Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
26 Jun

Why Did My Cholesterol Go Up After Going Primal?

cholesterol2While the majority of people who go Primal see their blood lipids improve, a significant minority do not in the short term. They see LDL cholesterol skyrocket, or their total cholesterol increase, and sometimes triglycerides even mysteriously elevate despite a low-carb intake.

What’s going on here? Should you go on statins? Should you add grains back in? Should you start jogging for a couple hours every night? Should you even worry about it?

Before you freak out, let’s go over a couple things:

Even though it may be sufficient to get your doctor to write a statin prescription, keep in mind that a total cholesterol level of between 200 and 240 is associated with the lowest risk of all-cause mortality (PDF).

If it’s LDL you’re worried about, total particle count is the thing to watch. Standard lipid panels, including LDL-C (amount of cholesterol inside the particles) and total cholesterol, can certainly give you an idea of your particle count, but you might want to read up on advanced lipid tests, too, if you’re not satisfied. Confirm that your “elevated cholesterol” is actually an issue.

That said, seeing a host of beyond-end-range numbers on your lipid test can be scary. It can also be confusing, especially if everything else appears to be going so well for you health-wise. So today, I’m going to explore a few of the reasons why your cholesterol might have gone up after going Primal. Some reasons will quell your fears, while some may provide avenues for further experimentation. At any rate, you’ll learn something.

You’re losing weight.

Going Primal often means weight loss. This is a good thing, as excess body fat is unhealthy. We want to increase lean mass while decreasing fat mass. Usually, such weight loss leads to improvements in lipid numbers. If you get your cholesterol checked when you’re fifty pounds overweight, lose it all, and check it again once your weight stabilizes, your numbers will likely have improved. That’s what the studies tend to suggest.

When you lose weight the good way – by burning body fat rather than lean mass – you are consuming pure animal fat. Say you’re dropping a pound of body fat every four days or so – that’s releasing a stream of 3500 calories-worth of animal fat into your blood stream as triglycerides and free fatty acids. If you take a snapshot of your lipids in the midst of this rapid weight loss, there’s a chance that your numbers will look off. Triglycerides in particular may be up, way up (since your blood is now full of them, newly liberated from adipose tissue).

Solution: Recheck once your weight has stabilized.

You’re deficient in some key micronutrients.

Yeah, the food we get to eat on Primal is delicious and incredibly nutritious, but that doesn’t mean we’re completely immune to nutritional deficiencies, especially considering a lot of the food we stopped eating – grain products like breakfast cereal and granola bars, and processed foods of all kinds – were our most reliable sources of vitamins and minerals thanks to the wonders of fortification.

A few of the most common include:

  • Iodine  – Iodine is required for production of thyroid hormone, and too large a reduction in thyroid activity can lower the expression of LDL receptors. Without enough LDL receptors, LDL doesn’t get cleared from the blood. Primal eaters who give up iodized salt for sea salt without making up the difference with adequate seaweed and seafood may be missing out on iodine (eating tons of goitrogenic cruciferous veggies at the same time might compound the problem).
  • Copper – Copper deficiency is associated with elevated levels of LDL, as well as increased particle number. Both oysters and ruminant liver are excellent sources of copper. You eating your offal and shellfish?
  • Selenium – Selenium deficiency is associated with reduced LDL receptor activity (and subsequent elevated LDL levels). Salmon, kidneys, and brazil nuts are great sources of selenium.

Check out my post on micronutrient deficiencies (plus this one) to see what else you might be missing.

Solution: Eat some liver, shellfish, seaweed, salmon, brazil nuts, and check your diet against a nutritional database for a couple weeks to see if you’re hitting all your targets.

You’re grazing all day.

People coming from a standard Westernized diet are usually ravenously hungry at all times. They have trouble going several hours between meals. And then they switch to Primal eating, their hunger issues improve, but the snacking remains. It’s tough to beat. After all, we live in a culture of snacking (those of us in the US, at least). If you work in an office, snacks abound. Donuts are always being trotted in and paraded about. Jars of candy beans and M&Ms adorn every second desk. People keep “snack stashes” in their desk drawers.

And so we snack. Instead of giving our bodies and digestive systems a break, we remain in “fed” mode. As soon as our bodies start to get a handle on the nutrition we’ve recently ingested, we send in some more – just as our guts were about to crack a beer and take a load off. Admittedly, I don’t have any studies to reference, but I don’t think it’s a stretch to say that staying in the fed state hampers our ability to utilize the fatty acids in our blood (since there’s a constant influx of nutrients, why bother burning what we have?), and thus might cause elevated cholesterol.

