In my last post I reviewed the results of all the labs my lipidologist ordered in which we learned:

• I am somewhat insulin resistant
• I have increased cholesterol synthesis which is possibly related to my insulin resistance
• I also have increased cholesterol absorption which is possibly related to an underlying gut issue
• I am ApoE 3/4
• My Lp-PLA2 is still elevated and we’re not sure if this is due to actual vascular inflammation or other causes like exercise or my dental issues.

Before going straight for prescription medications, the lipidologist suggested a few things for me to try which I was all over… but since I’ve been dealing with these cholesterol issues for so long and eager to get it under control, I decided to do every possible thing I could think of to help bring it down.

The following is the list of my entire 12 pronged anti-cholesterol gameplan:

DIETARY CHANGES

1. Reduce my saturated fat

I learned that because I’m ApoE 3/4 I can react badly to high saturated fat diets.  According to this paper in the British Journal of Nutrition from December 2000:

However, individuals with the ApoE epsilon3/epsilon4 genotype displayed a much stronger positive correlation between LDL cholesterol level and the percentage of energy derived from intake of saturated fat.

This means using more olive oil and cutting back on all of that lovely butter, delicious bacon, and tasty heavy whipping cream (sorry Kiefer)!

2. Eat More Beans

This is one of the steps Grace Liu Pharm D recommends since beans are a very good prebiotic.  Whenever I go to Chipotle or any other Mexican place, instead of getting my typical super low carb bowl, I plan to add in some beans.

3. Eat Low Carb but not Ketogenic

Because I’m insulin resistant, eating too many carbs is bad for my cholesterol… BUT because going ketogenic is what started all this off in the first place, staying in full on ketosis is also bad for my cholesterol.  So we decided it was best if I stayed somewhat low carb, in the 50-120 gm range depending on my activity level.

4. Reduce Coffee

Almost a year ago I explored the idea of how coffee can cause raise LDL.  In a mouse study, scientists found that Cafestol, a compound found in coffee, can stimulate increased cholesterol synthesis by the liver by suppressing bile acid production.

So no coffee and no saturated fat means no Bulletproof Coffee (sorry Dave Asprey).

Since I normally drink 1-2 cups of coffee per day, it will take quite an effort to cut this down.  I decided to go cold turkey for the entire week, only allowing myself one cup of coffee with heavy cream on Sundays.

Because I like having something warm to drink in the morning and still want some caffeine, I’ll switch over to Green Tea.

The BJJ Cavewife introduced me to Mighty Leaf Tropical Green Tea which tastes amazing, so I’ll be drinking this regularly.

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SUPPLEMENTATION

5. Prebiotics with Grace Liu Pharm D.’s Bionic Fiber

Since we suspect that I have an underling gut issue that is causing me to hyperabsorb cholesterol I decided to try Grace Liu Pharm D.’s 7 steps to healing the gut.  While I already follow most of her recommendations just by being paleo/primal, one area I wasn’t doing a good job at was using prebiotics, so I ordered all the components of her Bionic Fiber Version C [Amped Up Bionic Fiber for Fat Burning].

This consists of:

• Inulin FOS Powder – 1 tbsp
• Acacia Fiber – 1 tbsp
• Psyllium Husk Powder – 1 tbsp
• Raw Reserve High ORAC Green Powder Berry Flavor – 1 tbsp

I also rotated in some of the following:

• Glucomannan – 1 tsp
• Modified Citrus Pectin – 1 tsp
• Baobab Hadza Fruit Fiber – 1 tsp

She has a whole laundry list of other fibers you can rotate in if you want “for variety and diversity,” but I didn’t want to turn my already crowded counter space into a GNC store.

