My Anti-Cholesterol Gameplan

Anticholesterol Gameplan

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:


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.


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:

I also rotated in some of the following:

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.


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:

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.

27 Responses to My Anti-Cholesterol Gameplan

  1. Jim says:

    Great post Caveman.

    Interesting to see you’re leaving NK. How long were you on the diet?
    After 16 – months I left the NK diet a couple of weeks ago due to the flood of data against it. What did I do? I bought Paul Jaminet’s ‘Perfect Health Diet’. I am reading it now and am finding it promising (at least on paper). I have not finished reading the book but he seems to be inclined to believe that one cannot consume too much saturated fats . He also seems to be fearful of eating beans. Maybe he should read your post.


    • BJJ Caveman says:

      Haven’t actually been doing NK for a while. Sometimes I find mind self drifting into the Carb Nite template… most of the time I just eat lowish carbs, probably in the range of 50-100 gm.

      When I do a lot of training (like a 3 hr BJJ session)… I know this pushes me into the keto range. If I don’t train, then this keeps me out of keto.

      So I guess you can say that I’m generally out of ketosis, but I flirt with it occasionally depending on my activity level.

      • Jim says:

        You said in this post that being on the ketogenic diet is what caused your cholesterol numbers to take a turn for the worse. Would you please share with me how that occured? Did it damage your gut flora?
        Sorry for coming in late in the game.

  2. Dale says:

    You might try the tea of Captain Picard: Earl Grey.

    Earl Grey tea is made with black tea and bergomot. For me, drinking green tea is akin to drinking plain hot water.

    • BJJ Caveman says:

      I’ve seen a couple of articles talking about this and the online consensus (take it for what it’s worth) is that the concentration in Earl Grey isn’t enough to have any real effect.

      Again… take it for what it’s worth.

      I think if you tried this tropical green tea, you may like it more!

  3. charles grashow says:

    You might also consider panthetine as well – 600 mgs/day
    Pantethine, a derivative of vitamin B5 used as a nutritional supplement,
    favorably alters low-density lipoprotein cholesterol metabolism in low– to moderate–cardiovascular risk North American subjects: a triple-blinded
    placebo and diet-controlled investigation
    Pantethine, a derivative of vitamin B5, favorably alters total, LDL and non-HDL cholesterol in low to moderate cardiovascular risk subjects eligible for statin therapy: a triple-blinded placebo and diet-controlled investigation

    • BJJ Caveman says:

      It may be worth experimenting with also… but as you can see in the abstract the amount it lowers the cholesterol is on the order of 4-6 mg/dL.

      So in someone like me with an LDL-C of 190, bringing it down to 185 mg/dL is rather negligible.

      But then again any amount can help.

      Is this something you’ve found helpful?

    • BJJ Caveman says:

      Have you noticed any side effects?

      Has it been helpful for you?

      • charles grashow says:

        Well on my last blood test LDL-P was 873 and direct LDL was 67 so I must be doing something right AND I eat full fat dairy, egg yolks, and meat in addition to other foods

        • BJJ Caveman says:

          Since your numbers look so good, have you and your doctor considered cutting back even further on your statin? to 10 mg QOD… or even 5 mg?

          It seems like you now have some wiggle room with which to tinker.

  4. charles grashow says:
    Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins

  5. charles grashow says:

    However – with regard to Berberine
    Berberine Works But May Very Well Be Harmful

  6. Brant says:

    Man, came across your site today. You and I are the same. Work out, eat healthy, but the cholesterol numbers are high. I am in a serious n=1 experiment of my own. I do not want to take statins.

    I will be anxiuosly awaiting to see how these changes affect your numbers. Will be in touch and and visiting the site often going through some old posts. In the meantime, take care.

    • BJJ Caveman says:

      Thanks for the kind words, I’m in the process of putting together my next post, so keep an eye out later this week or early next week!

