What your doctor isn’t telling you about high cholesterol and IBS: The gut-heart connection

Fun fact: My former doctor tried to put me on a statin (cholesterol-lowering drug) when I was 26 years old. My cholesterol had skyrocketed from 150ish to over 300 since the last time it was checked. Being a registered dietitian already by that time, I felt ashamed, and didn’t tell many people! 

She tried to convince me that this new high cholesterol was “genetic” and that there was nothing I could do about it from a nutritional standpoint, especially because I was so young and already eating healthy. She was pushy, insistent, and even tried to scare me with statistics about heart attacks. 

(Spoiler alert: I opted not to take my doc’s advice about the statin. I knew in my gut – pun intended – that there had to be more to this story.) I ate very healthy, but was still on my gut-healing journey at the time. I went on to uncover the bigger picture of the gut-heart connection, and I was able to normalize my cholesterol numbers naturally over the next 3-6ish months.

Now, as an integrative gut health dietitian and former IBS sufferer, it scares me to think about how many in my situation probably would have just taken the statin… because most people don’t know what they don’t know about the gut-heart connection (including most doctors).

• Important Disclaimer: to be clear, I’m NOT telling you to stop taking a statin drug if you already take one, or to not listen to your doctor’s advice. Stay with me though!

“…if the blind leads the blind, both will fall into a ditch.” –Matthew 15:14, NKJV 

In my nutrition clinic, where we treat people with irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD) and sucrase-isomaltase deficiency, high cholesterol is something we see often. 

Let’s chat about why high cholesterol and gut issues are correlated– so YOU (or your clients, if you’re a fellow healthcare provider) can make more informed choices in cases where you’re seeing the two go hand-in-hand.

Disclaimer: This article was written to educate you, and should not replace medical or dietary advice from your healthcare providers.

Affiliate disclosure: This article contains several affiliate links*.

Let’s talk about cholesterol

Cholesterol 101

Cholesterol is a waxy, fat-like substance that’s actually super important for our bodies. It’s found in every single cell and helps build strong cell membranes, make key hormones (like estrogen and testosterone), and even support digestion (it’s used by our liver to make bile acids which help emulsify and digest fats). 

It travels through our bloodstream in little packages called “lipoproteins”…

Low density lipoproteins, aka LDL (often nicknamed “bad” cholesterol) delivers cholesterol to where it’s needed, but too much can start building up in our arteries. 

On the flip side, HDL (the “good” cholesterol) acts like a cleanup crew, scooping up extra cholesterol and bringing it back to the liver to be removed. 

When things get out of balance—especially with high LDL—it can contribute to plaque buildup, raising the risk for heart issues over time.

Omega-check

IMO, not enough practitioners are talking about the importance of the omega-6 to omega-3 fatty acid ratio in our diet– and in our blood.

• Omega-6’s are the fats found in other types of nuts, seed oils, peanut oil, and soybean oil. (One of these days, I’ll unpack the whole seed oil debate happening at this time in the nutrition and health industry!)
• Omega-3’s are the essential, anti-inflammatory, healthy fats found in foods like fatty fish (salmon, tuna, sardines, etc.) and certain types of nuts and seeds (walnuts, flax seeds, chia seeds, etc.).

It’s considered “optimal” to have an omega-6:omega-3 ratio of 4:1, in the United States. However, most Americans have an alarmingly high omega-3 to omega-6 ratio closer to 20:1. (1)

This impacts your inflammatory response which impacts cholesterol levels more than you may have been led to believe.

Cholesterol and inflammation

Here’s where it gets really interesting: inflammation (especially the low-grade, chronic kind) is actually a contributing factor to high cholesterol. 

Ongoing inflammation can mess with how well HDL clears cholesterol out, make LDL more likely to get “damaged” (oxidized), and fuel plaque formation in our arteries.

Gut health and high cholesterol: considerations

Dysbiosis and endotoxemia

Virtually everyone I’ve worked with who has IBS or another type of digestive disorder has turned out to have some degree of dysbiosis, a state of imbalance in the gut microbiome. (Quick review: this is the ecosystem of microbes – bacteria, fungus, protozoa – living in your gut, mostly in the colon!)