I’m not saying you have to fast, because you don’t. But I would caution people against grazing – against always having something on hand to absentmindedly munch on, against gallivanting around with a sackful of salted nuts on your belt, against eating 6-12 small “meals” per day so as to avoid imminent muscle catabolism. Just eat real meals, substantial plates of food that keep you sated for four to five hours a pop.

Solution: Eat real meals.

Your activity levels don’t match your carb intake.

While I’m a proponent of tailoring your workouts so that you don’t require a high-carb diet, many people enjoy maintaining a high level of sustained intensity in their workouts. That’s cool. I get it. Just don’t think you can stay very low carb and enjoy good health while maintaining high-intensity endurance or metcon training on a daily basis.

What’s this have to do with cholesterol? Well, if you’re hitting the metcons regularly without the necessary glucose infusions, your body conserves what glucose is available. We need some glucose for brain function (ketones and other sources can handle a lot of our brain’s needs, but not all of it), so in order to preserve what little glucose is available, T3 thyroid hormone is reduced. Normally, T3 increases glucose utilization, but when the body doesn’t have enough due to mismatched exercise output and carb input, T3 must drop to conserve glucose. Unfortunately, this lowered T3 can lead to lowered LDL receptor activity, which leads to increased lipid levels.

Solution: Align your activity levels with your carb intake.

You’re still not moving frequently at a slow pace.

I’ve said it before, and I’ll say it again: low level aerobic activity in the form of walking, hiking, easy cycling, or even light rowing is absolutely essential. There’s a reason it forms the base of my Primal Blueprint Fitness pyramid. When you go for a good-sized walk, you’re not burning calories. You’re not blasting your abz, bunz, and gunz. You’re not vomiting on yourself from overexertion. It’s not exciting. It won’t make a good Youtube video set to Linkin Park. But what you will be doing is utilizing those free fatty acids that might be throwing off your lipid panels.

In one study, patients who walked briskly were far less reliant on cholesterol, blood pressure, and diabetes medications. Those who took the longest walks at the briskest pace were the least likely to have LDL cholesterol high enough to warrant statins. In another, brisk walking was enough to reduce triglycerides and LDL particle count in overweight women.

Lifting heavy things and sprinting once in awhile are excellent acute stressors that elicit fantastic health and performance benefits, but constant low-level movement is the foundation of it all, especially if you’re eating more fat and trying to become a true fat-burning beast.

Solution: Do I even have to say? This isn’t optional. Go for a walk!

You’re not lifting heavy things.

Cholesterol isn’t out to get us, you know. We don’t manufacture the stuff to commit slow suicide. It actually serves a purpose in our bodies. From cholesterol, we produce steroid hormones, sex hormones, and make vitamin D (with a little help from the sun, of course). With cholesterol, lipid particles transport nutrients and antioxidants to various parts of the body. Research shows that, following weight lifting, we also use cholesterol to repair and rebuild muscles.

In fact, acute bouts of resistance training can cause large reductions in blood lipids. One study found that total cholesterol was reduced up to 48 hours after a single weight training session. Another (PDF) found that the cholesterol reduction persisted at 72 hours post workout. Interestingly, the drop in cholesterol in both studies accompanied a rise in creatine kinase, an indirect marker of the degree of muscle damage caused by strength training. The fact that the effects persist for days after a single bout of weight training suggests that regularly lifting heavy things can effectively manage your cholesterol.

Eating fat can increase cholesterol. Not in everyone, not even in most, but enough people see a (usually neutral) increase in cholesterol when they start eating more fat. That’s all well and good as long as you make use of it. Lifting heavy things, whether it’s your own bodyweight, someone else’s, a barbell, a log, or a machine, breaks down and then repairs muscle. Cholesterol is required to repair muscle, to make it stronger. To make you stronger. If you squander the opportunity to use all that cholesterol by failing to lift anything heavy, don’t be surprised if things get a little screwy with your blood lipids.

Solution: Lift heavy things at least twice a week.

Notice a common thread? Most of these reasons for elevated cholesterol are easily testable. And if you can test them, you can probably find a solution. Think back to the recent series on self-experimentation if you need some pointers.

