Functional Nutrition Intervention Protocols
DYSLIPIDEMIA
SSESSMENT
Anthropometrics
Biomarkers/Labs
Conventional
Height, weight, BMI
Waist circumference, hip circumference, waist-to-hip ratio
% body fat, % lean body mass
Fasting Lipid Panel: TC, LDL-C, HDL-C, TG
Emerging Biomarkers for CVD risk: expanded lipid profiles
that include: LDL-C pattern size and density, particle
number, lipoprotein(a), apolipoproteins (apoA1 and
apoB100 being the most useful); C-reactive protein.
Homocysteine and Vit D.
If elevated Triglycerides: HgbA1C, fasting glucose and insulin
RBC Magnesium, MMA, Vitamin B12
Functional
RBC fatty acids, Omega 3 Index. Organic Acids,
Nutrigenetic
APOE 1,2,3, 4, CETP, SELE, MTHFR,
Clinical Indicators
Nutrition-focused physical exam
Diet/Lifestyle Histories
Comprehensive intake form
Medical Symptom Questionnaire
Dyslipidemia/Hyperlipidemia, including hypertriglyceridema
and cardio-metabolic syndrome
IAGNOSIS
NTERVENTION
Core Food Plan
Choice of 3: balanced (50/20/30), fat-controlled (60/20/20),
or carb-controlled (40/30/30) based on patient’s needs
Food Plan Modifications
LDL-C - lowering- Fat-controlled core food plan
HDL-C - raising- Balanced core food plan with appropriate
Lipid Management therapeutic modifications (see chart)
Triglyceride-lowering - Carbohydrate-controlled core food
plan with 2-4 g/day omega-3 fish oil
Functional Foods/Medical Foods
Nuts – 30-50 g/day or 1-2 oz/d, ↓TC, LDL, TG; ↑HDL
Oats - ≈1 cup/d supplies 3 g beta-glucan), ↓LDL
Plant sterols/stanols - 2 g/d found in some enhanced
margarines and orange juices and supplements↓LDL.
Pomegranate - 40 g or 1.5-2 oz per day, ↓LDL
Soy - 25 g/day when substituted for animal protein, ↓TC
and LDL, isoflavones may ↑ HDL
Sesame- 40 gms/d ↓LDL
Dyslipidemia
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Functional Nutrition Intervention Protocols
Dietary Supplements
Vitamins
High quality daily multivitamin with minerals
Niacin(nicotinic acid) 1.5-3 g/d, ↓TC, LDL, TG ↑HDL.
Folic acid, B12 and B6 in therapeutic levels beyond what a
multivitamin can provide if elevated homocystiene.
Pantethine(not pantothenic acid)-300mg TID or 450mg BID
↑HDL. Peak effect at 4 mo. But may take up to 6-9 months.
Magnesium- 200-400 mg/d; encourage foods sources of
magnesium and supplement with a glycinate or citrate
form if more is needed beyond multivitamin. Monitor
blood levels ( RBC magnesium).
Chromium – GTF form-polyniacinate-200-800 mcg/d
Red Yeast Rice, up to 2400 mg/d to↓TC, LDL, TG; ↑HDL
CoQ 10, 100-200 mg/d, especially if on statin drug therapy
Fish oils, 3-4 g/d to ↓TG
Psyllium fiber, 7 g/d to ↓TC, LDL, TG
Polycosinol- 10 mg BID ↓TC, LDL, TG, ↑HDL
EPA/DHA -3/2 ratio,3-4 gms/d. Balance with GLA 50-90 % of
total EPA/DHA and add mixed tocoph. Vit E- 100-200 IU/d.
Minerals
Nutritionals
Botanicals
Artichoke extract, 1800 mg per day to ↓LDL
Food/Medication/Dietary
Supplement Interactions
Lifestyle Recommendations
Physical Activity
Caution re high dose niacin therapy and Red Yeast Rice on
liver function. Monitor liver enzymes.
