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High Cholesterol: the inside scoop

Almost 2 in 5 adults in the U.S. have high cholesterol. For decades, the medical community thought that dietary cholesterol contributed to increasing blood cholesterol levels, which lead to the elevated risk of cardiovascular disease (CVD). But to date, the current scientific evidence does not support a role of dietary cholesterol in the development of CVD.

It is now well understood that inflammation is the cause of chronic disease.

High cholesterol, also known as hypercholesterolemia, is a condition characterized by elevated levels of cholesterol in the blood. In individuals with high cholesterol, the liver is unable to excrete excess cholesterol, resulting in the buildup of plaque deposits in blood vessels.

In this article...

We cover the ins and outs of what causes high cholesterol levels, and what are the integrative health approaches that can prvent and lower your risk of chronis disease.

Lifestyle modifications for lowering cholesterol


What is Cholesterol?

Cholesterol is a white, waxy substances that is crucial for building cell membranes, and serving as the base material in the production of vitamin D, steriod hormones and bile acids. Our liver and intestines produce 80% of our cholesterol levels, while ~20% comes from diet. It is transported in the blood by molecules called lipoproteins.

Signs, symptoms, and health complications

Individuals with high cholesterol typically do not experience any symptoms. It is commonly diagnosed using a lipid panel to detect elevated levels of cholesterol in the blood.

Uncontrolled or chronic high cholesterol may be associated with complications, including:
  • Carotid artery disease

  • Coronary artery disease (e.g., angina, heart attack)

  • Peripheral artery disease

  • Stroke

Causes and risk factors:
  • Certain health conditions (e.g., chronic kidney disease, hypertension, hypothyroidism, type 2 diabetes) Certain medications (e.g., cyclosporine, diuretics, glucocorticoids)

  • Excessive alcohol intake

  • Genetics, familial hypercholesterolemia (FH)

  • High dietary intake of processed carbohydrates, trans fat and sugar-sweetened foods/beverages

  • Overweight and obesity

  • Sedentary lifestyle

  • Smoking


High cholesterol levels is a sign of inflammation

As previously mentioned, majority of our blood cholesterol comes from our liver and intestines. Research now confirms dietary intake of cholesterol has a much smaller impact on your blood cholesterol levels than once thought. The current scientific understanding is that body inflammation plays a significant role in plaque build up in our arteries.

What happens is when you have high levels of inflammation in the body, due to, age, lifestyle factors (smoking, excessive alcohol, lack of physical activity, etc.) and poor diet, such as the Standard American Diet (SAD) - which is made up of highly refined and multi-stepped processed carbohydrate foods, excessive sugar, fried cooking methods using seed oils, and overall overconsumption of portions - you get inflammation on the walls of your blood vessels.

This can weaken the wall over time, causing it to tear. A blood clot forms as your body tries to seal up the wound just like it does with a scab. Usually these blood clots are small, heal quickly and are mostly unnoticeable, but this can lead to scarring and calcification, which over time can narrow the blood vessel without blocking it and then the wall becomes thicker and stiffer. This is known as, atherosclerosis. Sometimes, these scabs can be big blood clots, which completely blocks the vessel - this leads to instances of stroke or heart attacks.

These inflammations can develop in any artery in the body, but the particularly dangerous ones are in the large arteries that carry blood to the brain and the heart. The narrowing of coronary blood vessels can cause chest pain, which is known as, angina. A blocked blood vessel to the heart muscle leads to a heart attack. A blocked blood vessel to the brain leads to a stroke.

A Lesser Known Root Cause of Hypercholesterolemia

The main way our body gets rid of excess cholesterol is through our bowel movements. The liver pumps excess cholesterol that is not needed into the bile, which is stored in the gallbladder. Bile then enters our intestines and leaves our body in daily stool output. If there is not enough fiber in the diet, a significant lack of water and chronic constipation, cholesterol in bile can be reabsorbed back into our bloodstream and this can lead to high cholesterol levels.

A good goal for fiber intake is ~30-35 grams per day. If your fiber is currently low, increase your intake slowly and gradually to avoid digestive discomfort and allow your GI tract to adjust to higher intake levels. Make sure you are also simultaneously increasing your water intake along with fiber to prevent constipation.


Preventing and lowering high cholesterol

Lifestyle modifications are the most impactful way to improve high cholesterol and lowering total body inflammation. In some cases, your doctor may put you on cholesterol lowering medications as a tool to manage your hypercholesterolemia, but it’s important that this is used in conjunction with behavior and dietary changes that lead to lasting results. Lifestyle changes include: regular physical activity, moderation of alchohol consumption, smoking cessation, weight management and dietary changes.

Adopting an anti-inflammatory style diet pattern is the best way to focus on lowering inflammation throughout the body and decreasing cholesterol levels.

