strategies that can help too. Some of them involve making dietary and lifestyle changes to reduce your risk of health events and there are also natural products like niacin, pantethine and red yeast rice that may bring your cholesterol numbers into a healthy range.
Lifestyle and Nutritional Strategies
Manage high blood pressure. This is one of the best things you can do to decrease inflammation in your arteries and your risk of heart attack or stroke. For more details about how to do this read my blog post here.
Stop smoking. Cigarette smoke contains many damaging carcinogens that can damage the lining of the blood vessels, increase oxidative stress and increase inflammation in the arteries. Come up with reasons that are important to you, pick a date and tell people so they hold you accountable. There are resources that can assist you in quitting including nicotine patches, gum and lozenges, acupuncture, medications and support groups.
Get moving! Regular physical activity benefits more than just cholesterol. It can reduce high blood pressure, help you lose weight and it makes you feel good! Aim for 30 minutes of activity 3-4 times per week. Commit to it and put it into your weekly schedule. Do what is enjoyable for you so you're more likely to look forward to it and stick with it long term.
Put the focus on a diet high in plant based foods. This type of diet will provide lots of nutrient dense foods, fiber and protective antioxidants. It may even help you to lose weight, which is another way to naturally manage cholesterol. One easy way to do this is to mentally divide your plate into sections. Fill your plate half full with vegetables, 1/4 full with protein and 1/4 full with whole grains. The Mediterranean diet has been studied for heart health so if you need a quick start guide check out Harvard's Heart Health post here.
Increase soluble fiber. Include sources of soluble fiber from legumes, whole grains, oats and fruits and vegetables to reduce cholesterol and inflammation. Aim for 35 grams per day.
Protect your arteries with antioxidant rich fruits and vegetables. One risk factor of plaque development is by oxidative damage and not having enough antioxidants to fight it. Check out my previous blog all about antioxidants here. Good dietary sources include colorful fruits and vegetables like berries, leafy greens, peppers, carrots, broccoli, kale, and cabbage.
Supplements for Cholesterol Management
Niacin - Niacin is also known as vitamin B3. It can lower LDL cholesterol and triglycerides, raise HDL cholesterol, and lower inflammatory markers. The most bothersome side effect is flushing, but you can get around that by using slow-release forms of niacin such as inositol hexaniacinate or products labeled as "no flush" niacin. Those with diabetes should use caution because high doses over 3000 mg/day may impair glucose metabolism although lower doses of 1000-2000 mg/day may not. Earlier forms of niacin impaired liver function, but newer forms don't seem to have that effect so use caution if you have liver disease.
Pantethine - This is also known as vitamin B5 and may lower LDL cholesterol, triglycerides, total cholesterol and raise HDL cholesterol. This would be a safer choice for those with diabetes since it doesn't have the same glucose related side effects as niacin and has a good safety profile.
Red Yeast Rice - Red yeast fermented on rice was the origin of modern day statin medications. In the fermentation process, the yeast produce monacolin, which is found in lovastatin. Red yeast rice is similar to a statin medication in how it works in the body to decrease cholesterol but may be better tolerated by some or for those who prefer a natural approach. Because it works much like a statin, you may have similar side effects like muscle weakness, fatigue or elevated liver enzymes.
What About Statins?
If you have high cholesterol chances are your doctor has recommended a statin medication. Commonly prescribed statins include atorvastatin (Lipitor), simvastatin (Zocor) and lovastatin (Mevacor). Statins work by blocking an enzyme in your liver that is involved in the production of cholesterol. I wanted to touch on some risks and benefits of statins that you could consider.
Risks
In addition to lowering your body's production of cholesterol, statins also lower the production of a protective antioxidant called CoQ10. CoQ10 is involved in energy production in all of your cells and is why some people get muscle weakness and fatigue when they take statins.
Statins can cause a rare side effect called rhabdomyolysis or muscle breakdown, which releases muscle proteins into the blood that can damage the kidneys.
Statins can increase blood sugar and increase the risk of developing diabetes.
Some people develop confusion or memory problems while on statins that may go away if the medication is changed or if they discontinue use.
There is an increased risk of liver damage which can show up as increased liver enzymes in blood work. Your doctor may check your liver function before starting a statin and continue to monitor it while you're on the medication.
Benefits
Stains may lower triglycerides and LDL cholesterol, which is more likely to cause plaque in the arteries and raise HDL cholesterol, the "good" cholesterol.
Stains may lower inflammation in the blood vessels leading to less plaque formation and reduced risk of heart attack and stroke.
Statin benefits might outweigh the risks in those who have very high LDL cholesterol, or in those who have existing cardiovascular disease, diabetes or who have had a heart attack or stroke.
Cholesterol plays an important role in our health from "bandaging" up damage in our arteries to providing us with materials for hormone production. However, too much cholesterol or having high levels of the "bad" LDL cholesterol and not enough of the "good" HDL cholesterol can have some serious risk factors for our health. There are many naturopathic strategies including diet and lifestyle changes as well as natural products that can help you manage your risk factors and bring cholesterol into a healthy range.
Have you used any of these recommendations to manage high cholesterol? What worked for you?
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In Health,
Jamie
Resources
Bhatt, A. (2018, April 09). Cholesterol: Understanding HDL vs. LDL. Retrieved from https://www.health.harvard.edu/blog/understanding-cholesterol-hdl-vs-ldl-2018041213608
Pietrangelo, A. (2017, March 14). Statins: Uses, Side Effects, and More. Retrieved from https://www.healthline.com/health/high-cholesterol/statins-uses-side-effects
Pizzorno, J. E., & Murray, M. T. (2013). Textbook of Natural Medicine (4th ed.).
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