The Whole Cholesterol Story 2

If you’ve read the first post you may be asking yourself, but wait what can we do? Just as the best crime reduction strategies involve not only arresting criminals, but also cleaning up the neighborhood, we too can create an environment in our bodies that minimizes our risk of heart disease.

Remember cholesterol is found at the scene of the crime, but is not the actual villain!

The real villains here are:

  • 1. Smoking - causes significant oxidative damage.  When we smoke we create a huge body burden of chemicals that can damage cells (including cholesterol).  Smoking increases blood pressure and increases the “stickiness” of blood.  Increased blood pressure damages small arteries and sticky blood increases risk of clots, while depriving tissue of oxygen.  If you are reading this and still somehow think smoking commercial cigarettes is good, well this is probably not the right blog for you.  Interestingly nicotine patches are not that helpful in helping people quit.  Most studies show that around 15-23% of smokers quit after a year of use. New treatments may soon be available, as evidenced by a small John Hopkins University study, which examined psilocybin and behavioral therapy on a group of 10 people around the age of 50 who each had a 30 year history of smoking.  Researches found that after 6 months and 3 doses of psilocybin, 80% of participants had abstained.  While we cannot make broad conclusions based on this study, one would hope research into safe yet taboo agents like psilocybin will soon become more available.
  • 2. High Blood Sugar - Having high blood sugar DOUBLES your risk of coronary heart disease! YES. READ THAT AGAIN!! DOUBLES RISK! Everyone should be familiar with their haemoglobin A1C levels. This is an important measurement of your average blood sugar over the past three months.  Red blood cells or erythrocytes live about 90 days, and when blood sugar is high, it basically sticks to the red blood cells, resulting in what you can impress your friends by calling “glycosylated haemoglobin”.  Don’t wait until your HBA1C is over 5.6% as this means you are already considered pre-diabetic.  Monitor and make changes before you reach 5% for optimal health.
    Sugar also sticks to cholesterol, damaging it, and causes an increase in insulin, which makes your blood clot more, prevents your body from being able to break down clots that do form, and increases the chance your body will make more of those pesky small and oxidised LDL particles that drive arterial disease. HIgh insulin levels are highly inflammatory and lead to high levels of triglycerides in the blood - another risk factor as described below.
  • 3. High Blood Pressure - High blood pressure causes damage to the walls of the arteries, as the force exerted with every heartbeat stresses the tissue potentially causing microscopic tears. Damaged arteries set the stage for cholesterol, fat and immune cells to build up resulting in arterial plaque formation.  High blood pressure also causes generalized hardening of the arteries.
  • 4. Unchecked Inflammation - One of the reasons Statin drugs work for some people, is likely due to the fact they also act as potent pharmacologic anti-inflammatories (as well as agents that block cholesterol production).  Without inflammation as a driver, cholesterol will not accumulate, become damaged or cause plaques. Smoking and poor diet; especially consuming processed foods, strongly drive inflammation.  Food allergies, stress, infection, vitamin deficiencies (especially B complex vitamins) and environmental toxicants all result in an increased overall inflammatory state.  You can check your body’s level of inflammation in regards to cardiovascular risk, by measuring your blood “hs-crp” and “homocysteine” levels.  The lower the better in general. 
  • 5. Infection and environmental toxicants - Can result in dysregulated or unchecked inflammation as the immune system attempts to rid the body of infectious organisms or environmental pollution. Excessive immune activation by certain bacteria can also lead to autoimmune attacks on heart tissue, or greatly increased chances of clots forming. Environmental toxicants such as lead, cause atherosclerosis in experimental animals, and other heavy metals (such as arsenic and mercury) cause oxidative damage to the body.
  • 6.  High Triglycerides - Triglycerides are basically a storage form of sugar.  When we consume calories that are not immediately required by the body, it turns them into TG’s to be stored in your fat cells.  When you are fasting, your body can liberate energy from fat through dumping these bad boys back into your bloodstream. TG’s are closely related to blood sugar and insulin levels. There has been a recent debate about whether high triglycerides directly contribute to coronary artery disease or are simply a biomarker of the disease process, but either way, strategies to reduce them will also be protective against heart disease.
  • 7. Certain Lipid Profiles - Yes cholesterol DOES matter…. to a degree.  We need to be familiar with not just our total cholesterol, LDL and HDL numbers, but more importantly