That’s what I’ve got. What about you? Has your cholesterol increased since going Primal? Do any of these sound familiar? If so, how are you going to approach the issue – if at all? Or, if something else was causing your increase, tell us how you fixed it. Thanks for reading, everyone!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Fatty liver was not directly referenced but approx. a third of Americans suffer from a non-alcholic fatty liver (source: dailylipid or kresser).

    LDL levels might even be worse if one has a fatty liver. I’d assume that living primal would eventually help the liver to remove the fat deposits in it. As Mark stated in the article, the fat has to go somewhere and that is your bloodstream.

    Paleo Bon Rurgundy wrote on June 26th, 2012
    • I had NAFL, numbers in the 200s, slowly slowly they went down, and then i started primal eating, within 6 weeks they were only slightly higher than the normal of about 35?. But, my LDL in all that time, was ok, below the ‘normal’ It has been 3 months of primal (and finding out i was diabetic, and already lowering meds once, BS are very good now) I havent had my cholesterol checked, but i am interested in seeing what they have done. I have also lost 20 lbs. Yay PB!

      Lorraine wrote on June 27th, 2012
  2. Great post!! My cholesterol has increased. I think it had to do with being too low on carbs when compared to my training regimen. I have now upped my carbs a bit, I feel much better and I will soon get re-tested. :-)

    Roberto wrote on June 26th, 2012
    • I’m not sure if my cholesterol has always been high or not, but it is above the recommended levels now. HDL and trigs are AWESOME though, so I doubt there’s anything “wrong” with me. My mom’s a healthcare practitioner and does worry about my high LDL, so I’m experimenting with some things before my next annual check up next month. I’ll let you know if my experiment has any effect on lowering the LDL. :-)

      TokyoJarrett wrote on June 26th, 2012
      • I am mostly primal after doing the Whole 30 a few months ago. I have a history of slightly high total cholesterol with LDL at 114 and HDL at 66 four years ago after getting LDL down from 144. Now,since going low carb/primal, LDL-C is 181 and HDL is 87 with triglycerides at 44.8. I don’t know what to think. After reading numerous MDA articles, I don’t think I should be concerned, but I’d like to be sure. Weight-lifting, walking often. Comments anyone?

        Nirit wrote on August 7th, 2012
    • So… I was wondering. Did this ever correct itself? My LDL doubled while I was half-marathon training, lifting 5-6 times a week, and “cutting” about 25 lbs all while eating primal/paleo. My carbs are prob tops 80 net a day. I’ve added in 225 mcgs of iodine a day and upped my carbs but can’t get a retest for a few months.

      Dustin wrote on September 12th, 2014
  3. I’ve had a problem with my cholesterol since I developed non-diabetic reactive hypoglycemia when I was 17. I refused to take statins. What I’ve discovered over the years is that reducing my carb intake and lifting heavy things really does help. Also, for me, my body does very well on trail mix with almonds, walnuts, and cranberries. I take Mega Red, an omega-3 supplement.

    Since increasing my nut intake, my cholesterol is now normal. Some research has been done to show that nuts do help lower cholesterol. I know that’s not exactly Primal, but that has been my experience.

    The Girl in Yoga Pants wrote on June 26th, 2012
  4. It could come back to bite me but I am simply staying away from the modern witch doctors until I either have no choice but to go unless my insurance or medicine in general greatly improves. I don’t see that happening in my life time even if I live to be 100.

    Groktimus Primal wrote on June 26th, 2012
  5. Been primal for about 4.5 months. Recent blood work results: Trig-67; chol-252; HDL-69; LDL-170. LDL increased about 55 points from pre-primal blood test. The article is very relevant for me and will review and experiment. Need to start lifting heavy things, but I do long & brisk walks.

    Jennifer Kane wrote on June 26th, 2012
    • my profile after semi primal is same above

      mack patel wrote on October 19th, 2012
  6. Just had a checkup (one year mostly primal) and sure enough, my total cholesterol went up a good bit, BUT my ratios were all better, my HDL went up and my triglycerides went down (my tri/HDL ratio was excellent .641). My total went from 168 to 210, so the automatic alarms for “near death by cholesterol over 200″ went off in the doctor’s office. Luckily the doctor understands the paleo/primal thing (mostly) and just suggested more lean meats and fish.

    I’ve read about a lot of people having the same experience as me. I kind of expected it and don’t plan on changing a thing.