  7. Fung Yen says:

    The game plan is in the right direction, but I have some comments :
    Number one is watch your diet; no saturated fat, follow the Paleo diet, no carb (means no beans) , no fried, BBQ, chemical processed food; one step further, try no meat (beef, pork, chicken…) for a while.
    No need to buy these supplementations; one of my doctor friends told me that most of them got washed out of your body in less than one day, need vitamin D ? go out and get tan.
    Probiotics looks ok but why not just have yogurt, instead.
    For Omega 3, please see Dr. Michael Greger lecture on Youtube
    Medications have side effects, if they can only make it not to go worse but not to cure it, in the long run the medications will damage your liver and kidney. After you take the medications you still need to watch your diet, logically, why take it ?
    Good luck and see the result in a couple of months.

  8. Raphi Sirt says:

    Hi BJJ Caveman,

    I would discourage you from focusing on LDL-c or LDL-p directly.

    Instead, I’d go for what matters most which, uncontrovertibly at this point, is insulin resistance: get a 2hr OGTT with insulin assay & focus on how circadian timing of light & food cues in addition to food macros & micros can bring you down to a euglycemic pattern.

    With all due respect, it’s time do graduate from the cholesterol/Dr.Dayspring rabbit hole & start considering some much better hypotheses.

    Best of luck!

    • BJJ Caveman says:

      “Their Fasting Insulin is a far too noisy variable also – it only gave solid diagnosis when >30 μU/ml. You need to be 3-5 μU/ml to be in safe haven from the fire.”

      My fasting insulin has been less than 5, so according to him I’d be in the safe zone wouldn’t I?

      And let’s suppose I went with an OGTT and insulin assay and they confirmed that I’m absolutely insulin resistant… What would I do differently?

      Eat low carb. Move more. Lift more weights. Sleep better. Things I’m doing now or am trying to do, so the results of the test wouldn’t really change anything for me.

  9. Chris says:

    Good luck with your plan! For me personally, I had rapid success bringing my cholesterol down to normal with #1 and #3 alone – lowish carb but not ketogenic Perfect-Health-Diet with more olive oil and less butter. I actually wonder if #3 would have done it without #1 – I’ve been eating a little more butter than I had been, just to see… I love me some saturated fat lol

    • BJJ Caveman says:

      I know for me, just doing #3 alone didn’t help much since I did a series of cholesterol tests while varying the degree of my low carb intake, and it didn’t make much of a difference.

  10. Eric says:

    What are your thoughts on replacing animal saturated fat with plant-based saturated fat? Do you think it would make a difference or do you favor across-the-board saturated fat limitations? Also, how important are the probiotics? Do you think it really matters to have those three specific brands or would a cheaper alternatives get the job done? And one more question, what carbs are you eating?

    I just got my labs back. My labs were basically identical to yours following a ketogenic diet. Everything went from perfect to horrendous. I lost a lot of weight and felt great but the numbers were atrocious. Slowly beginning to heal from the last year of weight loss and ketogenic experiment. My particle count has come down from 2800 to 1800 by making a conscientious effort to eat more carbs and stay out of ketosis but still have consumed significant amounts of animal base saturated fats. I’ve been on a pretty consistent probiotic regimen but have not been doing any of the prebiotics. I will start incorporating that in a little bit more. I would like to try the coffee free thing but that terrifies me! I’m guessing that my 8 cups a day probably isn’t healthy no matter how you look at it.

    • BJJ Caveman says:

      Plant based saturated fats… like avocados and coconut oil?

      I’m not sure how I feel about it yet. I’m still experimenting with things, so right now I’m just cutting it all back.

      I also wish I knew how important the probiotics were… at this point I’m can’t say what’s important or not.

      I think VSL3 is a good brand because of the research I’ve read on it, not many other brands can say they have available peer reviewed papers behind them.

      I’m not as sure on Prescript Assist or the primadophilus reuteri, haven’t found research… but haven’t looked either.

      Carbs I’m eating are mainly berries, potatoes, rice… and some occasional cheats here and there like ice cream.

      Hopefully you’ll be able to figure things out too! Keep us posted on how things go for you.

  11. Fung Yen says:

    I recommended you a doctor lecture on Youtube before;
    to get Omega 3 try flax seeds if you don’t like fish.
    you can watch many flax seeds benefits on Youtube.

    Stop putting un-natural stuff in your body.

    • BJJ Caveman says:

      It’s interesting that you say this, because all of the supplements I’ve been taking are actually pretty natural… although the benefits of the term ‘natural’ are actually controversial.

      Magnesium is natural.

      Probiotics are natural.

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