All Things Cholesterol
High cholesterol isn’t just about the numbers; it’s often a sign of underlying imbalances in the body. In functional and naturopathic medicine, we look at the root causes and support cholesterol regulation through nutrition, lifestyle, gut/liver health, and individualized botanicals. Let’s dive in.
Understanding Cholesterol from a Functional Perspective
Cholesterol is not simply “bad” or “good”; these labels are oversimplified. According to the functional approach:
The terms “LDL” and “HDL” refer more to the carriers (lipoproteins) of cholesterol rather than the cholesterol itself.
Elevated cholesterol can be viewed as a symptom of deeper issues such as metabolic dysfunction, thyroid imbalance, gut dysbiosis, inflammation, toxin exposure, and more.
Beyond standard cholesterol numbers, advanced labs (particle size, lipoprotein(a), non-HDL, LDL-particle number) provide additional insight into cardiovascular risk.
In short: When we see elevated cholesterol, our question becomes: “What is driving this?” rather than “Which drug will lower it?”
1. Nutrition: The Foundation
Whole, anti-inflammatory foods
Emphasize vegetables, fruits, nuts, seeds, legumes, and lean proteins.
Avoid (or limit) processed foods, refined carbohydrates, added sugars, artificial additives, trans fats, and refined seed/vegetable oils. These all contribute to inflammation and metabolic disruption, which in turn can impact lipid metabolism.
Replace refined carbs/sugars with fiber-rich complex carbs: Fiber helps improve insulin sensitivity & supports cholesterol via gut/liver pathways (see next sections).
Healthy fats & omega-3s
Include omega-3 rich foods: wild salmon, sardines, chia, flax, walnuts. Omega-3 fatty acids support lipid balance, reduce triglycerides, and reduce inflammation.
Use healthy fats like olive oil and avocado; avoid trans fats and refined seed/vegetable oils, which tend to be pro-inflammatory and may worsen lipid profiles.
Fiber, plant sterols & supportive foods
Soluble fiber (oat bran, barley, psyllium husk, legumes, apples, citrus) helps bind cholesterol in the gut and reduce absorption. Click here for my favorite fiber blends.
Plant sterols/phytosterols: These compounds in certain plant foods can modestly reduce LDL cholesterol by competing with cholesterol absorption.
Summary of nutrition key points
Whole real foods, anti-inflammatory focus
Omega-3s & healthy fats
Fiber and plant sterols
Limit refined carbs/sugar, avoid pro-inflammatory fats
2. Gut & Liver Health: Core Regulatory Hubs
Liver support
The liver is a major site of cholesterol production, processing, and elimination (via bile acids). If liver detoxification, bile flow, or hepatic metabolism are compromised, cholesterol regulation may suffer.
Supporting liver health: cruciferous vegetables (broccoli, kale, Brussels sprouts), beets, dandelion root, adequate hydration, limiting alcohol, supporting bile flow (e.g., with bitter herbs), all beneficial in a naturopathic/functional context.
Gut / microbiome & bile acid interplay
Emerging evidence: The gut microbiota plays a powerful role in cholesterol metabolism through bile acid modification, microbial conversion of cholesterol, production of short-chain fatty acids (SCFAs) which influence hepatic synthesis, and more.
For example: Dysbiosis (imbalanced gut flora) can impair bile acid recycling and increase cholesterol levels. One review cites five mechanisms by which gut microbiota influence cholesterol homeostasis.
Another study: Specific microbes (e.g., Oscillibacter species) have been linked to lower cholesterol via direct metabolism of cholesterol in the gut. Broad Institute
Summary of gut & liver key points
Support liver/detox/bile flow
Prioritize gut microbiome health: diversity, fiber, fermented foods, and avoiding gut irritants
Recognize that cholesterol metabolism is influenced by the gut-liver axis, not only by diet & genes
3. Lifestyle Factors: The Modulators
Movement & exercise
Regular physical activity (especially strength training and aerobic exercise) helps increase HDL, lower triglycerides, and improve insulin sensitivity, all vital for healthy lipid profiles. Functional medicine emphasises lifestyle first.
Stress & sleep
Chronic stress elevates cortisol and can worsen lipid patterns (via metabolic dysfunction, inflammation, and poor lifestyle habits).
Poor sleep is also linked to dyslipidemia, metabolic syndrome, and elevated cardiovascular risk; addressing sleep hygiene and sleep quality is crucial.
Click here for my favorite ways to destress
Click here for my favorite sleep tips
Summary of lifestyle key points
Exercise (cardio + strength)
Stress management (mind-body, meditation, adequate rest)
Quality sleep
4. Key Nutrients & Botanicals (Individualized)
In a functional or naturopathic setting, after foundational diet/lifestyle/gut-liver work is in place, targeted nutrients or botanicals may be used (under guidance, discuss with your health care provider before supplementing).