    JL wrote on June 26th, 2012
    • Lean meats and fish, did you forget? fat is good for you!!

      Achillies wrote on June 27th, 2012
    • same thing here. not to worry. if your HDL is up and trigs are down, that means your elevated LDL is on account of the big fluffy ones (healthy) as opposed to the VLDSs (unhelathy). do the test again once your weight is stabilized, and getting rid of the toxins fm your adipose tissue and liver are mostly over. i plan to do the same thing in a few months. till then, no worries :-)

      einstein wrote on July 4th, 2012
  7. My LDL was up since going primal, but the density was super low, meaning it’s the benign type.

    Mike wrote on June 26th, 2012
  8. As a 46 year old woman in the UK I am amazed at all the cholesterol level checks you have in the US. Most people in the UK only see their Dr if they are unwell and apart from my 70 year old MIL who had a stroke I dont know anyone who has had their cholesterol tested.
    Probably just as well for me not too be tested as I dont want to be told to take statins etc. not that I would even if advised to.

    Anne Dawso wrote on June 26th, 2012
    • Availability and disinformation creates demand.

      Joshua wrote on June 26th, 2012
    • As a 44 year old man from Canada I agree entirely with everything you said. We go to the doctor when we are ill and only then.

      JohnC wrote on June 26th, 2012
      • by then it might be too late especially if you are over 40. how about annual screening or bi-annual preventive screening? always better to be health conscious than not.

        einstein wrote on July 4th, 2012
    • I think a lot of people go when they can’t lose weight. That will lead to a CBC and cholesterol and thyroid test. Then it is usual to get those numbers retested down the line. Don’t worry, you’ll be catching up with the US just as soon as you have as many obese people as we do.

      CarlaC wrote on June 26th, 2012
      • I did my “over 45 bloods” with the GP (an Australian suggested health screening check) I opted for to see where I was at and all were perfect, perfect, perfect (I’m 49, been +/-55kg for almost 30 years). I had planned anyway on repeating them after 12 months primal so wait out on results! I actually dont expect much of a change because I rarely ate sugar anyway and dropping grains was much not that hard to do (thank goodness!).

        Michelle wrote on June 26th, 2012
    • At my company they’ve offered health screenings for many years. Last year they became “required”. Well, not required, but you pay an additional $20 per month if you don’t do one. That amount also applies to your spouse if they are on the companies health care plan (for a possible total of $40 extra per month).

      We’ve been told it’s optional to have a screening, not required. It’s up to us about what we want to do, but if we choose not to have the screening, we pay for it, each month.

      I’ve always had the screening, even before they started charging you if you skip out on it. Not sure if it is related to the healthcare reform, or has more to do with a particular requirement between our healthcare insurance provider and the company.

      Aaron wrote on June 27th, 2012
    • haha hey im totally with you there, at one point i hadn’t visited the docs for several years, thought it was just me when reading on everyone having checks
      for this that and the other, rather just get on with it.

      sara wrote on June 28th, 2012
  9. I’ve been 80/20 or maybe 70/30 Primal for over a year and have lost 25-30 pounds which puts my small-framed 5’4″ body at 120#. There’s a history of heart disease, stroke, diabetes (type 2), and low thyroid in my family, so while I hoped it wouldn’t happen, I wasn’t surprised at my first post-primal physical to see that my total cholesterol was 330, LDL-over 200, HDL-107, and triglycerides-67. I wasn’t surprised, but at 55 years, I was concerned. I re-read everything I could on this site and went to thedailylipid.com to read and listen to podcasts and then made my plan of action. For one month now I have been
    1. paying more attention to the ratio of polyunsaturated fats and monounsaturated fats in my diet using fitday.com to track that.
    2. Eating fish 2-3 times a week instead of 2-3 times a month.
    3. I won’t go back to grains, but have returned to eating well-soaked, fermented beans whenever I eat a meal high in polyunsaturated fats. I know this goes against primal guidelines but I’m the one with the high cholesterol and bad genes.
    4. I’m female but I’m trying IF by adding a 24 hour fast once a week and I like how I feel when fasting.
    5. I already walk daily, but I see that I need to increase my speed and to add lifting heavy things, although I can almost do one chin-up…yeah!
    6. Grazing all day is probably something I should pay more attention to.
    I’m very, very glad to see today’s post.

    Elsie wrote on June 26th, 2012
    • I would love to have your low triglyceride count. THAT’S a nice number.

