In this blog I will cover how to improve your cholesterol profile and the risks and benefits of cholesterol therapy, let’s dive right in!
Step 1: First and foremost, eat more fiber.
Fiber will lower LDL cholesterol and triglycerides, increase HDL cholesterol, and increase the size of your LDL and HDL particles.
The type of fiber matters. The best fiber choices are vegetables, fruits, beans, and nuts. Aim to eat 10 servings of fiber daily to optimize blood sugar and cholesterol levels.
As an example, eat daily:
- 3 cups of vegetables
- 2 cups of fruit
- ¼-1/2 cup of beans (for the 5-10% of the population that are lectin intolerant and have side effects from eating beans, avoid them, and focus on eating more vegetables, fruit, and nuts)
- 2 ounces of nuts
Unprocessed whole grains like brown rice and steel-cut oatmeal are also decent sources of fiber, but as eating grains in excess can raise blood sugar levels and shrink LDL and HDL particle sizes, limit yourself to not more than one cup of whole grains at a meal.
In addition, I recommend avoiding whole grain flour consumption as the rise in blood sugar offsets the benefit from the fiber in the grain and results in a jump in blood sugar levels and a drop in LDL and HDL cholesterol particle size. In general, limit your use of grain flour to only special occasions.
Step 2. Avoid Sugar and Refined Carbs
Eating sugar and refined carbs will lower your HDL cholesterol levels and shrink your LDL and HDL particle sizes—and results in a jump in arterial plaque growth.
Which refined carbs to avoid?
- Sugar, honey, corn syrup, fruit juice, rice syrup, and agave
- Grain flour (alternatively, try using almond flour as a substitute)
- Mashed or baked potatoes (eating small, boiled potatoes with the skin causes a lower jump in blood sugar levels than eating the inside of a large baked potato)
- Crackers, bread, pastries, and chips
Step 3. Eat more healthy fats.
Eating healthy fats will raise the size of your LDL and HDL particles, creating a cholesterol profile that is less likely to grow arterial plaque.
Examples of healthy fats include:
- Extra-virgin olive oil
- Avocado and almond oil
- Nuts (the best include—almonds, walnuts, pecans, pistachios, hazelnuts, and macadamias)
- Wild seafood, especially from fish, including—wild salmon, trout, sole, halibut, mussels, clams, and oysters
- Dark chocolate (must be at least 74% cacao butter to be called dark chocolate, and limit dark chocolate intake to not more than one ounce 4-5 days per week)
Step 4. Get more exercise.
The more exercise you get, the higher your HDL cholesterol will be, and the larger will be your LDL and HDL particle size. The minimal goal should be 30 minutes of activity every day, yet 60 minutes daily will improve your cholesterol profile more than just 30 minutes per day. When it comes to your cholesterol profile, more activity seems better. Although you have to balance the benefits of more exercise with the risks of injuries from more activity than you can handle. (Warning, especially if you are at elevated risk for heart disease, always check with your own medical provider before modifying your exercise routine to ensure that your plan is realistic and safe for you.)
Step 5. Avoid all tobacco use.
All forms of tobacco are terrible for your health. Quitting can be one of the best things you ever do for your health.
Lifestyle Therapy Summary
The combination of eating more fiber, more healthy fats, eating less sugar and refined carbs, and adding more exercise, plus avoiding tobacco use, will have a dramatic improvement on your cholesterol profile and can reduce your risk for arterial plaque growth substantially.
In my clinic, I used these combined lifestyle changes to help hundreds of patients shrink their arterial plaque load by more than 10%, making their arteries at least 10 years younger.
A warning for those taking cholesterol, blood pressure, or blood sugar medications. It’s critical to work with your medical provider before making substantial lifestyle changes to avoid complications from having your cholesterol, blood pressure, or blood sugar levels drop too low. Medications should not be stopped without first consulting with your medical provider.
WHAT ABOUT THE BENEFITS AND RISKS FROM CHOLESTEROL-LOWERING DRUGS?
