Dyslipidaemia/Cholesterol Management Naturopathic Protocol

Dyslipidaemia/Cholesterol Management Naturopathic Protocol

This Dyslipidaemia/Cholesterol Management Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan and should not be substituted for medical advise, diagnosis or treatment. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Dyslipidaemia/Cholesterol Management Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

HealthMasters Naturopath Kevin Tresize ND

 

Definition: Dyslipidaemia/Cholesterol Management

Dyslipidaemia is an acknowledged risk factor for cardiovascular disease, with over 51% of adults in Australia and New Zealand having high cholesterol. However, simply looking at total cholesterol (TC), which includes HDL and LDL cholesterol, doesn’t clearly assess CV risk. HDL’s have proven cardio-protective effects and should not be lowered, so it is better to evaluate TC, HDL and LDL independently, along with triglycerides. When levels of these fats are abnormal or disturbed, patients are at increased risk of atherosclerosis, hypertension, coronary artery disease, stroke and a number of other disorders. The most common types of dyslipidaemia patients can present with (either alone or in combination) are:

  • High LDL: low-density lipoproteins (LDL’s) transport cholesterol and triglycerides away from cells and tissues that produce cholesterol (e.g., liver), towards cells and tissues which are taking up cholesterol and triglycerides (e.g., peripheral tissues, muscles, nerves, etc). When too much LDL cholesterol circulates in the blood, it can slowly build up on the inner walls of the arteries that feed the heart and brain. Together with other substances LDL can form plaques: thick, hard deposits that can clog those arteries. This is why cholesterol inside LDL lipoproteins is called bad cholesterol. The risk of having a heart attack or stroke rises directly as a person's LDL cholesterol level increases.
  • Low HDL: high-density lipoproteins (HDL’s) carry cholesterol away from the arteries and back to the liver, where it's excreted via the hepatobiliary excretion route. HDL also removes excess cholesterol from plaques in arteries, thus slowing the progress of cardiovascular disease. This is why HDL cholesterol is known as the "good" cholesterol. Low HDL cholesterol levels increase the risk for cardiovascular disease.
  • High triglycerides: triglycerides are fats that contain a glycerol molecule attached to three fatty acids. These fats come from foods and are also made endogenously by the liver. The fat stored in the body is predominantly made from triglycerides. LDL carries triglycerides from the liver into the peripheral tissues and deposits it there; HDL carries it from the peripheries back to the liver for excretion. For this reason, hypertriglyceridaemia is commonly associated with high LDL and low HDL levels. High blood triglyceride levels are associated with increased risk for cardiovascular disease.

Important note on vitamin D / magnesium supplementation:

A number of enzymes involved in vitamin D conversion and activity are magnesium dependant. Therefore a deficiency of magnesium can independently lead to insufficient vitamin D activity and may interfere with supplemental restoration of vitamin D levels. Therefore co-prescription of magnesium with vitamin D supports not only healthy vitamin D levels, but the ability for vitamin D to carry out metabolic insulin sensitising, immune and skeletal health benefits.

 

Aetiology (Cause) / Risk factors: Dyslipidaemia/Cholesterol

Major causative factors and risk factors that can contribute to dyslipidaemia include:

  • Obesity
  • Excess calories in diet, particularly sugar and refined carbohydrates
  • Low fibre diet
  • Sedentary lifestyle
  • Stress
  • Smoking cigarettes
  • Hypothyroidism
  • Polycystic ovarian syndrome
  • Obstructive liver disease
  • Acute hepatitis
  • Acute and chronic alcohol abuse
  • Poorly controlled diabetes and/or insulin resistance
  • Overactive pituitary gland
  • Nephrotic syndrome and/or kidney failure
  • Porphyria
  • Systemic lupus erythematosus
  • Multiple myeloma
  • Medications (e.g., oestrogens, oral contraceptives, corticosteroids, beta blockers, anabolic steroids and isotretinoin)

 

Signs and Symptoms: Dyslipidaemia/Cholesterol

High cholesterol levels may cause few, if any, symptoms. Diagnosis is usually made through blood tests.  Severe symptoms may include:

  • Fat deposits that form growths, or xanthomas, in the tendons and skin (especially noticeable around the eyes)
  • Extremely high levels of triglycerides may cause enlargement of the liver and spleen, and pancreatitis, such as severe abdominal pain
  • Dyslipidaemia can also cause symptoms of cardiovascular disease such as angina and hypertension.