      Joy Beer wrote on June 26th, 2012
    • Please see this article from Dr. Michael Eades about low triglycerides and LDL chloresterol measurements. LDL levels are usually calculated rather than directly measured and having triglyceride levels <100 can throw off the calculation.

      http://www.proteinpower.com/drmike/weight-loss/low-carbohydrate-diets-increase-ldl-debunking-the-myth/

      Miki wrote on June 27th, 2012
      • Wow! This link and the eating academy link shared by Travis are amazingly interesting and very informative. I am learning so much! I can hardly stop reading. Thank you!

        Elsie wrote on June 28th, 2012
  10. Wow, a post on Cholesterol on MDA and there is no link to Dr. Peter Attia’s brilliant series on it. Travesty!

    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-vii

    This link is to Part 7 obviously you should start from Part 1 that is linked in Part 7. Have at it!

    Travis Koger wrote on June 26th, 2012
  11. It got so hot and humid here (Missouri a.k.a. Misery) that I gave up moving frequently at a slow pace, but this morning I threw my kids in the stroller, put on my vibrams, and walked in a fasted state all the way to the city park accidentally. Oh yeah! Walking fasted is so much easier for me. I had no idea.

    rabbit_trail wrote on June 26th, 2012
    • I am reading “The Book of the Eskimo”. The Inuits kept their sled dogs hungry because they ran better if fasted.

      Steve wrote on June 26th, 2012
    • I fast twice a week. On one of those days I actually step foot in a gym to do some heavy lift instead of the usually Calisthenics. The other fasted day I go for my weekly trail run. My performances are ALWAYS better when I’m in a fasted state!

      Mindy1986 wrote on June 26th, 2012
  12. Anne D

    If you’re bothered, Lloyds Pharmacy do a (rather basic) cholesterol check for just fifteen English pounds!

    art wrote on June 26th, 2012
  13. Mark, very timely article, thank you. I’m lucky that Primal and hefty weight loss is improving my lipids in every way. I do wish you had mentioned that cholesterol results can vary quite substantially over even a few weeks, so really, unless one has a couple prior tests as a baseline, one lone test does not a baseline make. I’m very glad you reminded us fat-losing folks that things will be off until our weight has leveled for a while.

    Again, a timely article! Thank you.

    kerryk wrote on June 26th, 2012
    • Thank you Mark for this. I needed to read this, as I have been a bit slack lately exercise wise. My cholesterol when it was checked in November 2011, nearly gave my doctor a coronary! LDL was way up, but my trig/hdl ratio was .76 (just done the math), and I was still loosing weight. She knew I would tear up a statin script, and we decided to test again in a years time, but I am going to see her soon, and point her towards the work being done on that ratio, and here (can only hope). I still have weight to loose, and it is going slowly, but I would never change what I am doing now, you and this community has changed my life and that of quite a few of my friends, so thank you one and all!

      Heather wrote on June 26th, 2012
  14. My LDL went down and my HDL went up after switching to the primal lifestyle, but I recently switched jobs that makes it so I have a lot less slow movement than I used to… should be interesting to see my next lab results.

    Tashi wrote on June 26th, 2012
    • Off topic, but what’s with the Jolly Honest Abe, there?

      em wrote on June 26th, 2012
  15. Brilliant! Should be required reading for all cardiologists and general practitioners.

    Harry Mossman wrote on June 26th, 2012
  16. there is a lower mortality in the range 200-240 only because countries with lower cholesterol are poor and with very bad healthcare not because somewhat more cholesterol is good.

    ddd wrote on June 26th, 2012
    • You MIGHT be right. Maybe not. I know that people here might attempt to pick what you’re saying apart, but it MIGHT be correct to some degree.

      Bob Crason wrote on June 26th, 2012
      • ddd is very likely correct. The graph represents pure associations, anyway, and it must NOT be concluded that higher cholesterol is responsible for decreased all-cause mortality.

        BillP wrote on June 26th, 2012
  17. If you are on of the lucky genetic ApoE4 variants out there, you will have terrible lipid panels. This group usually will suffer cardiac/stroke events at young ages. If you’re parents or their parents suffered heart attack or strokes at a very young age (30-45) you may be one of the genetic lottery winners; but you would need a genetic test to verify. The only way to help this out at all is to maintain a low carbohydrate/low fat diet.