Daily activity, as tolerated, preferably outdoors (sunshine)
30 min aerobic exercise most days and increase intensity
and duration to support ↑ HDL-C
Sleep
Full complement, as determined for individual patient
Psycho-social
Encourage social connections, activities that are meaningful
and pleasurable for the individual. Smoking cessation
benefits ↑HDL
ONITORING and
Follow-up Plan
Dyslipidemia
VALUATING
Periodic contact by functional nutrition practitioner
Return to clinic in 6 weeks to 12 weeks; more often if weight
management is needed.
Periodic contact by functional nutrition practitioner
Return to clinic in 6 weeks to 12 weeks ; more often if
weight management is needed.
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Functional Nutrition Intervention Protocols
References
Red Yeast Rice
Heber D, Yip I, Ashley JM, et al. cholesterol-lowering effects of a proprietary Chinese red-yeast rice dietary
supplement. Am J Clin Nutr. 1999;69:231-6.
Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary
supplements: implications of variability in chemical profile and contents. J Altern Complement Med.
2001;7:133-9.
Liu J et al. Chinese red yeast rice for primary hyperlipidemia: a meta-analysis of randomized controlled
trials. Chin Med. 2006 Nov 23; 1:4.
Magnesium
Davis WH, Leary WP, Reyes AJ, Olhaberry JV. Monotherapy with magnesium increases abnormally low high
density lipoprotein cholesterol: a clinical assay. Curr Ther Res. 1984;36:341–6.
Nozue T, Kobayashi A, Uemasu F, et al. Magnesium status, serum HDL cholesterol, and apolipoprotein A-1
levels. J Pediatr Gastroenterol Nutr. 1995;20:316–8.
Soy
Baum JA, Teng H, Erdman JW Jr, et al. Long-term intake of soy protein improves blood lipid profiles and
increases mononuclear cell low-density-lipoprotein receptor messenger RNA in hypercholesterolemic,
postmenopausal women. Am J Clin Nutr. 1998;68:545–51.
Teixeira SR, Potter SM, Weigel R, et al. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood
lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr. 2000;71:1077-84.
Niacin
Brown WV. Niacin for lipid disorders. Postgrad Med. 1995;98:185–93.
Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels
of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med.
2000;160:1177–84.
McKenney JM, Proctor JD, Harris S, et al. A comparison of the efficacy and toxic effects of sustained- vs
immediate-release niacin in hypercholesterolemic patients. JAMA. 1994;271:672–7.
Knopp RH, Ginsberg J, Albers JJ, et al. Contrasting effects of unmodified and time-release forms of niacin on
lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin. Metabolism. 1985;34:642–
50.
Gray DR, Morgan T, Chretien SD, et al. Efficacy and safety of controlled-release niacin in dyslipoproteinemic
veterans. Ann Intern Med. 1994;121:252–8.
Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin.
Am J Med. 1992;92:77–81.
Omega 3 Fish Oil
Dyslipidemia
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Functional Nutrition Intervention Protocols
Lavie CJ, Milani RV, Mehra MR, et al. Omega 3 polyunsaturated fatty acids and cardiovascular diseases. J
Am Coll Cardiol. 2009;54:585-94.
Nuts
Jenkins DJ et al. The portfolio diet for cardiovascular risk reduction. Curr Atheroscler Rep 2007;9(6):501507.
Oats and Psyllium
Romero AL, Romero JE, Galaviz S, et al. Cookies enriched with psyllium and oat bran lower plasma LDL-C in
normal and hypercholesterolemic men from Northern Mexico. J Am Coll Nutr. 1998;17:601-608.
Pomegranate
Esmaillzadeh A, Tahbaz F, Gaieni I, et al. Concentrated pomegranate juice improves lipid profiles in diabetic
patients with hyperlipidemia. J Med Food. 2004;7:305-508.
Dyslipidemia
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