Despite their numerous side effects, for people at high risk for heart disease (especially men), statin (cholesterol lowering) medications provide real benefits. Statin medications will:
- Lower LDL and Total Cholesterol levels
- Raise HDL Cholesterol levels
- Decrease inflammation
- Decrease clotting
- Statin medications have also been shown to reduce the risk of heart attack, stroke, and death for high-risk men.
But despite decades of research and clinical trials, most of the benefits are limited to high-risk men, and women have only had at most minimal to modest lifesaving benefits.
The reality is that the combined lifestyle recommendations noted above are more effective at reducing heart disease than only using medications. Although you do have the option to combine both for the greatest benefit. For many people who adopt all five lifestyle changes, they will no longer qualify for cholesterol-lowering medications and with the help of their physician can often stop these drugs.
Women appear to have more benefit from making beneficial lifestyle changes and less benefit from statin drugs.
What Are the Side Effects from Cholesterol Medications?
The side effects from cholesterol-lowering medications (statins) are numerous and real, including:
- Muscle tissue breakdown (muscle aches, serious adverse events in 1 per 1,000 people treated, although 10% of people given a statin will have this side effect)
- Liver inflammation (serious in 1 per 1,000 people treated)
- Lowers testosterone levels substantially, enough to cause symptoms in men and women
- Blocks conversion of vitamin K1 to vitamin K2, leading to an increased risk for bone loss and arterial calcification
- Decreases production of Co-Q-10 (ubiquinone) by at least 20%
- Memory loss and other cognitive impairment
- Increased risk for diabetes and elevated blood sugar levels
Most of these side effects are listed as an FDA black box warning that comes with these medications.
The lower the dosage of a statin medication, the lower these risks will be.
Red Yeast Rice Extract (RYRE, a natural combination of multiple low-dose statins) will lower cholesterol levels and has fewer side effects than prescription cholesterol medications, although it does not lower cholesterol as much as a drug and it has the potential to have all of these same side effects. As RYRE has real medications in it, I only suggest using high-quality RYRE to ensure the right dosage and ingredients.
Caution: Red yeast rice extract will not work for everyone, and has the potential to cause the same side effects as statin drugs in sensitive individuals.
How to Offset Side Effects from Cholesterol Medications
Statin drugs lower cholesterol levels by inhibiting HMG-CoA Reductase, but they also block a pathway that produces Geranyl geraniol (GG). GG is essential to:
- Repair muscle proteins,
- Form CoQ10 and vitamin K2,
- Produce testosterone
If you have side effects from taking a statin medication, I recommend that you discuss with your medical provider about the option to either try Red Yeast Rice Extract, click here for a recommended brand of RYRE, or try 170 mg of Geranyl-Geraniol daily. Adding GG does not prevent the cholesterol-lowering impact of statin drugs but may restore the normal GG pathway. For a link to ordering GG, click here.
When talking about cholesterol therapy options with your physician:
- Always ask to give the 5 lifestyle changes noted earlier a trial first. You are generally only supposed to start a statin medication if you have failed lifestyle interventions.
- These lifestyle changes will improve not only your cholesterol profile, but will also enhance your blood pressure, your blood sugar level, your brain function, your sexual function, and help reduce your risk for heart disease.
If your physician is recommending drug therapy:
- Ask to measure an advanced cholesterol profile to see the size of your LDL and HDL particles. (Your insurance may or may not cover this depending on your physician).
- Ask for some measurement of your arterial plaque load. This could be with a carotid IMT study using ultrasound, or a heart scan to measure arterial calcification. If you do not have substantial plaque, you have greater leeway to focus on lifestyle changes. If you have advanced plaque growth, the combination of medications and lifestyle changes are more effective than either alone. (Plaque measurements are typically not covered by medical insurance, but in recent years some techniques are available for close to $100.)
For more details on preventing and reversing heart disease, please read the latest edition of my book, The 30 Day Heart Tune Up!
I wish you the best of health!
Steven Masley, MD, FACN, FAHA, CNS
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