    John wrote on June 26th, 2012
    • So which genetic group can’t increase their numbers no matter what. I have decided to quit worrying about it, but from time to time I worry. My total cholesterol is in the 120’s, the ratio is ok, and my triglycerides are usually 48. I always read every comment on cholesterol posts to see if anyone else, other than my father and children, is like me,

      Cavecanem wrote on June 27th, 2012
    • You cannot have both low carb and low fat. Which did you mean?

      yodiewan wrote on June 27th, 2012
  18. Interesting that this article just came out. I just got my blood tested after being primal for a little over a year, and the doctor said that everything is looking great!

    Max Ungar wrote on June 26th, 2012
  19. Thanks for the weight lifting link. One of my tween fantasies was to become a female bodybuilder. I didn’t like being called a dyke for doing chin-ups on the playground, though. It’s great to see encouragement for women to be strong.

    As for cholesterol, I had it checked once when I was 15. Doc said I had the cholesterol of a 12 year old! Woah.

    yoolieboolie wrote on June 26th, 2012
  20. After 4 months of Paleo my TC went up about 60 points.

    HDL:80, Tri: 71, LDL: 192.

    My doctor was not happy. Although, I did point out that my ratios are still ideal! She wanted me to either go on statins or talk to a cardiologist and tell him about my paleo diet. I opted out for both for now, and am doing the following as a test:

    • More fish/seafood
    • Less bacon (i know, i know)
    • Reducing my nut intake (I was sort of over indulging on almonds and pistachios)

    Matt wrote on June 26th, 2012
    • That HDL:Trig is GREAT. If you’re going to ignore that, pls read the cholesterol series at Dr. Attia’s eatingacademy.com

      If you’re taking a statin, you should absolutely be taking Co-Q10, as statins basically shut down your body’s production of it.

      Jeffrey of Troy wrote on June 26th, 2012
    • your Lipids are almost exactly as mine and my physician is freaking out. I was already on a low dose of Lipitor (10mg). Any more of any statin than 20mg literally makes me ill. I was eating a few more processes meats very high in saturated fats and not enough “good” fats a month prior to testing. So I understand the Bacon dilemma. I will continue the same statin and increase the better fats and reduce the high saturated fat intake but not eliminate it. I’m at 9% body fat do the slow moving everyday and lift to bodybuild 5 times a week. My doc is crazy if she thinks I’m unhealthy.

      ddrewes wrote on June 26th, 2012
  21. An interesting post. Thank you. I have been referred to a hospital lipidologist (UK) by my GP on account of a very high LDL reading. Very good HDL and Tri, but very high LDL.

    Phil wrote on June 26th, 2012
    • In American money(last time they were measured, anyway): Total,483; HDL,93; Tri,71.

      Phil wrote on June 26th, 2012
      • Hmmm. I’d ask for a free retest.

        BillP wrote on June 26th, 2012
  22. Hi, I have been folowing your website and reasing your book , it has been 2 months already since I became 100 % Primal, went to the doctor 3 days ago, He call me today and said to me your blood work looks good, cholesterol high ( 186 ) is that high ? and testosterone high 1400 , is that high.
    I’m 48.

    Todd wrote on June 26th, 2012
  23. Total cholesterol levels do not really correlate with anything. If you have good triglyceride to HDL ratios, I would not worry about the rest. A few years ago, my total cholesterol level went up to about 245, but my tri/HDL ratio was about 1. My doctor wanted to put me on statins immediately. I politely declined. My doctor is overweight and recently had a heart attack. Hmmmmm…

    Damien Gray wrote on June 26th, 2012
    • “My doctor is overweight and recently had a heart attack. Hmmmmm…”

      Incredible! What a great advertisement he is of CW. You should send him a copy of PB..

      mars wrote on June 26th, 2012
    • Same experience here… I’ve been paleo/Primal for almost two years, run regularly, CrossFit regularly and yet the doctor expresses concern to me over my high cholesterol that was from a blood test two years ago without even waiting to see what my new bloodtest shows. Important to note… this doctor was at LEAST 60lbs overweight! Thanks, but, no thanks. On a side note, but related, does anyone know of any Paleo/Primal doctors or functional medicine doctors in Phoenix, Arizona?!? Apparently I’m in need of a new doctor!

      Rebecca wrote on June 26th, 2012
      • I’m in Phoenix too and would love to find a paleo friendly doctor.

