Introduction

Dyslipidaemia means that you have abnormal levels of lipids (or fats) in your blood. Having high blood lipid levels can damage the lining of your blood vessels, cause chronic low-grade inflammation, lead to plaque deposits in your arteries and reduce your body’s ability to use insulin (which will lead to you having high blood sugar). As a result of this, dyslipidaemia doubles your risk of cardiovascular disease.¹

There are many causes of dyslipidaemia; however, the most common include the following:

• Unhealthy diets
• Being overweight or obese
• Having high cholesterol that runs in your family
• Having diabetes

If you have dyslipidaemia, changing your diet (and possibly taking supplements) could help you achieve normal lipid levels. This is because there is scientific evidence to show that specific diets and supplements can target the pathways that cause abnormal blood lipid levels. 

The basics of dyslipidaemia

Lipids are fats that have essential functions in your body. When we speak of dyslipidaemia, we are generally referring to abnormal findings in a lipid profile (which is a blood test that your healthcare practitioner will order).

High LDL cholesterol

If your low-density lipoprotein cholesterol (LDL) levels are too high, this may cause plaque to build up in your arteries. This buildup risks making your arteries narrow, and this is a cause for heart disease. This is why LDL is sometimes referred to as “bad” cholesterol. 

Your doctor will generally advise you to keep LDL below 2.6 mmol/L.

Low HDL cholesterol

High-density lipoprotein cholesterol (HDL) picks up extra cholesterol in your blood and carries it to your liver, where it is flushed from your body in your stool. HDL also has anti-inflammatory properties.

A HDL reading of less than 1.0 mmol/L for men and 1.2 mmol/L for women is considered low and may indicate an increased risk of cardiovascular disease. 

High triglycerides

Triglycerides are fats in the blood, and elevated levels are generally caused by diets that are high in sugar, saturated fat and simple carbohydrates.

It is generally considered best for cardiovascular health to keep your triglycerides below 1.7 mmol/L.

High Apolipoprotein B 

Apolipoprotein B (ApoB) is a protein found in LDL. It is measured because it shows the number of harmful cholesterol-carrying particles. 

If your ApoB is higher than 1.3 g/L, you may be at increased risk of heart disease.

Dietary patterns for dyslipidaemia

Changing what you eat has the potential to regulate your blood lipid levels, even without using medications like statins.² Some of the diets that show promise in scientific research include:

• Mediterranean diet
• Portfolio diet
• DASH diet
• Ketogenic diet
• Vegetarian and vegan diets

Mediterranean diet

The Mediterranean diet is one of the most studied diets and is associated with many health benefits.³ Fruits, vegetables, legumes, wholegrains, and olive oil form the basis of the diet. This is then followed by avocado, nuts, seeds and olives. Dairy, eggs, fish and white meat can be eaten a few times during the week, but red meat should only be eaten occasionally. The Mediterranean diet also includes some alcohol, in the form of red wine.

Studies show that the Mediterranean diet has a beneficial impact on blood pressure, dyslipidaemia, inflammation, oxidative stress, and the buildup of plaque in the arteries.⁴

A scientific review showed a 39% and 33% reduction in cardiovascular disease and stroke risk, respectively, with the Mediterranean diet.⁵ This is a higher reduction compared to that demonstrated by statins, which are usually prescribed to regulate blood lipid levels.

Portfolio diet

The Portfolio diet emphasises a high intake of soy beans and legumes, which makes it mostly a plant-based diet. The diet reduces foods from animal sources, particularly red and processed meat, high-fat dairy, and eggs. This means it is naturally low in dietary cholesterol, which may raise LDL cholesterol in the body.

The diet also emphasises a high intake of viscous fibre. Viscous fibre is important as it binds to bile acids, which carry fats from your small intestine into the large intestine, where they are excreted in your stool. This causes your liver to produce more bile acids. This process requires cholesterol. If your liver doesn't have enough cholesterol, it takes it from the bloodstream, thereby reducing your circulating LDL levels. 

The diet is naturally high in plant sterols, which help limit the amount of cholesterol the body can absorb. These are high in nuts, seeds, vegetables, legumes and wholegrains.

In research, the Portfolio diet has been associated with a 14% lower risk of cardiovascular disease. This is because it was associated with more favourable lipid profiles and lower levels of inflammation.⁶

DASH diet

The Dietary Approaches to Stop Hypertension (DASH) diet was initially designed to help control blood pressure but has since also been used for dyslipidaemia. This diet focuses on the consumption of lean proteins (like fish), lots of fruits, complex carbohydrates, low-fat dairy products, and foods low in unsaturated fats (like olive oil). It is essential to limit red meat and foods that are high in sodium (salt). 

