Statin medications reduce the risk of coronary events, including heart attacks, in people at high risk. The main benefits occur through reducing cholesterol (really LDL particles) and inflammation (measured as hs-crp). But there are natural ways to reduce LDL particles and lower hs-crp, and statins may not always be necessary.

Summary of natural ways to do what statins do to reduce LDL particles and reduce the risk of heart disease.

If you are insulin resistant (overweight, visceral fat, triglycerides to HDL ratio >3, diabetic or prediabetic), follow a nutrient dense diet with a low carbohydrate (or low fat if you prefer) diet, eliminate processed foods, perform intermittent fasting, and exercise to eliminate visceral fat and improve body composition. LDL particles will go down.

Increase dietary fiber with a diet rich in plants. LDL particles will go down.

Optimize thyroid function by focusing on the causes of weak thyroid activity. This usually means reducing the effects of stress with meditation, exercising appropriately, improving sleep quality and quantity, and reducing inflammation. LDL particles will go down.

If you are not insulin resistant, be certain to have adequate carbohydrate intake to keep insulin levels normal. If  insulin levels are too low LDL particles will go up. This is sometimes a problem with ketogenic diets in thin people.

Measure hs-crp and if elevated seek out sources of infection or causes of unresolved inflammation and correct them. Repair leaky gut and identify chronic infections. LDL particles will go down.

Correct nutrient deficiencies and LDL particles will go down.

The effects of PUFA vegetable oils on cholesterol is complex and although vegetable oil may improve the cholesterol number the risk of heart disease probably won’t decrease. Complicated, read below.

There are supplement like berberine that act similar to the drug PCSK-9 inhibitors and reduce LDL particles. Read below about PSK-9.

Why does this work?

The main determinates of LDL particles in the blood are the amount of cholesterol present in the liver, the availability of insulin, the availability of thyroid hormone, and inflammation. All of these work by increasing receptors on the liver that bring LDL into the liver and out of the blood.

Heart disease results when LDL particles are not removed from the blood efficiently by the liver.

Cholesterol does not dissolve in water so it is carried in the blood in lipoprotein balls called LDL particles.

It is not so much the total amount of cholesterol in the blood that is related to heart and artery disease, it is more about the total number of cholesterol LDL particles in the blood. Artery disease occurs because the LDL particles that carry cholesterol (and triglyceride) are not removed efficiently from the blood by the liver.

Rancid cholesterol particles damage arteries.

When LDL particles linger in the blood the phospholipids (fats) in the membrane of the LDL particle becomes damaged or oxidized. Having a large number of oxidized LDL particles is a big risk for developing artery disease because they enter into the artery wall and cause an inflammatory response. So things that encourage the liver to remove LDL particles is a powerful way to reduce the risk and complications of heart disease. Statins do this, but there are other ways to do it more naturally.

The best tests to determine heart disease risk are the ratio of Total Cholesterol to HDL, LDL particle number, or Apo B levels.

When your blood tests show a ratio of Total Cholesterol / HDL cholesterol between 3 and 4, your liver is doing a good job of removing LDL particles. A normal LDL particle number or a normal Apo B level are also a good sign. If these tests are not in the ideal range you have work to do. The Functional Medicine approach to lowering cholesterol and optimizing the TC / HDLc ratio begins with understanding why your liver is not removing the LDL particles from your blood.

LDL particles are removed in the liver by LDL receptors.

The body tightly regulates the number of LDL particles in the blood. When they are elevated the body believes that there is a good reason to raise them. A protein named PCSK-9 is used to decrease the number of LDL receptors and increase the number of LDL particles in the blood in times of stress, particularly infection. LDL particles are not removed from the blood efficiently when LDL receptors are reduced by increased PCSK-9 protein.

Lower PCSK-9 increases LDL receptors. There is a very effective and expensive medication that reduces PCSK-9 and lowers cholesterol. But just as in the case with statins, there are natural ways to do the same thing.

Reducing the cholesterol in the liver increases LDL receptors and lowers LDL particles.

The liver makes its own cholesterol but it can also increase its cholesterol by absorbing LDL particles using LDL receptors. A strong signal to increase LDL receptors comes when the liver needs more cholesterol in its cells. This is the way statins work. Statins reduce the production of cholesterol by the liver so it must take in cholesterol from the blood. This is the way fiber works. When more cholesterol is excreted in the stool, the liver is in short supply of cholesterol to make bile and absorption of LDL particles increases.

With insulin resistance and visceral fat accumulation there is excess cholesterol stored in liver cells and the liver reduces the intake of LDL particles. You can reduce the amount of cholesterol in the liver by losing weight.

The control mechanism is always working to keep adequate levels of cholesterol in the liver cells.

Insulin resistance increases cholesterol in the liver, reduces LDL receptors, and increases LDL particles.

The most common reason for cholesterol build up in the liver is insulin resistance. Insulin resistance is reversed by losing weight, particularly the visceral fat that builds up inside the body. Visceral fat can be present even in thin people and testing body composition fat percentage or insulin levels may be needed if insulin resistance isn’t obvious.

Eliminating visceral fat is accomplished most easily with a low carbohydrate diet, perhaps because it has beneficial effects on appetite (although a low fat diet also works for some people). Intermittent fasting is a very effective, safe, and well tolerated way to reduce visceral fat as well. Although very low carbohydrate or ketogenic diets accomplish good weight loss, there are some disadvantages to this approach, particularly after the weight has been lost.

Insulin, in the absence of insulin resistance, increases LDL receptors and reduces LDL particles.