 

Core Treatment: Dyslipidaemia/Cholesterol

If with dyslipidaemia

If elevated total cholesterol and/or LDL and ApoB:  

Antioxidant Cholesterol Support Complex1 capsule at night 

PLUS
If elevated triglycerides: 
High Purity, Low Reflux, Concentrated Fish Oil Liquid OR Capsules - 5mL (1 serve) daily OR 2 capsules twice daily
PLUS
If with low HDL: 
Omega-3 and Astaxanthin Complex1 capsule at night

If overweight or obese

Shake It Practitioner Weight Management Program
PLUS

Support cardiovascular health

Reduce cholesterol oxidation

If with low vitamin D levels, i.e.: < 75nmol/L 25(OH)D

Vitamin D3 Capsules or Liquid - 2-4 capsules or 0.5-1mL daily

If 25(OH)D levels are non-responsive to Vitamin D supplementation after 12 weeks, add magnesium

High Potency Taurine, Glycine and Magnesium for Cardiovascular Health -  1 serve twice daily

Ongoing, consume an anti-inflammatory, low-glycaemic load diet, with exercise and stress management

Wellness and Healthy Ageing Program
PLUS
High Purity, Low Reflux, Concentrated Fish Oil Liquid OR Capsules - 5mL (1 serve) daily OR 2 capsules twice daily
AND/OR
Specialised Pro-Resolving Mediators [*] - 1 capsule twice daily
PLUS
Resveratrol Age Well1 tablet daily 

If gut-derived inflammation or environmental toxin exposure is leading to insulin resistance and dyslipidaemia

Metagenics Clinical Detoxification Programs

If stressed (elevated cortisol and inflammation can contribute to insulin resistance and dyslipidaemia

Assess neurobiology using the Mood and Stress Questionnaire (MSQ)      
Review other factors that may be affecting cardiovascular system