The top factors that compromise an anti-inflammatory diet are:

  • Balancing levels of omega-3 to omega-6 fatty acids

  • Increasing anti-inflammatory foods and nutrients, including omega-3 fatty acids and phytonutrient-rich plant foods such as vegetables, fruits, nuts and whole grains

  • Maintaining a stable blood sugar pattern

  • Avoiding pro-inflammatory foods, such as highly, multi-stepped processed foods, refined carbohydrates, trans fats and excess vegetable seed oils

  • Supporting gut microbiota health for regulating immune function and optimal digestion

Deep nutrition for healthy cholesterol: what you can start doing today

Eat more omega-3 rich foods

Omega-3 has 3 different forms: ALA, DHA, and EPA.

EPA and DHA are responsible for the beneficial functions of Omega-3. We convert ALA into DHA and EPA but we lose some in the process.

DHA + EPA Omega-3 rich foods include:

  • Salmon

  • Anchovy

  • Herring

  • Mackerel (Pacific chub or Atlantic)

  • Sardine

  • Trout (freshwater)

  • Whitefish

ALA Omega-3 rich foods are plant-based sources like:

  • Ground or milled flaxseed (aim for 2 Tbsp/d)

  • Algae oil (Spirulina)

  • Canola oil

  • Chia seeds

  • Edamame

  • Flaxseed oil

  • Soybean oil

  • Walnuts

Dietary suggestions for Omega-3s:
  • Order fish when you are out to eat at restaurants

  • Use tuna packets for lunch/snacks

  • Add anchovies as toppings on dishes/salads Have sardines on a Wasa cracker for an appetizer with fresh herbs

  • Put flax or chia seeds in your smoothies

  • Add edamame to your salads or stir-fry dishes

  • Eat walnuts with a piece of fruit for a mid-morning snack

  • Make your own salad dressing with Spirulina

Increase your intake of monounsaturated fats

This type of fat is considered healthy as it may help to control inflammation and support heart health. Plant based fats like nuts, seeds, nut butter, avocados, and olive oil should be eaten daily. Aim to have about 2 servings of these types of foods every day.

  • Olive oil

  • Peanut oil

  • Sunflower seeds/oil

  • Avocado oil

  • Macadamia nuts

  • Hazelnuts

  • Peanuts

  • Almonds

  • Cashews

  • Pistachios

  • Avocado

Dietary suggestions for Monounsaturated fats:
  • Use olive oil and vinegar as a dressing for salads

  • Cook with olive oil or drizzle olive oil and lemon on steamed green beans

  • When dining out, ask food to be prepared with olive oil as opposed to butter

  • Buy pre-portioned 100 kcal packs of nuts for on-the-go snack options (Try these: my favorite on-the-go heart healthy snack 😍)

  • Add avocado to a smoothie for a fluffy texture

  • Make guacamole for a veggie side dip

Include more soluble fiber in your meals

There are different types of fiber: insoluble, soluble & prebiotic. While, they are all beneficial for overall health, soluble fiber specifically works to lower cholesterol levels in the body. It acts as a bulking agent by attracting water during digestion and turning into a gel. In this way it binds to cholesterol and bile acids in the intestine, making it unavailable for absorption. So when the liver needs to replace the bile acids that went out with the fiber, it pulls cholesterol from the bloodstream to make more bile acids. Thus resulting in a reduction of blood cholesterol levels.

  • Oats Beans

  • Legumes

  • Sweet potatoes

  • Onions

  • Fruits (apples, bananas, pears)

Dietary suggestions for Soluble fiber:

Keep frozen fruit on hand to blend in smoothies or as cottage cheese toppings

Make easy pan sheet recipes using sweet potatoes and onions for weeknight family dinner meals Toss chickpeas or kidney/black beans on top of salads, lunch bowls or into soups

Supplement Spotlight -

Psyllium husk comes from the crushed seeds of the plantago ovata plant, an herb native to parts of Asia, the Mediterranean and North Africa. Psyllium has been used for centuries in herbal remedies as a gently bulk-forming laxative for constipation. Similar to oats and wheat, psyllium is rich in soluble fiber.

Norish & flourish your microbiome

Your gut is the foundation for a healthy metabolism, proper nutrient digestion and optimal immune response. Whenever there is inflammation in the body, the immune system is being triggered - so with elevated cholesterol levels there is an exaggerated inflammatory response, thus the immune system is being overworked. If you focus on building a healthy, resilient microbiome - it’s like putting your best foot forward. A resilient microbiome is built on diversity and abundance. This looks like a lot of different plant fibers, colors, and polyphenols.

1. Whole Plant Foods: soluble fibers, insoluble fibers, prebiotics: pectins, gums, mucilages, & polyphenols

These escape digestion in the upper gut and make their way to the colon to be used as food by the microbes.