Research shows that LDL levels are reduced on the DASH diet, but it does not seem to positively impact HDL levels or lower triglycerides.⁷

Ketogenic diet

A ketogenic diet is a low-carbohydrate, high-fat, moderate-protein diet that leads to the production of ketone bodies by mimicking a fasting state. The body then burns ketones for energy instead of glucose from carbohydrates.

Most research indicates that reducing carbohydrate intake lowers triglyceride and total cholesterol while increasing HDL levels. A ketogenic diet can increase LDL particle size, which may lower the cardiovascular disease risk associated with smaller, more harmful LDL particles.⁸

Vegetarian and vegan diets

Plant-based diets are diets with low or no intake of animal products. Whilst many vegetarian diets may still include dairy products and eggs, vegan diets avoid all animal products, including honey.

Research shows that eating a vegetarian or vegan diet generally reduces blood levels of LDL cholesterol. However, it is difficult to ascertain whether this improvement has been due to weight loss or the impact of the diet on blood lipids. In the case of vegetarian or vegan diets, it does seem as though treatment with statins is superior in reducing lipid and lipoprotein levels.⁹ 

Nutraceuticals and supplements

Whilst dietary changes can positively impact the degree of dyslipidaemia, they can be hard to maintain long-term. As a result of this, there is increasing interest in nutraceuticals and supplements that positively impact blood lipid profiles in the following ways:

• Lower the amount of cholesterol absorbed in your intestines
• Lower the amount of cholesterol synthesised by your liver
• Increase your excretion of LDL

Plant sterols and stanols

Plant sterols are present in almost all vegetable sources (in particular in vegetable oils, nuts, seeds and legumes) and are structurally similar to cholesterol. Due to this similarity, they can compete with animal cholesterol and help lower your cholesterol level. They can reduce LDL levels by 12% with intakes of approximately three grams per day.¹⁰ For these therapeutic dosages, it is much easier to take a plant sterol in a nutraceutical form.

Soluble fibre supplements

Soluble fibres decrease the rate at which food moves from the stomach into the small intestine and therefore delay the absorption of cholesterol from your diet. This delayed emptying also restricts the amount of glucose entering the bloodstream, thereby regulating insulin levels. This is important because insulin resistance is associated with increased cholesterol synthesis. Soluble fibre supplementation improves serum triglycerides, total cholesterol, LDL cholesterol, and Apo-B concentrations. 

Ideally, to achieve positive results with soluble fibre supplements (e.g., psyllium), a dosage of 15 grams per day is needed.¹¹

Red yeast rice

Red yeast rice is a nutraceutical obtained by the fermentation of a yeast (in general, Monascus purpureus) in white rice. This yeast enriches the rice with a complex of substances (one of which is called monacolin K) that have the ability to lower blood lipids. Monacolin K lowers cholesterol by blocking an enzyme called HMG-CoA reductase, which your body uses to make cholesterol.¹²

There have been some safety considerations with the use of red yeast rice due to levels of citrinin, a mycotoxin metabolite derived from the fermentation of Monascus. Mycotoxins are poisons that can cause diseases. As such, it is important to only use red yeast rice products from reputable companies.

Berberine

Berberine is a natural compound found in plants. It is often used in traditional Chinese Medicine and may be beneficial in many chronic conditions, including diabetes and heart disease. Berberine reduces the intestinal absorption of cholesterol, increasing its excretion through your stool. It also promotes liver cholesterol turnover.¹² Research shows that Berberine may have potent anti-inflammatory effects.

Dosages vary amongst research studies, but generally start at 600mg per day.

Green tea extract

Green Tea is rich in compounds that have been shown to reduce both LDL and total cholesterol levels.¹³ It does this by reducing absorption of cholesterol in the gut as well as inhibiting HMG-CoA reductase (the enzyme the body uses to make cholesterol).

Positive benefits are seen at dosages from 250 mg to 1200 mg of green tea extract per day. Although green tea extract is generally well tolerated, high dosages can lead to deficiencies of iron and folate (two important micronutrients). 

Omega-3 fatty acids

Omega-3 fatty acids are unsaturated fats that have many positive effects on health. Research shows that taking omega-3 fatty acids can help reduce triglyceride levels. Some of the ways they do this are by decreasing the activity of enzymes that help make triglycerides and increasing the breakdown of fats for energy, as well as reducing the body’s own fat production.¹²

Research showing positive benefits is centred around DHA (Docosahexaenoic acid) and EPA (Eicosapentaenoic acid) at dosages of between two and four grams per day.

Summary

Both nutritional approaches and supplements seem to hold promise when it comes to managing dyslipidaemia. However, with any interventions like this, it is advisable to seek individualised counselling. Biochemical individuality (the different ways that our genes, diet and lifestyle interact with the environment) means that what works well for one person may not have the same therapeutic effect for the next. It may be necessary to combine different diets and supplements to achieve the best outcome. Ultimately, though, nutritional approaches show real promise and should form an integral part of any intervention to regulate lipid levels and reduce the risk of chronic disease.