Refer to Cardiovascular – Metabolic Disease Protocol

Alphabetical Reference of Nutritional Support: Dyslipidaemia/Cholesterol

Formula Catch Phrase

Key Benefits

Antioxidant Cholesterol Support Complex A proprietary blend of citrus flavonoids (polymethoxyflavones, PMF’s) and tocotrienols (natural isoforms of vitamin E), shown to reduce cholesterol synthesis and beneficially support cardiovascular health.
Cocoa, Cinnamon and Chromium for Metabolic Syndrome A combination of herbs and nutrients to support and maintain healthy blood glucose levels and carbohydrate metabolism, which will help to improve metabolic disturbances in patients with metabolic syndrome, such as insulin resistance, dyslipidaemia, endothelial dysfunction and high blood pressure.
Enhanced Bioavailability Ubiquinol for Energy and Cardiovascular Health Ubiquinol is the active form of coenzyme Q10, a potent antioxidant and mitochondrial stimulant. Efficient conversion of inactive ubiquinone to ubiquinol is reported to decrease with aging and in conditions with high oxidative stress, thus making active ubiquinol best suited for patients whose ability to convert is compromised.
High Potency Taurine, Glycine and Magnesium for Cardiovascular Health Magnesium with activated B vitamins and chromium combine to protect the CV system. A number of important enzymes involved in the conversion and activity of vitamin D are magnesium dependant, and Mg may be required for vitamin D activity and restoration.
High Purity, Low Reflux, Concentrated Fish Oil Liquid OR Capsules Omega-3 essential fatty acids are consistently shown to reduce inflammation and support cardiovascular health by maintaining healthy lipid profiles, blood pressure and protecting arteries.
Mixed Tocopherols & Tocotrienols for Free Radical Defence A mixed form vitamin E supplement of the highest potency, including all 8 isoforms of vitamin E for broadest range of activity with cardio-protective benefits. Shown to reduce cholesterol synthesis and LDL oxidation, reduce apoB, increase APOA1, as well as being antithrombotic and anti-inflammatory. Safe for long term CV protection.
Omega-3 and Astaxanthin Complex Krill oil is highly bioavailable and rich in omega-3, phospholipids and naturally occurring antioxidants, astaxanthins. Krill is shown to support healthy lipids, and enhance HDL synthesis.
Resveratrol Age Well An anti-inflammatory antioxidant formula designed to protect DNA and mitochondria. With resveratrol, turmeric and quercetin, this age-defying formula protects the cardiovascular system.
Specialised Pro-Resolving Mediators SPMs are lipid mediators that promote resolution, reduce pain, encourage clearance of pathogens and mitigate pathological inflammation, without immunosuppression. SPMs regulate macrophage polarisation; triggering the switch from M1 (proinflammatory) to the M2 (anti-inflammatory) phenotype, therefore promoting resolution.
Vitamin D3 Capsules or Liquid Low vitamin D &/or sun exposure is associated with increased risk of developing insulin resistance with increased risk of dyslipidaemia.
Vitamin K2 for Bone and Cardiovascular Health Vitamin K2 provides cardioprotection via reducing vascular and soft tissue calcification, while also supporting healthy blood coagulation.

 

Diet, Lifestyle and Specific Natural Treatments: Dyslipidaemia/Cholesterol

  • Weight reduction where appropriate is essential. The Shake-It Professional Weight Management Program is a safe fat loss program that sensitises insulin signalling, burns fat, helps to lower blood triglycerides and increase beneficial HDL levels.
  • Maintaining dietary fibre is an important part of the dietary management of dyslipidaemia.  Water soluble fibres, taken with adequate water, help prevent cholesterol absorption from the gut and promote ease of elimination.
  • Dietary intake of foods high in antioxidants is important as an inverse association has been found between dietary antioxidants and risk of CVD – vitamin E appears to be of particular value.
  • Omega-3 fatty acids (particularly DHA) from cold-water fish may be beneficial for lowering elevated triglyceride levels.
  • Permanent change in the amounts of saturated fat and cholesterol consumed is also required.
  • The Mediterranean Diet has been found to be beneficial in managing dyslipidaemia. This is comprised of whole grains, fresh fruits and vegetables, fish, olive oil and garlic. This diet is high in monounsaturated fatty acids and has been shown to increase HDL cholesterol plasma levels and reduce susceptibility to LDL oxidation. The principals of this diet are found in the Wellness and Healthy Ageing program.
  • Lifestyle modifications that are beneficial include increased physical activity, stress reduction and smoking cessation (tobacco use lowers HDL cholesterol).

 

Supportive Lifestyle Programs: Dyslipidaemia/Cholesterol

Supportive Lifestyle Program Description
Shake It Practitioner Weight Management Program There is growing evidence that obesity is a disorder of energy homeostasis, and that the set-point for obese individuals is set to a higher level. The Shake It Practitioner Weight Management Program is a novel 3 phase program structure to prevent metabolic adaptation, reset the patient’s metabolic set point, and provide regular psychological breaks from active dieting in order to achieve sustained weight loss. The program as collection of supportive materials in order to implement behaviour change techniques and two diet options: Ketogenic (low carbohydrate, higher fat), or Low fat (lower fat, liberal carbohydrate). For Metabolic syndrome patient’s carbohydrate-restricted ketogenic diet is the diet with the most supporting evidence for those with insulin resistance. Reducing dietary glycaemic load will reduce insulin release and help patients lose fat, particularly visceral adipose tissue, thus helping to minimise the risk of many chronic illnesses.
Metagenics Clinical Detoxification Programs Gut-derived inflammation is a potent driver of low-grade systemic inflammation, contributing to insulin resistance, CV risks and dyslipidaemia. Incorporating anti-inflammatory dietary principles with a questionnaire helps to determine the most appropriate detox prescription.
Wellness and Healthy Ageing Program This program recommends a low glycaemic load diet with lifestyle recommendations for exercise and effective stress management – all factors associated with healthy ageing and chronic disease prevention.

