Functional Health Hyperlipidemia Treatment without Traditional Medications

Shared foundation (2026 guideline)

The 2026 ACC/AHA/Multisociety Dyslipidemia Guideline (Circulation/JACC, 13 Mar 2026) replaced the 2018 guideline. Care here uses PREVENT-ASCVD risk estimation, a once-in-a-lifetime Lp(a), ApoB when it adds clarity, LDL goals matched to risk, screening for secondary causes, and lifestyle as the foundation. Lipids are typically rechecked 4–12 weeks after a change.

Foundations first

• Portfolio-style eating pattern emphasizing plants, soluble fiber, and replacement of saturated fat
• Soluble fiber (for example oats, barley, psyllium, beans) as a daily habit
• Plant sterols/stanols when appropriate as part of food or supplement strategy
• Resistance training and aerobic activity matched to your capacity
• Sleep, alcohol moderation, and weight management as lipid-relevant lifestyle pillars

Supplement considerations (not FDA-approved treatments)

• Berberine — discussed case-by-case for metabolic and lipid support; watch interactions and tolerability
• Bergamot — emerging evidence; optional adjunct after discussion, not a substitute for indicated medication
• Nattokinase — optional adjunct after a visit with Dr. Owens; not a substitute for Traditional Hyperlipidemia Treatment (rosuvastatin) or the non-statin medication pathway in ASCVD, familial hypercholesterolemia (FH), or LDL-C ≥190 mg/dL. In the largest clinical series (Chen et al., Frontiers in Cardiovascular Medicine, 2022; n=1,062), 10,800 FU/day for 12 months was associated with about 18% lower LDL-C, 16% lower total cholesterol, 16% lower triglycerides, 16% higher HDL-C, about 36% smaller carotid plaque among those with carotid atherosclerosis, and lower CIMT; 3,600 FU/day did not lower lipids or slow plaque. Authors suggested roughly 6,000–12,000 FU/day. This was not a randomized controlled trial — these are associated findings from a clinical series, not proof that nattokinase prevents heart attack or stroke. Safety: fibrinolytic; do not combine with warfarin, a DOAC, or dual antiplatelet therapy unless Dr. Owens has cleared it; hold before procedures; not for active bleeding, recent stroke or surgery, or pregnancy. Not FDA-approved to treat hyperlipidemia.
• Omega-3 fatty acids — used primarily for triglycerides, not as an LDL-lowering strategy

What we do not use in this pathway

• Red yeast rice — not recommended in this protocol
• Niacin as a cardiovascular risk-reduction drug — not used for that purpose here

Workup labs (examples)

• Fasting or non-fasting lipid panel as clinically appropriate
• ApoB when particle burden clarifies risk beyond LDL-C
• Lp(a) once in a lifetime (or if never documented)
• TSH, A1c/glucose, liver enzymes, and kidney function to screen secondary contributors
• Additional markers only when they change management

Exit rule

If LDL, ApoB, or overall ASCVD risk remains above agreed goals despite adherence — or if risk is high enough at the outset — we move to Traditional Hyperlipidemia Treatment (rosuvastatin) or the non-statin medication sequence. Lifestyle continues alongside medication when medication is started.

Ordering supplements

There is no matching public Fullscript hyperlipidemia plan for this pathway yet. After enrollment, Dr. Owens can recommend specific products in visit. Use Discuss with Dr. Owens / Enroll rather than self-checkout for this protocol.

Related hyperlipidemia pathways