The Functional Medicine Approach to High Cholesterol

The Functional Medicine approach to high cholesterol differs significantly from the ‘conventional’ approach. The conventional approach involves the prescription of a statin, which treats only the symptom of high cholesterol. The Functional Medicine approach looks towards the underlying causes of high cholesterol and how they can be treated.

We know that, for around 75% of the population, the amount of cholesterol we eat has little impact on the cholesterol in circulation in the body. The liver is responsible for making most of the cholesterol in circulation. The majority of this cholesterol doesn’t originate from the food we eat.

The other 25% of the population may be hyper-responders to dietary cholesterol. In there case, we still start by looking at the possible causes of high cholesterol we discuss in this article. If we still aren’t seeing improvement after addressing possible causes, we may then move to more of a lower fat Mediterranean diet which emphasises mono-unsaturated fats, such as olive oil, rather than saturated fats.

Underlying Causes of High Cholesterol

The most common causes of high cholesterol include

  1. Metabolic dysfunction which includes high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels
  2. A hidden source of inflammation in the body, such as obesity, the gut or a latent viral infection
  3. Low thyroid function

There are calculators that assess a number of cardiovascular risk factors. The Reynolds Risk Score, for example, uses a marker of inflammation called C-reactive protein and systolic blood pressure in addition to age, total cholesterol, HDL cholesterol, and family history to determine the 10-year risk of heart disease expressed as a percentage.

In Australia, Nutripath offer a number of tests to measure markers for cardiovascular risk, including the size of the LDL subfractions (which is important as the small dense particles are most problematic as they cause more damage when they slam into the side or arteries causing inflammation). It also measures inflammation in the body through a high sensitivity CRP marker.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include raised blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

The three pillars that support improvements in metabolic health are diet, movement and sleep. Addressing these pillars will also reduce inflammation in the body and help achieve a healthy body weight and body composition.

A 2010 study suggests that sticking to the recommendations for daily intake of vegetables, fish, fruit, and fatty acid composition may reduce the cardio-vascular disease risk by 20-30% and result in approximately one extra year of life for a 40-year-old individual. The Mediterranean diet or the Institute of Functional Medicine’s Cardio-Metabolic food plan provide effective templates to improve metabolic health.

The Mediterranean diet is also an anti-inflammatory way of eating. A template for an anti-inflammatory diet would include:

  • Fatty fish high in omega-3 fatty acids at least twice a week (trout, salmon, sardines, anchovies, mackerel)
  • Olive oil for sautéing and in salad dressings
  • Liberal use of anti-inflammatory spices – like turmeric, ginger, cayenne, cinnamon, clove, sage, and rosemary
  • Plenty of green, yellow, and orange vegetables
  • Dark red, blue, and purple berries

In addition, fibre such as psylium husk can lower cholesterol as it escorts bile out of the gut, rather than the bile being re-absorbed. The liver is then forced to produce more bile, which uses cholesterol in its synthesis. Technically, as the liver has an increased requirement for cholesterol, it increases its number of LDL receptors. These receptors then bind to cholesterol in the blood stream, and circulating LDL cholesterol is therefore reduced.


Research has shown that only about 50% of the people who have heart attacks have high LDL cholesterol. Inflammation seems to be the reason why the other 50% with low LDL still have heart attacks. Inflammation can be measured through C-reactive protein (CRP), a by-product of inflammation. Indeed, the New England Journal of Medicine journal (2002) concluded that CRP outperforms LDL cholesterol as a predictor of cardiovascular risk.

Inflammation can be the result of a gut infection, such as H Pylori, heavy metals or mold in the body, or even a latent viral infection. In fact, every chronic disease has some degree of inflammation associated with it. Therefore, it’s critical to find and address these sources of inflammation in order to reduce cardio-vascular risk.

Diet, which we have already discussed, maintaining a healthy weight, regular exercise, good sleep and targeted supplements such as curcummin and Vitamin C can all keep the fire of inflammation under control.

Low Thyroid Function

Low thyroid function is often associated with elevated cholesterol, and it doesn’t need to be overt hypo-thyroidism – it can just be a slightly under active thyroid. In fact in the 1980s and earlier, before Statins were in widespread use, doctors often used thyroid hormones to treat high cholesterol, even with normal thyroid numbers. It’s always worth having your thyroid checked in the case of elevated cholesterol.