Lower Cholesterol Naturally
High cholesterol is a concern primarily because it increases the risk of heart attack and stroke. While not the only risk factor (about one half the people who have heart attacks have normal cholesterol), it is a significant one. Other risk factors include family history of heart disease, smoking, overweight, high blood pressure, physical inactivity, stress, and elevated C-reactive protein (CRP is a blood test for inflammation). To reduce risk, it is important to address all of these risk factors. The focus of this article, however, is on lowering cholesterol specifically.
Types of Cholesterol
Cholesterol is a term that applies to a number of different substances in the blood, some of which increase the risk of heart disease and some which lower the risk. Total cholesterol is a more specific term that applies to all the various types of cholesterol. When cholesterol is tested a lipid profile is usually run in addition to the total cholesterol. A lipid profile includes the total cholesterol and its primary constituents, HDL, LDL, and triglycerides. HDL is the good cholesterol which lowers the risk of heart disease. It carries cholesterol away from the blood vessels and back to the liver to be metabolized. LDL is the bad cholesterol. It carries cholesterol to the arteries where it forms cholesterol plaques that cause heart disease. Triglycerides are fats in the blood and they also increase the risk of heart disease. In some cases specialized testing is done that further breaks down the HDL and LDL cholesterol into subtypes, but a discussion of these subtypes is beyond the scope of this article.
There are different patterns or types of high cholesterol. The two most common are elevated triglycerides (which is often accompanied by a low HDL) and elevated LDL cholesterol. These patterns can occur alone or in combination, but they have different causes and hence different treatments. Causes of both types of high cholesterol can include genetics, diet, physical inactivity, and obesity.
The first pattern, elevated triglycerides (>150 mg/dL) and low HDL (<40 mg/dL in men and <50 mg/dL in women), occurs primarily as a result of eating too many high glycemic foods. High glycemic foods such as sugars, grains, and potatoes are rapidly digested and absorbed and lead to a spike in the blood sugar. Foods such as vegetables, fruits, and proteins (beans, nuts, soy, dairy, eggs, meat, fish, and poultry), on the other hand, are low glycemic and help to stabilize blood sugar and prevent these spikes. While fruits contain a lot of sugar, it is a type of sugar that is slowly digested and absorbed, which gives fruit a low glycemic index. The most effective treatment for this pattern of high cholesterol is to reduce or eliminate the high glycemic foods and eat lots of the low glycemic foods.
While genetic factors often play a role, even triglyceride levels of 400 or higher can generally be normalized within 6 weeks with the appropriate dietary intervention. Often people with high triglycerides and low HDL cholesterol have a condition known as metabolic syndrome. They may also have high blood pressure and blood sugar and be overweight. For these individuals, a low glycemic eating plan is particularly important.
Another effective treatment for high triglycerides is fish oil. Fish oil contains omega 3 oils, which are critically important fats that aren’t found in most other foods. They have been approved by the FDA to lower triglycerides and are available in prescription form as Lovaza. They are much cheaper, however, as over the counter cod liver oil or fish oils. In addition to the triglyceride lowering effect, fish oils have been shown to substantially reduce the risk of heart disease (by about 30%) and they lower CRP, an inflammatory risk factor for heart disease.
Raising HDL (good) Cholesterol
Niacin, which is vitamin B3, lowers triglycerides by 20-50% and LDL cholesterol by 5-25%, and also raises HDL cholesterol by 15-35%. It is more effective at raising HDL, in fact, than any prescription drug or other intervention. Niacin is inexpensive and generally very effective, but can have a few side effects (although it is generally much safer than prescription drugs used to lower cholesterol such as the statin drugs). Niacin commonly causes a niacin flush, which is similar to a hot flash. While annoying, the niacin flush is not dangerous and can generally be prevented by using time-release niacin. Niacin can also cause liver inflammation, although there are natural medicines that can generally prevent this. For this reason liver function must be checked regularly and it should only be used under the supervision of a physician.
In addition to the aforementioned low glycemic eating and niacin, increased physical activity and smoking cessation can also be very effective at raising HDL cholesterol.
Lowering LDL (bad) Cholesterol
High LDL cholesterol, on the other hand, is not lowered by consuming low glycemic foods. It is lowered by consuming foods such as water soluble fiber, nuts, soy, and plant sterols. Water soluble fiber is found in oats, beans, fruits, and psyllium and plant sterols are found in vegetable oil, nuts, legumes, whole grains, fruits and vegetables (although in much smaller amounts than is used therapeutically). Individually, these foods have been shown to lower LDL cholesterol (plant sterols alone, for example, can lower LDL up to 14%). Researchers have also studied the combined effects of these foods, however, which they dubbed the “Portfolio diet.” The Portfolio diet was found in one study to lower LDL cholesterol by 29% in 4 weeks, which is statistically the same as what is achieved by statin drugs.
While decreasing fat intake is the most common approach recommended to lower LDL cholesterol, it is not the most effective. In a head to head comparison of the portfolio diet to a low fat diet, the portfolio diet was the clear winner, lowering LDL by 13% compared to only 3% for the low fat diet. In addition the portfolio diet also lowered triglycerides and blood pressure and did not suppress the good HDL cholesterol, which can happen with low fat diets.
Nutritional medicines that can lower LDL cholesterol include red yeast rice and the previously mentioned niacin. Red yeast rice is a fermented rice extract that naturally contains compounds known as monacolins that prevent cholesterol synthesis. It can be very effective at lowering LDL cholesterol and has few side effects. Because one of the monacolins found in red yeast rice is also found in a statin drug, however, the FDA limits the amount in red yeast rice products. The effectiveness of over the counter products is therefore variable and the amount of monacolins is rarely stated on labels. Because of this, we stock a high-potency, effective red yeast rice product in our office.
For those with both patterns of high cholesterol, the combined effect of the low glycemic eating plan and the portfolio diet can be dramatic. In a 2005 controlled study, participants were asked to follow either the American Heart Association Step 1 low fat diet or a low glycemic eating plan (LGEP) with soy and plant sterols (2 of the 4 elements of the portfolio diet). Those on the LGEP with soy and sterols lost 8% of their body weight in 12 weeks, their total cholesterol dropped 16%, LDL decreased 15%, and triglycerides dropped by 45%. In addition their blood pressure decreased 5-8% and their HDL cholesterol increased by 6%.
Bottom Line in Lowering Cholesterol Naturally
Whenever possible, it is best to lower cholesterol through diet and lifestyle changes. As seen in the study above, the effects go beyond changes in cholesterol and can include weight, blood pressure, CRP, and other risk factors. When dietary changes are not feasible or are not enough, there are a variety of safe and effective natural medicines available.
Here are the key nutritional interventions to lower cholesterol naturally:
To lower triglycerides:
- Follow a low glycemic eating plan
- Take fish oils
- Take niacin
To raise HDL (good) cholesterol:
- Take niacin
- Follow a low glycemic eating plan
- Increase physical activity
- Stop smoking
To lower LDL (bad) cholesterol:
- Try a portfolio diet
- Take niacin
- Take red yeast rice
How We Can Help
Naturopathic doctors are physician experts in treating the underlying cause of disease and using natural medicines to help people get and stay well. To find out which natural treatments are appropriate for you or to be tested for cholesterol, CRP, or other risk factors, schedule an office visit or make a selection below.
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(About the only plans we can't accept are Medicare and out-of-state plans.)