Measuring basic lipids, including total cholesterol, LDL calculation, HDL direct, cholesterol to HDL ratio, and triglycerides, is fundamental for assessing cardiovascular health and overall well- being. Yet there is so much more than a basic lipid panel to assess cardiovascular risk. If lipids or cardiovascular risk is a concern, also consider requesting the following labs: apolipoprotein B, hsCRP, homocysteine and a NMR profile assessing the size of the lipoprotein particles.
Risk Factors for Heart Disease
Chronic Inflammation
Inflammation is caused by excessive oxidative stress at the cellular level. And this oxidative stress inhibits mitochondrial. You may be surprised to find out that the heart actually contains one of the highest mitochondrial densities out of any other organ and therefore experiences the effects of chronic inflammation much more quickly.
Poor Calcium Metabolism
Calcium coordinates with magnesium, vitamin D, and vitamin K to help ensure that calcium is deposited in the bones. Insufficient amounts of these nutrients or certain types of these nutrients are more likely to contribute instead to arterial plaques, increasing the risk of cardiovascular disease.
Micronutrient & Fatty Acid Deficiencies
These include flavonoids, polyphenols, electrolyte minerals, and healthy omega-3 fats. Flavonoids, other antioxidant compounds, and omega-3 fatty acids have anti-inflammatory effects to reduce oxidative stress. Polyphenols, antioxidants founds in some plant foods, support mitochondrial function, and hence, are protective for the heart. Minerals ensure proper conductance of electric signals.
Blood Sugar Imbalances
Diets rich in refined carbs, sugars, and processed foods creates massive fluctuations in blood sugar that contribute to the formation of advanced glycation end products (AGEs). AGEs are highly inflammatory to the epithelial lining of the arteries, and serve as a contributing risk factor for heart disease.
Chronic Stress
As we experience chronic stress, we release higher amounts of stress hormones like cortisol, epinephrine, and norepinephrine that influence our risk of heart disease.
Let’s discuss a few biomarkers of cardiovascular risk and how to use nutrition to lower our risk.
Cholesterol is vital for cell membrane structure and serves as a precursor for various hormones, such as the estrogens, progestogens, androgens and mineralocorticoids. It’s also essential for the synthesis of vitamin D and bile acids, which aid in fat digestion. Having a low lipid level rarely causes a problem, but it may indicate the presence of another disorder. More often than not, we seek to lower our cholesterol.
LDL cholesterol (Low-Density Lipoprotein) serves as the main transporter of cholesterol in the bloodstream, primarily responsible for delivering cholesterol to both peripheral and liver cells. The progression of atherosclerosis occurs when oxidized LDL cholesterol is internalized by macrophages and subsequently accumulates within atheromatous plaques, leading to the development of atherosclerotic lesions.
Apo B (apolipoprotein B) is a key structural protein associated with various lipoprotein particles, primarily LDL and very low- density lipoprotein (VLDL). Apo B plays a critical role in the transport of lipids in the bloodstream and is often associated with the concept of "bad cholesterol" because it’s involved in the delivery of cholesterol to peripheral tissues, including the arteries. Higher levels are associated with increased cardiovascular risk and it has been reported that ApoB is more effective than LDL in assessing CVD risk. Higher ApoB levels have been found in those who follow a diet high in carbohydrates and saturated fats.
Strategies to Lower total Cholesterol, LDL Cholesterol & Apolipoprotein B
Dietary fiber: 5-10 grams soluble (oatmeal, legumes, vegetables, fruits) daily
Omega-3 fatty acids: 1-3 grams daily
Wild, cold-water fatty fish (salmon, sardines, trout, black cod, anchovies, herring) at least 2 times/week
Plant sources 5-7 days weekly
1 ounce or a small handful of walnuts
2 tablespoons of seeds (flax, chia, hemp hearts, sacha inchi seeds)
Replace carbohydrates with monounsaturated fats
If consuming a diet rich in carbohydrates, consider replacing some of the carbs with healthful fats, including extra-virgin olive oil, avocados, and almonds.