A healthy gut microbiome helps keep cholesterol levels low, in various ways (2):

1. Healthy gut microbes (probiotics) can help alter the reabsorption rate of bile acids in a way that helps keep cholesterol levels optimal
2. Probiotics make short-chain fatty acids (postbiotics) like butyrate, which help inhibit cholesterol synthesis in the liver
3. Probiotic gut microbes can regulate gene expression related to cholesterol metabolism
4. Healthy probiotic microbes can convert cholesterol to another substance called coprostanol

On the other hand, people with dysbiosis (a major underlying root issue in most IBS cases) are more likely to have high cholesterol, because of a pro-inflammatory endotoxin called lipopolysaccharides (LPS) which get produced by certain types of dysbiotic (unhealthy, abnormal, unfavorable) microbes in their gut (2). 

SIBO

About 38% of people diagnosed with IBS have tested positive for small intestinal bacterial overgrowth (SIBO), a gut condition in which microbes have migrated from the large intestine up to the small intestine– triggering a slew of unwanted IBS symptoms (3). 

Research is now uncovering that people with SIBO may be at increased risk of having high cholesterol, possibly due to the underlying inflammatory nature of SIBO (4). 

For example, many people with SIBO are at increased risk of developing endotoxemia, a state in which LPS (inflammatory endotoxins released by the bacteria) migrate and “leak” through the gut barrier into the bloodstream, wreaking havoc and– you guessed it– raising blood levels of cholesterol (2).

IBD

In my clinic, many people who come to us initially thinking they have IBS actually have a type of inflammatory bowel disease (IBD) such as Crohn’s disease (CD) or ulcerative colitis (UC).

According to a 2023 review, cardiovascular diseases (and high cholesterol) are more prevalent in folks with IBD compared to the general population, specifically because of factors such as “chronic inflammation, oxidative stress, altered platelet function, endothelial dysfunction, hypercoagulability, gut dysbiosis, and drug-related side effects.“ (5) 

TLDR: Getting inflammation under control is a key component of keeping cholesterol levels in check, in cases of IBD.

Adult-onset sucrose intolerance

If you have adult-onset sucrose intolerance, this could have been acquired by a case of SIBO or IBD left untreated for too long. I often see my clients with sucrase-isomaltase deficiency present with high cholesterol, and I think it’s all connected. 

Work with your healthcare providers to identify the underlying root cause of the sucrose intolerance, and you’ll likely find that SIBO, celiac disease or IBD are the source of inflammation.

Gut health diets and cholesterol 

Many restrictive diets such as Paleo, GAPS, specific carbohydrate, low sucrose/low starch, Whole30, keto, and even the carnivore diet tend to be higher in fat, since certain sugars and starches/grains are restricted.

For example, while I was still in the trenches of navigating IBS, I followed a diet called the “Gut and Psychology Syndrome” (GAPS) diet – a type of IBS diet very similar to the Paleo diet, plus or minus a few foods. 

Symptom-wise, I was feeling GREAT at that time. (I had removed all the primary food sources of fungal overgrowth and dysbiosis, which followed too many rounds of antibiotics, plus a perfect storm of too much stress, added sugar, and alcohol.)

However, hindsight is 20/20: My downfall on GAPS was eating a little too much saturated fat from red meat, animal fat, and ghee! This was a blind-spot. Otherwise I was eating boatloads of fruits and veggies, and no refined sugar. I was batch cooking, making and drinking copious amounts of bone broth, and keeping up with lots of homemade fermented probiotic foods.)

I also will admit wasn’t exercising enough at that time, due to feeling overwhelmed by and prioritizing the food prep (juggling alongside working fulltime, socializing, and being in a committed relationship).

Similarly, many of my clients with sucrase-isomaltase deficiency (which often gets misdiagnosed as IBS) also notice their restricted diets tend to be higher in fat, due to their limited oral tolerance to certain sugars and starches.

Gene variants

In my nutrigenomic training, I also eventually uncovered I have an APOE gene variant.

People with an APOE gene variant will be more susceptible to high cholesterol and other inflammatory states, if eating a diet too high in saturated fat, ultra-processed foods, and/or not staying physically active.

Fortunately with some simple tweaks to my routine I was able to get my cholesterol back down into the normal range.

What I did

(Disclaimer: these things worked for me, but they don’t work for everyone with IBS or other gut issues.)

I continued eating plenty of Jenna-friendly fruits, veggies, avocado, and Jenna-friendly nuts to feed the probiotics in my microbiome, crowding out the dysbiosis. I continued limiting my sources of added sugar to raw honey and dates, and some occasional real maple syrup (making my gut less hospitable to dysbiosis and fungal overgrowth).

For functional foods, I also continued eating lots of probiotic fermented foods and drinking bone broth to support my gut biome and gut lining.

On the other hand, I drastically reduced my red meat intake down to a few times a month- I was no longer anemic so I didn’t need or crave as much meat.