6. Probiotics

I decided to incorporate these three probiotics for the following reasons:

VSL#3 – As I wrote in a prior post, Grace Liu Pharm D. actually introduced me to this brand inadvertently when she sent me the link to this paper which found that

… the probiotic preparation VSL#3 affected insulin sensitivity, lipid profile, and atherogenic index favourably and reduced hsCRP, a marker of inflammation, in overweight/obese adults. Probiotic given in combination with omega-3 was more effective than probiotic alone.

The improvement in the lipid markers was specifically:

HDL increased by 23.2% and LDL decreased by 10.7%; triglycerides decreased by 7.78% and VLDL by 7.78% in the probiotic with omega-3 group, compared with baseline levels

So here we have an actual scientific paper showing a significant benefit in serum lipids with this specific brand of probiotics… this was all the endorsement that I needed.  With almost every other probiotics, the only data available are anecdotal reports and Amazon reviews, which leave a lot to be desired.

I also liked this probiotic for a few other reasons.  Firstly, it’s shipped cold!  It comes in a heavy duty styrofoam container filled with ice packs to ensure that the cultures stay active.  Secondly, each capsule contains 112.5 billion bacteria!  This is up to 10-15x more than the amount seen in other probiotics.

Since our gut contains somewhere around 100 trillion microbes, taking a pill containing 10-20 billion bacteria is just a drop in a bucket.  I wanted to get the most bang for my buck.

If I were really hardcore I would’ve used the VSL#3 Sachets which contain 450 billion bacteria per pack… but I don’t like feeling the actual powder itself, so I opted to go for the capsules.

Prescript Assist – This is the brand touted by paleo bigwigs like Robb Wolf and Chris Kresser.  I chose to add this in because of all the additional bacterial species it provides hoping to promote diversity in my biome.  One thing that I was a little worried about was that each capsule only contains 145 million (not billion) bacteria, although according to their FAQ:

Prescript-Assist cannot be compared to CFU’s in lacto and bifido based probiotics. These products require these massive numbers because 99%+ die during manufacturing, prolonged storage, stomach acid, etc.

Prescript-Assist is a shelf-stable probiotic that has been tested to retain its potency over time (with variations of less than 5% over 2 years from date of manufacture when stored at 98°F / 37°C). This is the primary reason that the CFU’s are not listed in our materials.

Primadophilus Reuteri – This is a blend containing which contains Lactobacillus reuteri which I first came across this series of lectures by Dr. Dayspring, where I learned that this species can lower serum LDL.

Here is a paper from the European Journal of Clinical Nutrition from 2012 showing that

The present results suggest that the deconjugation of intraluminal bile acids results in reduced absorption of non-cholesterol sterols and indicate that L. reuteri NCIMB 30242 capsules may be useful as an adjunctive therapy for treating hypercholesterolemia.

The reason I went with this specific brand was simply for cost reasons.  I can’t tell you why I drew the line with this specific bacteria to cut costs… but I did.  Each capsule contains 5 billion bacteria, so this flies in the face of what I just said about my reasons for choosing VSL#3.  I made sure to take 2-4 capsules each time to try to get the numbers up, but this was pretty unscientific.

In retrospect, I probably should have gone with this brand, Microbiome Plus+ GI, because it actually contains the specific NCIMB 30242 species mentioned in the paper where as the one I chose has the HA-188 species.

Now you may be wondering why I chose not to go with Klaire Labs Ther-Biotic, which is the brand recommended by my lipidologist.  When I looked at the label, there was a lot of overlap with VSL#3, BUT each capsule only contained 25 billion bacteria, so it didn’t make sense for me to add this on top of everything else.

7. Berberine

This was a supplement recommended by my lipidologist.  She explained that it had a lot of similarities to Metformin and may help with the cholesterol hypersynthesis side of things.

Here is a paper from Natural Medicine in 2004 showing that berberine is a

…new hypolipidemic drug with a mechanism of action different from that of statin drugs.

Here is a another paper from Expert Opinions on Investigational Drugs from 2005 showing that

Berberine upregulates the LDL receptor (LDLR) by a mechanism distinct from that of the statins…

…reduced LDL-cholesterol (from 3.2 to 2.4 mmol/l) without any effect on high-density lipoprotein-cholesterol.