When people who are not insulin resistant and do not have buildup of visceral fat are on a low carbohydrate high fat diet, cholesterol can increase substantially. People that are not insulin resistant given a meal with low carbohydrate and high fat will have a low insulin level and high fat load from that meal. Low insulin level signals the body that there is not much food energy available and LDL receptors are low. The high fat load is not expected, the fat is not stored in fat cells but is cycled through the liver resulting in increased liver cholesterol and reduced LDL receptors. People who are not insulin resistant should have adequate carbohydrate in the diet from unrefined plants to assure adequate insulin. This problem sometimes is seen with ketogenic diets in thin people whose cholesterol increases severely.

This is the reason for the confusion about carbohydrate intake and cholesterol.

This difference in lipid response between people with and without insulin resistance is not widely known and is why there is confusion and controversy regarding the effects of a low carbohydrate diet. For this reason (and others) low carbohydrate intake is good for some people and bad for others.

Why does fiber in the diet help reduce cholesterol?

Another way to reduce cholesterol in the lever is to encourage the liver to use more cholesterol to make bile. Fiber in the diet does this because it binds bile acids and eliminated them in the stool so the liver has to make more bile and use more cholesterol. When the liver needs more cholesterol to make bile it will absorb more LDL particles. A nutrient rich, high fiber diet with plenty of unrefined plants is fundamental for reducing cholesterol both because it is good for weight loss and because it eliminates cholesterol from the liver as bile. A high fiber diet reduces liver cholesterol, increases LDL receptors, and lowers LDL particles.

How can eggs help cholesterol?

There are nutrient deficiencies that can cause accumulation of cholesterol in the liver. One important one is choline deficiency which aggravates or causes fatty liver (NAFLD non alcoholic fatty liver disease). One of the bests source of choline is eggs. So much for eggs being so bad for your heart. Taking in higher dietary cholesterol does not much raise cholesterol because the body is good at absorbing only the amount of cholesterol it needs from what you eat.It is important to understand the nuances of nutrition. Like most things, eggs may be good or bad in different circumstances.

The role of vegetable oil in prevention of heart disease is misunderstood and misrepresented.

Eating PUFA (polyunsaturated fatty acids) or vegetable oil reduces liver cholesterol and blood cholesterol. This is why vegetable oil is recommended by conventional cardiologists. But the reduction in blood cholesterol by PUFA is not real. PUFA changes “free” cholesterol into “esterified” cholesterol. So blood cholesterol, which measures free cholesterol is lower, but the body is full of stored cholesterol esters which cause problems of their own. Vegetable oil PUFA also easily oxidizes or turns rancid. Oxidized fats cause oxidation of LDL particles and increase heart disease risk. This is an example of how looking at one poor surrogate of heart disease risk is an oversimplification and can result in bad medical advice.  

Even borderline low thyroid levels increase LDL particles.

A low thyroid state indicates to the body that resources are low and need to be conserved. This includes blood cholesterol. Reduced thyroid function increases LDL particles by reducing LDL receptors. Even borderline reductions in thyroid function that conventional doctors would call normal can increase LDL particles. This does not necessarily mean that the thyroid is diseased or that thyroid hormone therapy is needed. More often the thyroid hormone production is impaired secondary to another problem like stress, lack of sleep, or inflammation. Lack of insulin as may occur on a very low carbohydrate diet in someone who is not insulin resistant can also reduce thyroid hormone production. Improving stress, sleep, visceral adiposity, inflammation, and having the appropriate carbohydrate intake can normalize thyroid function and reduce LDL particles.

Inflammation increases LDL particles.

LDL particles are an important part of the immune system. They inactivate bacterial LPS (lipopolysaccharide). LPS increases with leaky gut (intestinal permeability).  Infection and inflammation increase LDL particles. Persistent inflammation or the failure to resolve inflammation increases LDL particles chronically by keeping PCSK-9 high which in turn reduces LDL receptors. That’s why we have PCSK-9, to control the levels of LDL particles when we need them.

Finding and eliminating sources of persistent inflammation like occult infections, visceral fat, unresolved inflammation, and leaky gut will reduce LDL particles.

The natural ways to do what statins do to reduce LDL particles and reduce the risk of heart disease.

If you are insulin resistant (overweight, visceral fat, high triglycerides and low HDL, diabetic or prediabetic), follow a nutrient dense diet with a low carbohydrate (or low fat if you prefer) diet, eliminate processed foods, perform intermittent fasting, and exercise to eliminate visceral fat and improve body composition.

Increase dietary fiber with a diet rich in plants.

Optimize thyroid function by focusing on the causes of weak thyroid activity by reducing the effects of stress with meditation, exercising appropriately, improving sleep quality and quantity, and reducing inflammation.

If you are not insulin resistant assure adequate carbohydrate intake to keep insulin levels normal.

Measure hs-crp and if elevated seek out sources of infection or causes of unresolved inflammation and correct them. Correct leaky gut.

Correct nutrient deficiencies.

The effects of PUFA vegetable oils on cholesterol is complex and although vegetable oil may improve the cholesterol number the risk of heart disease probably won’t decrease.

There are supplement like berberine that act similar to the drug PCSK-9 inhibitors and reduce cholesterol.

AT CCFM we understand cholesterol and lipid problems in a sophisticated way. We have programs designed to use natural ways to do what statins do.

Call 303-500-3038 for more information or for a free Discovery Call

www.CCFuncMed.com

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Other inquiries please use: info@ccfuncmed.com

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