Your triglyceride levels

Your ratio of triglycerides to HDL

Your ratio of total cholesterol to HDL

LDL particle size and number (LDL profile)

oxLDL levels

If your GP is not familiar with these tests consider looking for a licensed naturopathic or an integrative/functional medicine trained physician. By examining all of the above lipids and lipid ratios, you will get a much more in depth understanding about your cardiac risk, and treatment can be guided based on your personalized risk factors.

  • 8. Obesity - Obesity, and especially visceral fat (that big belly), is a huge contributor to inflammation! did you know your visceral fat cells are like little hormone factories, pumping out inflammatory cell signaling molecules as well as things like estrogen?  Hello, man boobs!. Inflammation underlies heart disease.
  • 9. Stress - This is a big one.  Evolutionarily stress was supposed to be intense and acute (you got eaten by the tiger or not, but the chase only lasted a few minutes).  Nowadays we get stressed over traffic, people not returning an email on time or losing a job.  Stress tends to exist at a lower level, but often never really gets turned off.  This leads to metabolic derangements, high blood sugar, increased blood pressure and cholesterol. Learn to manage stress hrough the high art of not giving a f*uck, when you can not, in fact change something. Laughter, sex, human connection, yoga, reading and meditation are great stress relievers, but it is important you find something that you can stick to and enjoy.
  • 10. Diet and lack of physical activity - A diet high in refined and processed foods (sugar, plant oils like canola, corn and peanut oil), trans fats, and a diet devoid of colorful fruit and vegetables increase inflammation, and set you up for everything from heart disease to cancer. Alas, your mom knew more than your doctor, so just eat that damn broccoli already please.

What changes do I make to my diet to reduce my risk of coronary heart disease ?

  • 1. REDUCE OR ELIMINATE REFINED SUGAR!  Healthy blood sugar balance is vital for protecting our blood vessels and preventing damaged small LDL.   Refined carbs also increase triglycerides, chylomicrons and LDL and VLDL (which in excess are also detrimental to cardiovascular health).  If you insist on eating Krispy Kreme donuts and Pineapple Lumps all day,  you're likely reading the wrong blog.  Try this one: Sugar addiction is a real thing.


  • 2. Eat less animal products - Chose fish and limit your intake of red meat to 3-4 times a week. Meat from conventionally raised and grain fed animals is full of an inflammatory fat called arachidonic acid. In contrast pasture raised and finished animal products tend to have higher levels of anti-inflammatory omega-3 fats.


  • 3. Eat your vegetables! The colored pigments in fruits and vegetables are actually polyphenols- types of antioxidants, which protect LDL from becoming the immune stimulating and plaque forming oxLDL.  Vegetables also contain soluble fiber which decreases total cholesterol levels. Aim to eat  at LEAST 6-7 servings of colorful fruits and vegetables a day. Ideally, start drinking smoothies or vegetable juice as well to squeeze in an extra few servings.


  •  The food we eat interacts with our genes, and many of the polyphenols found in colorful fruit and vegetable, not only act as antioxidants, but also turn on antioxidant producing genes while turning off genes that code for inflammation.  Google : Nutrigenomics, and prepare to have your mind blown.


  • 4. Avoid TRANS FATS.  These fats produced by the food industry to increase the shelf life of packaged foods, will significantly decrease YOUR shelf life!  Trans fats not only raise levels of small oxLDL but also decrease HDL and are highly inflammatory.  Look for and avoid any food with “partially hydrogenated vegetable oil” on the label. Foods that usually contain trans fat include margarine, and packaged foods.  Bakery goods are trans fat bombs, avoid these like the plague. If you choose to eat bread - it should only have 3 main ingredients; wheat, water, yeast.  


  • 5. Balance your fats -  Too many refined oils from plants (corn, soybean, canola, peanut) and too little omega 3’s creates the perfect environment for inflammation to thrive.  Choose instead- extra virgin olive oil, and anytime you see a deep fryer just think of it as a bubbling poison factory.  Coconut oil while high in saturated fat is a good choice for high heat cooking, as is grass fed butter or ghee.


