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Cholesterol
Cholesterol Case Study

Let us talk about a common issue – cholesterol, also known as dyslipidemia. 

I saw a recent case of dyslipidemia in my practice: a 45-year-old man diagnosed with elevated levels of Triglycerides. His doctor had given him three months to address the issue, failing which he would get started on statin. 

He was just 45 years old and was not keen to go down this path of medication. He wanted to try out the functional medicine approach. He had heard about my work from some of my previous patients and came for a consultation. 

I started with a thorough evaluation of his symptoms, lifestyle, and history. He had a family history of heart disease, stroke, and dyslipidemia. He had fatigue, bloating, anxiety, and fluctuating high blood pressure. Though his weight and BMI were normal, his body composition analysis revealed high visceral fat. Based on my initial findings, I suspected a genetic predisposition. I developed a comprehensive functional lab testing plan to identify underlying issues and guide the patient toward better health. Functional lab tests revealed a wide range of potential root causes. These included:

  • Genetic predisposition to dyslipidemia, he was an APOE2 carrier
  • A severe immune reaction to gluten
  • Depleted Omega 3 fatty acids
  • Low testosterone
  • Elevated levels of lead and mercury
  • The presence of harmful intestinal microbes and depleted beneficial microflora
  • Dysfunctional adrenal glands
  • Deficient levels of essential vitamins, minerals, and amino acids
  • High inflammation
  • High cardiac risk factors

Given that he was an APOE2 carrier on his DNA report, my first priority was to work on switching off the genes that predisposed him to dyslipidemia. We know ApoE plays a key role in the transport and metabolism of cholesterol, Triglycerides, and other lipids within many organs, including the brain.

APOE2 predisposes to elevated Triglycerides and LDL, Hyperlipoproteinemia Type III, and insulin and blood sugar concerns. Numerous studies have investigated the relationship between APOE2 and lipid metabolism, unveiling its predisposition to elevated triglycerides and LDL-C.

Apolipoprotein E (ApoE)  is a multifunctional protein involved in the transport and metabolism of cholesterol, triglycerides, and other lipids. It plays a pivotal role in maintaining lipid homeostasis within the body, ensuring the proper functioning of organs, including the brain.

I started his program with epigenetics work, which was based on functional nutrition, lifestyle strategies, and therapeutic supplements needed to “switch off” the genes for cholesterol issues.

His intervention included: 

  • Personalised food plan with therapeutic foods and the right portion size as per his requirements and body composition
  • Reduce saturated fat and trans fat intake; replace with mono-unsaturated fats
  • Moderating intake of carbohydrates, especially refined carbs
  • Increase antioxidant intake from vegetables and other food sources
  • Reduce oxidative stress by decreasing/avoiding alcohol intake and cessation of smoking
  • A personalised exercise prescription with moderate and low-intensity exercises
  • Omega 3 fatty acid  2-4g EPA/DHA as he had high Triglycerides
  • Personlised supplement protocol to help with APOE2

His DNA report also showed IL-1 activity. We know that IL-1α and IL-1β act as potent proinflammatory cytokines at the local level, causing tissue damage and tissue stress.

To address this, I recommended red & purple fruits and vegetables. These are rich in dehydroascorbate, anthocyanins, and  transresveratrol). I encouraged him to eat like the rainbow with phytonutrient-rich food. 

I started him on an anti-inflammatory food protocol, adding Curcumin r & annatto tocotrienols for supplements. 

Working on other issues:

After epigenetics work, we worked on other issues without the need for medications. 

I assisted this patient in reducing inflammation in his body, improving hormonal balance, gut health, detoxification, and replenishing his body with the necessary nutrients. 

Progress and Results

He began to feel better with the changes I recommended, and his cholesterol improved without the need for statins. A little over a month after our first meeting, his triglyceride levels fell from 280 mg/dL to 140 mg/dL. Our epigenetics work, and the recommended nutrition and exercise plan had a significant impact and showed good results. 

8 weeks into the program, his energy levels had gone up dramatically and he was able to progress to a more challenging exercise regime. His inflammation markers had improved significantly. The functional medicine approach to hormonal balance was evident in his results and resolved most of his symptoms. 

Rationale for Epigenetics

The initial detailed consultation revealed a family history of dyslipidemia at an early age. I suspected a genetic predisposition, and his genetic test confirmed the exact genetic SNP for dyslipidemia. My first goal was to use epigenetics work to switch off the responsible gene using the functional medicine toolkit mentioned above.

His recovery hinged on his ability to regulate the transport and metabolism of cholesterol, Triglycerides, and other lipids. Once this was addressed, we could include the necessary vitamins and minerals needed for energy production. Lifestyle and nutrition interventions such as mindfulness-based stress reduction worked beautifully to resolve his issues of anxiety and fatigue. 

Conclusion

It is important to note that every case is different, and identifying the correct root cause is a very important first step in the functional medicine approach. Dyslipidemia or cholesterol is a common issue and is a result of a number of underlying causes. Seek help from a certified functional medicine practitioner if you or someone you know might benefit from this approach.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1684560/

Dr Menka Gupta

IFMCP, MSc, MBBS

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