 

Pathology Tests: Dyslipidaemia/Cholesterol

Pathology Test Interpretation Guidlines
Fasting Lipids

This blood test is done to detect serum levels of blood fats and is required for positive diagnosis of dyslipidaemia.

Normal values:

Total cholesterol: <5.5mmol/L

HDL levels (female): 1.0-2.2mmol/L

HDL levels (male): 0.9-2.0mmol/L

LDL levels: 2.0-3.4mmol/L

LDL:HDL Ratio: <3.7

Triglyceride levels: <1.7 mmol/L

Triglyceride: HDL ratio: <1.8

Total cholesterol:HDL ratio: <4.5

Homocysteine Raised serum levels of this amino acid have been associated with increased risk of coronary artery disease and stroke, particularly in patients with dyslipidaemia. Ideally, homocysteine levels should be less than 10mcmol/L.
High Sensitivity C-Reactive Protein (hsCRP)

Indicator of inflammatory processes

Normal Range: 0.2 – 3 mg/L normal range

Ideally: < 1mg/L

ApoB (Apolipoprotein B)

If TG:HDL ratio is >1.8, LDL >3.3mmol/L, with low ankle brachial pressure index, or with history of CV disease.

Ideal: <0.9 g/L

Normal/low risk of atherogenesis: 1.0-1.1 g/L

High risk of atherogenesis: >1.2 g/L

Omega-3 Index Test A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.

 

Pharmaceutical Treatments: Dyslipidaemia/Cholesterol

  • HMG-CoA reductase inhibitors (statins): pravastatin, simvastatin, atorvastatin, rosuvastatin and fluvastatin treat elevated LDL and triglyceride levels. They also raise HDL and nitric oxide; the latter may be reduced in the presence of oxidised LDL. Mortality rates in dyslipidaemic patients decrease when taking statins. These drugs inhibit cholesterol synthesis and upregulate LDL receptors in the liver. This class of drugs is first-line therapy for dyslipidaemia because they are more effective than any of the other hyperlipidaemic medications. Side effects include myositis, arthralgias, gastrointestinal (GI) upset, and elevated liver transaminases.
  • Nicotinic acid (niacin): used to treat elevated LDL and triglycerides; also increases HDL better than other cholesterol lowering medications at doses of 1500 to 2000 mg/day. Can cause cutaneous flushing, GI upset (which usually resolves over a few weeks), headache, dizziness, blurred vision, and elevated glucose, uric acid, and liver function tests. Starting with a low dose and increasing gradually helps to reduce the potential side effects. Taking aspirin 30 minutes prior to administration decreases flushing. Avoid with gout, diabetes, hypotension, or history of peptic ulcer disease.
  • Bile acid sequestrants: cholestyramine and colestipol are used to treat elevated LDL by promoting bile acid excretion and increasing LDL receptors in the liver. Common side effects include bloating, constipation, heartburn, and elevated triglycerides. May lead to increased calcium excretion and deficiency of fat soluble vitamins.
  • Fibric acid derivatives: gemfibrozil and fenofibrate are used to treat elevated triglycerides and low HDL when niacin is not tolerated. Side effects include myositis, GI upset, photodermatitis, gallstones, arrhythmias, and elevated liver transaminases.

 

Footnotes: Dyslipidaemia/Cholesterol

[*] The Omega-3 Index Test can be used to differentiate between patient requirements. Specialised Pro-Resolving Mediator supplementation is indicated in instances of pain and inflammation, where omega-3 status exceeds 8%. In instances of deficiency, consider prescribing omega-3 essential fatty acids to increase overall omega-3 status.
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