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.