I upped my intake of chicken, turkey and fish), reduced the portions of ghee and replaced animal fat for cooking with olive oil and avocado oil. (These were things I used to do prior to the GAPS diet, as a dietitian. But during this season of the journey, I was following the guidance of Dr. Natasha Campbell McBride, founder and creator of the GAPS diet.)

Lastly, I got back into my old exercise routine (with help from a personal trainer to hold me accountable for the first 3 months) and outsourced some of the cooking by investing in ready-made broths, and making some budget tweaks (no cable for a few years!) to account for the increased grocery expenses.

What can be done about high cholesterol with IBS? (General best practices)

Diet

Even on a modified diet, make sure to still include you-friendly fruits and veggies (for antioxidants and fiber) as well as omega-3 food sources and/or supplements, and other healthy fats like olive oil and avocado (as tolerated) in your diet to help keep cholesterol at bay.

I also recommend leaning more towards lean proteins (don’t make red meat, bacon or sausages a staple in your day-to-day routine).

(If you want some guidance on how to make this happen, consider checking out our 7-day low FODMAP meal plan or 7-day low sucrose meal plan for inspiration, examples, and ideas – or apply for our 1-1 services for more customized support!)

Lifestyle

As we cover in our upcoming Holistic Gut Repair Foundations online course, getting enough exercise, good quality sleep, and reducing/managing stress are key but often overlooked elements of setting your body up for success on your gut-healing journey. Please don’t skip these things! 

Supplements

The following plant extracts and supplements may help reduce inflammation and/or cholesterol naturally, while also holistically supporting your gut microbiome and/or gut lining:

• Turmeric (6)
• Pomegranate extract / organic pomegranate juice powder (7)
• Ultra InflamX (for IBD)
• Green tea (8)
• Omega-3 fish oil (9)
• Organic garlic tincture* (low FODMAP) (10)

Make sure to consult with your healthcare providers as needed, since there may be some food/herb-drug interactions and/or clinical safety contraindications for your unique case. (To list everything could probably fill a book, and goes beyond the scope of a blog article!)

Heal your gut

From SIBO to LPS/endotoxemia to bile acid diarrhea to IBD, gut imbalances are a common but little-known source of inflammation-induced high cholesterol.

Identifying and addressing the underlying cause of your gut imbalances is critical if you want to stop the source of inflammation at its roots.

(If you’d like assistance with this, consider applying for our 1-1 functional nutrition services here!)

Cholesterol-lowering interventions and IBS: what to look out for

Garlic and IBS

Garlic is a popular herbal intervention, well-known in the integrative and functional nutrition space to help reduce cholesterol (but not triglyceride) levels naturally, with little to no side effects… for most people (11, 12).

First and foremost, please know that garlic is not inherently bad for gut health– in fact, garlic is considered a natural prebiotic herb and does not cause IBS.

However, many IBS sufferers are generally prone to FODMAP intolerances (and/or sometimes a sulfur intolerance) and may feel worse after consuming high FODMAP/high sulfur foods like garlic.

But not all garlic is the same!

Fructans in garlic

Many (but not all) forms of garlic (such as garlic powder, garlic cloves, some garlic capsules, minced garlic, and garlic-infused broths) are considered high in fructans. 

These forms of garlic are considered high FODMAP herbs/supplements and may trigger or worsen IBS symptoms, particularly if you have a fructan intolerance. (You’d also feel worse after eating onions, wheat, and other high-fructan foods in this case.).

If you’re interested in exploring garlic extract as a natural remedy for high cholesterol before going on a statin, but you suspect you could be reacting to the fructans in some types of garlic, consider asking your healthcare providers about low FODMAP garlic options such as garlic tincture, garlic-infused oil-based extracts, or integrating garlic scapes and garlic-infused olive oil into your culinary dishes.

Sulfur in garlic

On the other hand, if you’re reacting to the high sulfur content of garlic, no types of garlic would be compatible with your IBS and high cholesterol treatment plan, unfortunately.

Some people with sulfur intolerance have a gene variant blocking your ability to digest and break down high-sulfur compounds in foods, while others have a gut imbalance such as an overgrowth of sulfur-reducing bacteria in your intestines. 

• If the sulfur-reducing microbes are in your small intestine, this state or condition is referred to as hydrogen sulfide small intestinal bacterial overgrowth, FYI!

Always listen to your gut (literally and metaphorically) and when in doubt, make sure to consult with your healthcare team to navigate your oral tolerance to foods and herbs.