Plant Sterols and Stanols: 3 grams daily
Foods that contain the greatest amount of phytosterols:
Nuts – pistachios the highest, then almonds, pecans, and walnuts
Whole grain products – flax seed and wheat germ the highest
Vegetables – corn, brussels sprouts, broccoli, cauliflower, lettuce
Fruits – blueberries, avocados
Red Yeast Rice: Standardized to 10 monacolin K daily
Berberine: 500 mg three times daily
Green tea (EGCG): 300-400 mg daily
Policosanol: 10 mg twice daily
Strength training
Weight loss, if appropriate
HDL cholesterol (High-Density Lipoprotein) facilitates cholesterol scavenging from the bloodstream, escorting it to the liver for elimination. Subsequently, the liver orchestrates the removal of excess cholesterol from the body. Elevated HDL cholesterol levels contribute to a reduced susceptibility to heart disease and stroke. Generally speaking, high HDL levels are associated with a lower risk of heart attacks and strokes.
Strategies to Increase HDL Cholesterol
Regular (daily) exercise of 30 minutes or more
Increase intake of omega-3 fats through diet and supplementation 1-3 grams daily as noted above
Niacin (vitamin B3): 500-2000 mg daily
Nicotinic acid is commonly used to lower cholesterol and triglycerides. The most common side effect is facial flushing. This effect can be ameliorated by taking a slow release formulation of niacin or adding aspirin to niacin. Starting with a low dose and gradually increasing the dose may reduce the flushing and itching. Niacin may NOT be appropriate if you have gout, an active stomach ulcer, glaucoma, uncontrolled type 2 diabetes, active liver disease, alcoholism, a clotting disorder, and/or an oversensitivity to niacin. Please discuss with your healthcare provider before using.
Policosanol: 10 mg twice daily
Triglycerides function as carriers for fatty acids, provide a source of energy, insulate and protect organs, and help transport fat- soluble vitamins. Triglycerides can be elevated with insulin resistance, hypothyroidism, vitamin D deficiency, zinc deficiency, chronic infections, certain medications, as well as oxidative stress & inflammation.
Strategies to Lower Triglycerides
Dietary modifications:
Minimize simple carbohydrates and sugars
Increase dietary fiber to 30-45 grams daily
Limit or avoid alcohol
Regular exercise for a minimum of 150 minutes per week
Niacin (vitamin B3): 500-2000 mg daily
See above on niacin
Omega-3 fatty acids: 1-3 grams daily
See above on omega-3 fatty acids
Fenugreek: 5-10 grams daily
Policosanol: 10 mg twice daily
Homocysteine is an amino acid associated with an increased risk of cardiovascular disease when elevated; may indicate deficiencies in B vitamins or genetic factors (i.e., MTHFR).
Strategies to Lower Homocysteine
B Complex containing the methylated forms of vitamin B2, vitamin B12, vitamin B6 & folate
Diet with adequate protein and sulfur containing foods
Sulfur containing foods include meat and poultry, fish, eggs, and certain vegetables like onions, garlic, and cruciferous vegetables (i.e., cabbage, broccoli)
Trimethylglycine (TMG)
Histamine controlled diet, if necessary
hsCRP measures levels of C- reactive protein, a marker of systemic inflammation and cardiovascular risk. Lower levels of hsCRP are generally considered beneficial and not clinically significant.
Strategies to lower hsCRP
Omega-3 fatty acids: 1-3 grams daily
See above on omega-3 fatty acids
Exercise: Regular exercise for a minimum of 150 minutes per week
Curcumin: 500 mg twice daily
Opt for a 3rd generation formulation that has much greater bioavailability, including Longvida, CurcuWin, and CurQfen
Reduce evening snacking and lengthen overnight fast
Ensure adequate level of serum 25-OH vitamin D aiming for 40-80 ng/mL
Steps to Maintain Healthy Lipid Levels
Diet: Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit refined sugars and simple carbohydrates. Avoid trans fats and be wise with saturated fat consumption.
Physical Activity: Engage in regular exercise to raise HDL cholesterol and lower triglycerides.
Weight Management: Maintain a healthy weight through a combination of diet and exercise.
Nutritional therapies: Plant sterols, soluble fiber, omega-3 fatty acids, garlic, vitamin B3, green tea, red yeast rice, and berberine all have a positive effect on lowering lipid levels.
Medication: In some cases, medication may be prescribed by a healthcare provider to manage lipid levels, especially if genetics or underlying health conditions are significant factors. Note that statins can deplete levels of various nutrients, including CoQ10, beta carotene, vitamin D, vitamin E, zinc, copper, selenium, and essential fatty acids. If you’re taking a statin medication, be sure to monitor your nutrient levels and/or consider supplementation to replete nutrient levels.
Regular Monitoring: Periodic lipid profile assessments are crucial to track progress and make necessary adjustments.
Whew, hope I didn't overwhelm you. But yes, there is much more to cardiovascular health and overall health than a simple lipid panel.
In Health,
Natalie