  • 6. Limit grains, and AVOID wheat.  Of course, not everyone has Celiacs Disease, BUT everyone will have some degree of gut inflammation in response to gluten, the protein in wheat.  When we eat gluten, our bodies produce zonulin, an irritating little molecule that basically breaks down the tight junctions between the cells in our gut. For most people in the short term this is no emergency, but over a lifetime, the breakdown of barrier function of the gut, leads to inflammation and autoimmune disease. Avoiding food allergies in general can improve inflammation in the body).

Specific foods that benefit cholesterol: 

  • Omega 3 fatty acids from fish and plants. Omega 3 oils from fish, increase HDL and LDL particle size, while reducing Triglycerides and LDL particle number.  Fish oil also improves insulin resistance.  Omega 3 source from plants include flax seeds which have been shown to increase nitric oxide.  Hemp is also a good source of omega 3 oils.
  • Olive Oil. Aim for 2 tbsp of extra virgin olive oil a day. Olive oil lowers oxLDL and LDL, and increased HDL.  Extra virgin cold pressed olive oil also contains antioxidants that protect blood vessels and LDL.
  • Nuts- Nuts contain vitamin E which protects cholesterol from damage.  Also contains healthy oils that are shown to reduce the risk of heart disease.
  • Garlic. Garlic reduces blood clotting, lowers LDL and reduces calcification in coronary arteries.  Garlic is also a strong antimicrobial/antiviral, remember infections can damage arteries so this aspect of garlic may also benefit heart health.
  • Pomegranate juice shown to benefits cardiovascular disease.  Reduces small damaged LDL and is high in antioxidants.

Supplement Ideas - Talk to your doctor to see which may be most useful to you.

  •  1.     Plant Sterols - Decrease inflammatory markers and immune system activation.  Prevent the absorption of dietary cholesterol. Dose: 2-3 g day needed to see benefits in total cholesterol numbers.


  • 2.     Guggul - Increased bile excretion of cholesterol thus lowering total amount. Improves HDL/LDL ratio. Dose: 50-75 mg standardized to 2.5-5% guggulsterones needed for benefit.


  • 3.     Niacin/Vitamin B3 - Use Niacin NOT niacinamide or inositol hexanicotinate. Prevents LDL oxidation and reduces particle number. Increases HDL.  Dose: 1-2 g twice a day (begin at 250 or 500 mg and increase 100 mg per week up to 1g).  Flushing, redness and skin tingling will likely occur at this dose. This is not harmful but actually a “healthy” although slightly uncomfortable side effect, that occurs because niacin increases circulation to the skin and causes a release of the chemical histamine.  After a few days at a certain dose flushing usually goes away. Taking an aspirin 30 minutes before niacin, or taking it with applesauce or apples, as well as increasing your dose slowly (100mg week) will reduce flushing.


  • 4.     Green Tea (EGCG) - Reduces cholesterol absorption, activates genes that protect LDL from oxidation, improves insulin sensitivity and decreases blood sugar. Dose: 500 mg EGCG twice a day or 60 oz green tea daily.


  • 5.     Resveratrol - Reduces blood pressure, protects walls of arteries and vessels, protects LDL from damage, anti-inflammatory and reduces the uptake of oxLDL by immune cells. Dose: 100 mg trans-resveratrol per day.


  • 6.     Turmeric - Excellent anti-inflammatory protects LDL, reduces arterial stiffness. Use at least ½ tsp of powdered turmeric in oil with some black pepper added to food twice a day.


  • 7.     Red Yeast Rice - works similarly to Statins to lower cholesterol. If using should take with Coenzyme Q10 to prevent deficiency.


  • 8.     Probiotics - Important for immune balance and gut function.  Systemic inflammation often begins in the gut.  By using probiotics we are telling our bodies to moderate the inflammatory response.


  • 9.     Vitamin D3 - Decreases inflammation and helps balance immune activation 1000-5000 iu for most people, but depends on genetic factors as well as blood levels at start.