Can statins cause IBS?

The verdict is still out – we can’t answer this with a definitive “yes” or “no” at this time. 

For example, before I niched down to gut health, in private practice I used to work with many 1-1 clients who would take statins, and they didn’t have IBS (at least, not to my knowledge).

However…

Anecdotally, I’ve also observed first-hand that statin drugs can actually trigger or worsen IBS symptoms for several of my 1-1 clients. For example, one of my clients recently experienced (and gave me permission to share here, on her behalf, anonymously): 

“My cardiologist switched my statin from Simvastatin to Atorvastatin. He felt that the new medication would be more effective in lowering my cholesterol and I’ve been on the new medication for about a month. I have noticed a couple of changes with my gastrointestinal system since I started taking the new statin. I have had increased gas throughout the day, my poop has changed in consistency and smell, and my stomach feels tender and sore. “

Since she switched back to Simvastatin from Atorvastatin, she reported feeling better within a few days.

On paper, this may be attributed to statin-induced dysbiosis (a state of imbalance in the gut microbiome, which correlates with IBS). For example, a 2024 editorial publication uncovered that certain statins are associated with an increased risk of developing type 2 diabetes, secondary to statin-induced gut dysbiosis (13).

• This is noteworthy because in my gut health nutrition practice, 100% of my clients with IBS who run a functional stool analysis test end up having some degree of gut dysbiosis!

Statins and coenzyme Q10 (CoQ10)

If you take a statin drug, please don’t stop taking it without medical guidance and clinical tapering supervision from your doctor.

That’s because coming off a statin cold turkey (especially following long-term use) can actually cause an adverse inflammatory response.

Someone I know personally tried to do this, and her cholesterol skyrocketed up into very scary numbers.

However, one thing you can (and SHOULD) do, if you’re on a statin drug, is to make sure you’re taking CoEnzyme Q10 (with food, since it’s fat-soluble). This is an antioxidant that is supposed to get produced endogenously (in-house, in the body) – but the statin drug stops your body from making its own CoQ10.

A generally healthy dose of CoQ10 is 100 to 200 milligrams per day, but make sure to run this by your treatment team (don’t self-prescribe).

Final thoughts

Okay, we just covered a LOT of ground on all things cholesterol, IBS, SIBO, dysbiosis, IBD, and more.

If you’ve made it this far, take a deep breath and give yourself a pat on the back for reading all of this. 😉

To recap, while we’ve only touched the tip of the iceberg of the gut-heart connection, the microbial landscape and barrier integrity of the gut appear to play major roles in cholesterol and inflammation.

People with digestive disorders seem to be at increased risk of high cholesterol, due to the nature of these disorders being associated with dysbiosis and other types of gut imbalances.

On the other hand, certain cholesterol-lowering medications (particularly statins) and some supplements (specifically most types of garlic) can potentially trigger or worsen IBS symptoms for some, by altering gut microbes or fermenting in the intestines (leading to gas, bloat, osmotic diarrhea, etc.).

Optimizing your diet, supplements, and lifestyle habits to help reduce inflammation and rebalance your gut biome (whether with prebiotics, probiotics, postbiotics, herbal antimicrobials, detox binders, or a little of everything) are worth considering before you go straight to a statin drug for high cholesterol. 

Consider working with a qualified holistic healthcare provider for customization, clinical supervision and expert guidance. 

Next steps 

Reflections

If you (or a client, if you’re a fellow healthcare provider) is navigating gut issues and high cholesterol, I strongly encourage you to first take a step back and look for any major blind-spots.

• Are you or your client eating too much saturated fat?
• Is your ratio of omega-6’s to omega-3’s in your diet (and in your blood) too low?
• Does your diet include enough prebiotics, antioxidants, and soluble fiber from you-friendly fruits, veggies, and possibly whole grains?
• Are you or your client not getting enough regular exercise?
• Are there genetic variants impacting your body’s response to saturated fat and exercise (or lack thereof)?
• Is there an underlying source of inflammation (such as LPS/endotoxemia) coming from imbalances in your gut microbiome?

Let’s stay connected

If you found this helpful and would like to stay in touch, join us in the private Facebook community, Whole-istic Living for Better Gut Health where you can connect with others navigating gut issues holistically!

For practitioners

For my fellow RDNs and other nutrition experts in outpatient clinics and private practice…

Are you looking to learn more about how you can support your clients with evidence-based herbalism?

Check out this CDR-accredited continuing education course (in book format, with a CE exam) where you can learn about herbs, and get 21 CEU’s to show for it!