This is a very interesting substance and and is well studied with quite a few PubMed papers exploring its properties.  I plan on dedicating an entire post exploring this, so I won’t go into too much detail here.

I chose to go with Thorne Research Berberine taking 500 mg twice a day, because Thorne is a trusted brand.

8. Citrus Bergamot

This was another supplement recommended by my lipidologist.  She explained that this may help with my cholesterol hypersynthesis because its mechanism of action was similar to that of statins but without the side effects.

In my research, it seems like this is a relatively new substance with one of the main articles touting this coming from the Wall Street Journal in January 2015 citing a study showing:

In a monthlong study of 77 patients published in 2013 in the International Journal of Cardiology, 1000 mg daily of bergamot extract lowered cholesterol from an average of 278 mg/dl to 191.

Here is a link to the abstract of the study itself.  As opposed to Berberine, there really isn’t much data out there, and we still don’t know what the exact mechanism of action is and what the side effects are.

Since I was willing to do anything to bring down my LDL-P, I figured a 30 day trial with this should be ok.

I went with HP LifeScience Citrus Bergamot because their website looked reputable to me… which probably isn’t the best criteria to use.

9. Omega 3

Because my Omega 3 index is less than the optimal 8% and I’m ApoE 3/4 which gives me a higher risk of Alzheimers, my lipidologist recommended increasing my intake of Omega 3 oils via fish and fish oil.  Since I don’t really like eating fish because… well.. I’m not sure, it’s been a sort of mental thing for me ever since I was a kid, I’ve been making a conscious effort to acquire the taste.

We’re eating at Japanese restaurants a lot more and instead of opting for my usual teriyaki chicken or beef, I’ve been getting into sashimi and sushi.

I’ll also be better about taking my preferred fish oil, Exos Lemon Berry Omega 3, because I trust the brand and find that this is the best tasting fish oil out there.

10. Other Vitamins and Minerals

For completions sake, here is the list of all the other vitamins and minerals I’ll be taking.

• Athletic Greens – Good source of vitamins, with methylated forms of folate and B12, antioxidants, and some prebiotics and probiotics
• Magnesium Glycinate – The most absorbable form of magnesium
• Magnesium Threonate – Another form of magnesium that I heard about on Tim Ferriss’ Podcast with Charles Poliquin, which is supposedly great for the brain.  Sometimes I amaze myself at how easily convinced I am to try things I hear on podcasts without doing deeper research.
• Zinc Picolinate – Another mineral I heard about on the Tim Ferriss Podcast with Charles Poliquin.  This is supposedly good for testosterone.
• Exos Vitamins D + K – Again I find my Vitamin D levels to be on the low side so I need to be better about supplementation.  I like this dropper better than the Athletic Greens Vitamin D dropper, and I like that it also contains Vitamin K2.

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OTHER

11. Optimize Oral Hygiene

I’ve already written about the relationship between gum disease and both high cholesterol and high Lp-PLA2 and the results of my MyPerioPath test, so I’ll be continuing the new oral health regimen my dentist recommended which includes:

• Brushing at my gum line with my Oral B electric brush
• Using Oxyfresh Mouthwash
• Flossing
• Brushing with these angled go between brushes

I’ll also start playing around with oil pulling using coconut oil because it can help to reduce the bad organisms in the mouth… but more so because I now have a lot of coconut oil that I don’t know what to do with since I can’t eat it due to its high saturated fat content.

12. Maintain My Current Exercise Regimen

Continuing with my current regimen of BJJ 4-5 times per week and weight lifting 1-2 times per week can only help things, especially by making me more insulin sensitive and countering my genetic predisposition for insulin resistance.  I also don’t think there’s really any room to do MORE even if I wanted to.

Next up… what my followup labs show.

*Image found here.