Prebiotic Foods:

Inulin/Fructo-oligosaccharide (FOS)

  • Artichokes

  • Yacon

  • Burdock roots

  • Chicory root

  • Dandelion root

  • Garlic

  • Onion

  • Leeks

  • Asparagus

  • Lentils

  • Chickpeas/Hummus

  • Pinto bean

Galacto-oligosaccharides (GOS)

  • Legumes

  • Brassica family

  • Beets

  • Sunflower seeds

  • Pumpkin seeds

Mucilangenous herbs

  • Marshmellow root

  • Slippery elm

  • Licoricse root

  • Aloe vera

  • Comfrey

  • Plantain

  • Psyllium

  • Fenugreek

Prebiotics-like foods

  • Brown rice

  • Unpeeled carrots

  • Black currants

  • Dark cocoa

  • Almonds

  • Green tea

Dietary suggestions for Whole Plant Foods:
  • Try different colors of the same fruit/veggies you like (e.g., rainbow carrots)

  • Add to smoothies: frozen cauliflower/brocoli rice, mixed berries, fresh greens, frozen zucchini, raw carrots, roasted sweet potatoes, spices: cinnamon, ginger, turmeric, cardamom

  • Make a spinach & artichoke dip

  • Drink herbal teas: dandelion root, marshmallow root, licorice root, slippery elm

  • Add different legumes to dinner meals: lentils, pinto beans, etc.

  • Use chickpeas/hummus on snack plates as a veggie dip

  • Juice blackcurrant fruit for a mocktail mixer

Supplement Spotlight -

Try Traditional Medicinal brand for a variety of herbal teas to use at night to create a calming, relaxing routine before bedtime and to prevent nighttime snacking!

2. Polyphenols: Lignans, phenolic acid, anythocyanins, flavonoids, flavonols, flavones, isoflavones, tannins

These are chemical molecules that give plant foods their color. They up regulate the body’s natural defense (antioxidant) systems. They are too large to be absorbed, so 90-95% reach the colon and bacteria consume them as food.

Black, blue, red, purple, brown, green foods

  • Cloves

  • Dried peppermint, spearmint

  • Star anise

  • Oregano, sage, rosemary, thyme, basil, parsley, marjoram (fresh and dried)

  • Celery seeds

  • Curry powder

  • Ginger

  • Cumin

  • Cinnamon

  • Cacao & cocoa powder & dark chocolate

  • Coffee

  • Black tea, green tea, matcha

  • Red wine

  • Black chokeberry

  • Black elderberry

  • Black currant, red currant

  • Pomegranate

  • Blueberries, cherries, blackberries, strawberries, raspberries

  • Black grapes

  • Plum, prunes

  • Apple

  • Apricot, peach, nectarine, blood orange

  • Purple carrots, red carrots

  • Red potatoes

  • Sweet potatoes, purple sweet potatoes

  • Red cabbage

  • Red lettuce

  • Radicchio

  • Endive

  • Escarole

  • Red onion

  • Spinach

  • Broccoli

  • Capers

  • Olives (black, green)

  • EVOO

  • Flaxseed

  • Chestnut

  • Hazelnuts

  • Pecans

  • Almonds

  • Walnuts

  • Black tahini

  • Red rice, black rice, red and black quinoa

Dietary suggestions for polyphenols:
  • Use herbs & spices while cooking in dishes to add variety of flavor and body to meals

  • Alternate between green tea/matcha and coffee in the mornings for a drink

  • When having chocolate looks for brands that are dark chocolate and ~75% or more cacao

  • Make red colored smoothies or juices with 3-4 different red colored fruit/vegetables

  • Have apples and oranges as part of your snack plates

  • Make stews, soups and pan sheet dinners with a variety of different colored potatoes

  • Add capers and olives to your salads or snack plates

  • Make warm lunch bowls with different quinoa types

Lifestyle changes for high cholesterol: how you can make an even bigger impact

Reduce your processed carbohydrate intake

These are mostly in the form of packaged multi-stepped processed food - like refined white breads, chips, crackers, and baked goods. These types of food cause insulin and blood sugar spikes as well as elevated inflammation within the body.

Move your body every day

Regular physical activity may help lower cholesterol levels and manage weight. For high cholesterol treatment, the AHA recommends adults engage in at least 40 minutes of moderate- to vigorous-intensity aerobic exercise, three to four times a week. Examples of aerobic exercise include brisk walking, cycling, dancing, ice skating, jogging, swimming, and tennis.

Moderate alcohol & quit smoking

Excessive alcohol intake and binge drinking have been associated with elevated total cholesterol. Current guidelines limit alcohol intake to two standard drinks per day for men and one standard drink per day for women. A standard drink is defined as 12 oz (355m mL) of regular beer (5% alcohol), 5 oz (148 mL) of wine (12% alcohol), or 1.5 oz (44 mL) of 80 proof distilled spirits (40% alcohol). In individuals who smoke cigarettes, smoking cessation is an essential step to reducing the risk of high cholesterol and cardiovascular disease. If required, seek social and professional support to help quit smoking.

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