Some examples:
Niacin – may raise HDL and improve lipid profile (needs clinical supervision).
Red yeast rice – contains naturally occurring statin-like compounds; used in some functional protocols. Naples Center for Functional Medicine
Berberine – has been shown to support lipid health by influencing LDL receptor expression and PCSK9 enzyme. Rupa Health
Plant sterols/stanols – help reduce cholesterol absorption.
Fiber supplements – e.g., psyllium husk, to bind cholesterol in the gut.
Antioxidants – such as CoQ10, curcumin, and green tea extract to reduce oxidative stress on lipids and endothelial health.
Important caveats:
These should not replace foundational diet/lifestyle/gut-liver work.
Always individualized and supervised (herbs/supplements can interact with medications, and underlying conditions must be considered).
Functional medicine emphasises root cause — these supports are adjuncts, not primary fixes.
5. Root Cause Assessment: What’s Driving the Numbers?
What underlies elevated (or dysregulated) cholesterol? Functional and naturopathic medicine zooms out and asks: Why is this happening? Key areas to assess:
Metabolic dysfunction / insulin resistance: Insulin resistance often drives elevated triglycerides, small dense LDL, reduced HDL. Correcting blood sugar/insulin dynamics can improve cholesterol.
Thyroid function: Even subclinical hypothyroidism can impair lipid metabolism (reduced LDL receptor activity, slowed clearance).
Inflammation & oxidative stress: Chronic low-grade inflammation oxidises LDL, making it more atherogenic.
Gut dysbiosis / impaired bile acid metabolism: As above, gut-liver axis dysfunction can impair cholesterol regulation.
Toxin exposure / heavy metals: Environmental toxins may trigger liver dysfunction, inflammation, disruption of lipid metabolism.
Genetics: Genetic conditions (e.g., familial hypercholesterolemia) need to be considered but even then, root drivers often amplify the genetic predisposition.
By identifying which of these (or which combination) is present in the individual, a more precise plan can be built rather than simply “lower the LDL”.
Putting It All Together: A Functional/Naturopathic Strategy for Cholesterol
Here’s how you might structure a plan (always individualized, with practitioner oversight):
Baseline labs: Beyond standard lipid panel, consider advanced lipid testing (LDL-particle number, lipoprotein(a), non-HDL) plus liver panel, thyroid panel, insulin/HbA1c, inflammation markers (CRP, IL-6), gut markers if indicated.
Diet overhaul: Anti-inflammatory, fiber-rich, healthy fats, minimal processed/refined carbs, ample omega-3s as described above.
Gut & liver support: Encourage diverse microbiome (prebiotic fiber, fermented foods), support bile flow (hydration, liver herbs, cruciferous veg), correct gut dysbiosis if present.
Lifestyle upgrade: Daily movement (strength + cardio), stress reduction (e.g., meditation, breathwork), optimize sleep (7-9 hours, consistent schedule).
Targeted supports: Based on labs and individual needs, perhaps berberine, plant sterols, psyllium, antioxidants, red yeast rice, etc.
Root cause work: Address insulin resistance, thyroid health, inflammation, and toxin exposures.
Monitoring: Repeat labs (e.g., 3-6 months) and adjust interventions accordingly.
Why This Matters
When cholesterol is treated only as a number to suppress (e.g., with a drug) rather than a symptom pointing to metabolic, gut-liver, or inflammatory dysfunction, you may miss the opportunity for deeper improvement. As one functional medicine practitioner puts it: “High cholesterol is a symptom, not the disease.”
By addressing the root causes, you may not only improve cholesterol but also enhance overall metabolic, cardiovascular, and endocrine health.
Take-Home Key Points
Elevated cholesterol = a signal. Go beyond the lab number.
Nutrition, gut/liver health, and lifestyle are foundational.
Gut microbiome & bile acid metabolism play major roles in cholesterol regulation.
Targeted herbs/supplements have a place, but only in the context of the whole plan.
Root cause assessment is critical: metabolic health, thyroid, inflammation, toxins, and genetics.
Functional/naturopathic approach = personalised, integrated, layered.
References
Kresser C. The Functional Medicine Approach to High Cholesterol: Six underlying causes of high cholesterol. Chris Kresser
Lee et al. The Role of Gut Microbiota on Cholesterol Metabolism in Health and Disease. (PMC) PMC+1
X et al. Effect of Gut Microbiota on Blood Cholesterol: A Review. (MDPI) MDPI
Mayo Clinic Staff. Cholesterol-lowering supplements may be helpful. Mayo Clinic
“3 Ways to Lower Your Cholesterol Without Medication” – Rupa Health. Rupa Health
Fairfield Nutrition. The Functional Medicine Approach to High Cholesterol. Fairfield Nutrition
