Cholesterol has numerous essential functions in the body. 

It is precursor for vitamin D and steroid hormone synthesis and also plays a role in lipid digestion as a precursor for bile salts, while also forming part of the lipid bilayers of the body’s cell membranes.

However in excess, cholesterol can be a risk factor for atherosclerotic diseases.¹ Hypercholesterolemia is the presence of normal plasma triglycerides with high total cholesterol and an increase in low density lipoprotein (LDL).² Hypercholesterolemia can be attributed to a number of lifestyle and genetic risk factors, such as gene mutations, sedentary lifestyle and dietary factors.³

Although originally thought to be related to a diet high in saturated fat, acquired hypercholesterolemia is now being attributed to a wider variety of dietary and lifestyle factors, including a high intake of sugar and refined carbohydrates, with a strong link between insulin resistance and elevated LDL cholesterol. This has been attributed to an upregulation of cholesterol synthesis and a downregulation of cholesterol absorption via insulin.⁴

Given these factors, it is important as Practitioners to understand that hypercholesterolemia is a multifactorial driven condition. As such, numerous angles must be addressed in order to provide holistic care and treatment, rather than relying on a mono-therapy of hypocholesterolemic herbs or nutrients.

A tiered approach to treatment which is built upon a foundation of dietary and nutritional factors is paramount to good patient outcomes, while also addressing the drivers. From here the application of specific herbal or nutrient therapy can then be utilised.

This particular case demonstrates the efficacy of a holistic approach for the treatment of hypercholesterolemia.

Initial Presentation

A 67 year old female presented with a high cholesterol.

The blood tests showed that the patient’s cholesterol was 7.2 mmol/L (reference range <5.5mmol/L). LDL cholesterol 3.9mmo/L (reference range <3.mmol/L) and HDL cholesterol 2.5 mmol/L (reference range > 0.9mmol/L).

The test results also showed elevated alkaline phosphatase (ALP) of 111 U/L with the recommended range being 30 – 110 U/L. Further testing was done to rule out other causes of this elevation, for example vitamin D deficiency or hepatobiliary conditions such as hepatitis or cirrhosis.

The patient had a “sweet tooth”, indulging in desert every night after dinner, eating sweet pancakes for breakfast and sweet snacks between meals eg. cakes/sweet buns. She was slightly overweight with central adiposity.

Treatment Plan

Diet – The Treatment Foundation

The patient was put on a low glycaemic load (GL) diet and told to include more vegetables and water soluble fibres. This was recommended as high insulin is responsible for endogenous cholesterol production, a low GL diet will assist in preventing spiking of blood glucose and subsequent insulin release. It is through this, that further stimulation of endogenous cholesterol production can be avoided. The addition of fibre assists with binding and clearance of cholesterol. As such, this formed a long term sustainable foundational treatment for this client.

The Nutritional Wellbeing Base

In addition, the following supplements were recommended to establish a nutritional foundation for patient wellbeing:

• B multivitamin (bioavailable / active form) – 1 tablet in the morning, for general health and wellbeing to provide a good base upon which to build her nutritional status and health.
• A multi-strain probiotic – 1 teaspoon, equivalent to 120 billion CFU, in the evening, to assist with cholesterol lowering activity. One mechanism postulated is via their ability to deconjugate bile via production of bile salt hydrolase (BSH). Deconjugated bile salts are more readily excreted through faeces due to their hydrophobic nature. New bile salts are then synthesised from cholesterol thus leading to lower serum cholesterol levels.
• Omega 3 Essential Fatty Acid 1000mg capsules – 2 capsules, twice a day to improve blood triglycerides via antiatherogenic and antithrombotic activity. Supplementation with Omega 3 also has an inverse relationship with cardiovascular disease.

Addressing Drivers and Implicated Organs/Systems

The liver is also responsible for endogenous cholesterol production. As such support of healthy liver function is vital in treating elevated cholesterol. To address this, the patient was recommended:

• Liver and gallbladder support tablets containing: Silybum marianum 7.0g, Cynara scolymus 800mg, Taraxacum officinal 400mg, Buplerum falcatum 300mg, Chioanthus virginica 160mg – 2 tablets twice a day. This was prescribed for cholesterol metabolism and clearance. This occurs via conversion of cholesterol to bile acids and clearance of free cholesterol via biliary excretion as neutral sterols through the bile. Bile is required for cholesterol clearance through the intestines.

Targeted Support for High Cholesterol

Finally, for targeted management of the hypercholesterolemia, the patient was given:

• High berberine phellodendron tablets containing: phellodendron 8.8g standardised to berberine 200mg – 2 tablets twice a day. Berberine has been reported to having hypolipidaemic effects.

Outcomes

The patient was very compliant and followed the treatment plan exceptionally well. The pathology results reflected the patient’s adherence to the recommended regime.

Conclusion

This case is a great demonstration of the Naturopathic principle of “treating the whole person”. Often it is easy to become focused on a specific end goal e.g. “reduce cholesterol”. However understanding there is a greater symphony at play, which has led to an imbalance or disease process and taking a multifaceted treatment approach, will lead to positive clinical outcomes and the greater wellbeing of our clients.

References

1. Zárate A, Manuel-Apolinar L, Saucedo R, Hernández-Valencia M, Basurto L. Hypercholesterolemia As a Risk Factor for Cardiovascular Disease: Current Controversial Therapeutic Management. Archives of medical research. 2016 Oct 1;47(7):491-5.
2. Martinez-Hervas T, Ascaso J. Encyclopedia of Endocrine Diseases: Hypercholesterolemia [Internet]. Madrid: Elsevier; 2019 [cited 2018 Oct 8]. Available from: https://www.sciencedirect.com/science/article/pii/B9780128012383653400
3. Polychronopoulos E, Panagiotakos DB, Polystipioti A. Diet, lifestyle factors and hypercholesterolemia in elderly men and women from Cyprus. Lipids in health and disease. 2005 Dec;4(1):17.
4. Gylling H, Hallikainen M, Pihlajamaki J, Simonen P, Kuusisto J, Laakso M, Miettinen TA. Insulin sensitivity regulates cholesterol metabolism to a greater extent than obesity. Lessons from the METSIM study. Journal of lipid research. 2010 May 1:jlr-P006619.