Two  patients came in recently with high cholesterol levels.  One is a woman in her twenties and another is in her 60’s who recently decided to stop taking statins because of the side effects.

There are some medications that do more good than harm.  Statins are not in this category  This is one drug that is prescribed in cases where other interventions really ought to be tried first. When patients bring in labs with elevated cholesterol and other lipid markers I have a few ways I support them.  Those on Statins report serious side effects like  insomnia, muscle weakness, pain, abdominal cramping and the list goes on.  Having looked at the research I have a few suggestions.

Is cholesterol and saturated fat bad?

We now know that dietary cholesterol and saturated fat do not cause heart disease or raise blood levels of cholesterol.  What current research shows is metabolic issues, like insulin resistance, and inflammation play a much more significant role. Your risk of developing heart disease is not based on dietary fat intake.  Blood sugar dysregulation is more of a factor.

Vitamin K2 and Fat Soluble Vitamins

Vitamin K2 is only produced by grass-fed animals.  It can be found in pastured raised egg yolks, grass-fed dairy and animal products.  It is essential for bone health and protects against cardiovascular disease.  All fat soluble vitamins have a complex synergy so ensuring enough vitamin A and D from cod liver oil is also key.

Dietary Considerations

An ancestral or paleo type diet that is low in processed foods, removes industrial seed oils and increases healthy fats is a good choice for most people.  This nutrient dense approach is anti-inflammatory and includes important micronutrients.  Individualization is incredibly important and possible within this approach.  For example, those with insulin resistance, high triglycerides and low HDL will benefit from a low carbohydrate diet. For someone else who has high cholesterol but no insulin resistance, could enjoy a Mediterranean paleo diet.

A low carbohydrate diet means that 15% or less of calorie intake is from paleo-friendly carbs. This may increase LDL for 3-6 months but will then level out.  HDL increases on a low carb diet while metabolism and weight stabilize. Intermittent fasting can be a useful tool as well depending on blood sugar and stress response.

A Mediterranean diet includes more paleo -friendly carbohydrates. Aim for 25-30% of calories from fruit, starchy tubers, and full-fat dairy, white rice, or properly prepared grains. Focus more on monounsaturated fats like avocados, olives, and nuts, and long-chain omega-3 fats EPA and DHA found in cold-water fish and shellfish.

If you are concerned with heart health, focus on fish and monounsaturated fats. These reduce LDL, triglycerides, and inflammation. They increase HDL and lower blood pressure. Aim for a pound of cold water fatty fish each week. Those fish with high levels of EPA and DHA such as salmon, mackerel, herring, sardines, anchovies, and bass are excellent choices. Include shellfish like oysters, clams, and mussels.  Olives, olive oil, avocados, and macadamia nuts are great as well. All tree nuts can be included. Several studies prove several benefits to nuts in terms of cardiovascular risk factors like BMI, waist circumference, and systolic blood pressure.

Other Important Factors

I have written extensively about fermentable and soluble fibers.  Gut is the core of our health. Attending to the microbiome has clinically shown to regulate cardiovascular markers.

Antioxidant and polyphenols are found in many of the foods that are part of a paleo-type diet. A quality CoQ10 supplement may be one worth taking for a period of time.

Sleep is important.  Research shows we require 7-9 hours a night.  One night of lost sleep raises inflammation throughout the body.  Poor sleep has far-reaching effects including contributing to metabolic disorders.

Enjoying movement regularly supports a healthy weight, improves blood pressure as well as insulin sensitivity and lipid markers.

What if I have a family history?

Even with a family history of cardiovascular disease there are a number of steps you can take to prevent being on a statin.  Lifestyle and environmental factors are more relevant than genetics in most cases.  Without a trigger to activate the genetics there may never be an expression even with a strong family history present.

Keep in mind that people are diagnosed with familial hypercholesterolemia often without a full panel of all the relevant markers being done.  What’s important to test for is lipoprotein (a). Particle number for HDL and LDL are also important.

A functional approach is to do a full case review starting gut health, blood sugar, diet and cortisol regulation. Addressing these can bring people out of the high risk zone and provide a foundation for a happy heart and a long life.