        Chris wrote on June 26th, 2012
        • Chris — check out the site below. It might be of help to you.

          http://paleophysiciansnetwork.com/

          Marianne wrote on June 26th, 2012
        • I was thinking that too, thanks, Marianne.
          I just had my annual check up at my nephrologist(renal transplant)and I’m on some medicines for life,but a different medical opinion might be informative and helpful.

          Jay Booth wrote on June 27th, 2012
        • I have tried that link for searching for paleo physicians here in AZ and unfortunately, it seems that there isn’t much of a selection to choose from. Do any of you live in Arizona (Phoenix area) and have a good naturopath/homeopath doctor or functional medicine doctor that you like? If so, please email me at wylandfn1992@gmail.com ;)

          Thanks!

          Rebecca wrote on June 27th, 2012
    • Just adding my support.

      Search “cholesterol myths” on Amazon.com and you will find dozens of well-researched, fair texts indicating the mythological status of cholesterol concerns.

      Sean wrote on June 30th, 2012
  24. Simple blood tests like total cholesterol and LDL-c are likely to go the way of the dinosaurs in the next few years, just like the PSA tests that are now being de-emphasized (I remember reading about how useless many physicians considered these even several years ago; the bureaucracies are just now changing their recommendations).

    The only test considered a good indicator of coronary disease is the TG/HDL ratio.

    Endlessly worrying about fine-tuning one’s paleo/primal diet may be needlessly stressy. The whole point of the diet is to make certain changes (i.e., dump grains, beans, and dairy) so that one doesn’t NEED to worry anymore!

    BillP wrote on June 26th, 2012
    • Agreed— everything I’ve read has indicated that the TG/HDL ratio is really the only thing to look at.

      JL wrote on June 26th, 2012
    • Correct. Paleo for 3 years and counting. My TC pre paleo was 180. Now is it is between 300 -340 but my HDL is over 80 and Trigs around 50. I’m 5 9″ 168lbs bodyfat under 10 percent, 40 years old, lift heavy and often. I even had a direct LDL measurement which confirmed my LDL is pattern a (large). Furthermore my insulin resistance score was 4 on a scale of 0-100 (VERY insulin sensitive). The lipid hypothesis is crap!!! We all know grandparents who lived into their 90’s eating high fat before doctors new about cholesterol. It’s total nonsense!

      Jim M wrote on June 26th, 2012
  25. I went low carb, then primal last year and dropped ~70lbs total and have kept it off since then pretty easily. My doctor was pretty astonished at the improvements in my lipid tests. Because he sent me for lipid tests on the same day he gave me a tetanus shot, I had an elevated CRP result. After a month I re-tested and all was okay. So I have 3 different sets of tests to compare on my blog, if anyone is interested:

    http://www.lowcarblearning.com/2011/12/my-cholesterol-test-results-on-lchf-low-carb-high-fat-diet/

    For reference, I’m 40yo. Was holding at 191 lbs for a few months (my lowest since high school) but started CrossFit last month and have put on 5 lbs of muscle since then.

    Mark wrote on June 26th, 2012
  26. Good resource is Dr. Thomas Dayspring. Google him and listen to some of his easy to understand explanations of the cholesterol issue.

    As to primal fine tuning. Shrimp and seaweed are key.
    You can’t just eat bacon and 12 ounce steaks every day. Eat real food, keep it simple, don’t stress and as Mark says, take lots of walks.
    Enjoy it…that’s what life is about anyway :-)

    Marc

    Marc wrote on June 26th, 2012
  27. My total cholesterol went up a few points after going primal. But, Blood pressure dropped a ton when I lost all of my 10 lbs of belly fat. My doctor will actually take me off of BP med. (Lisinipril 10mg) if the BP stays so Low!!
    I still have a great Good to bad Ratio for cholesterol.

    Jim S. wrote on June 26th, 2012
  28. Mark what do you think about The Art And Science of Low Carbohydrate Performance?

    Pierre wrote on June 26th, 2012
    • I haven’t read this one yet, but I’ve read their book designed for athletes. Found it to be really well-researched and a worth-while read.

      Low-carb athletes do great.

      Sean wrote on June 30th, 2012
  29. Hmmm, I posted a link to Dr. Peter Attia’s site where he is running a brilliant series on cholesterol. Apparently it didn’t make it through the moderator.

    I highly recommend you take a look at eatingacademy.com for some seriously in-depth information on cholesterol.

    Travis Koger wrote on June 26th, 2012
    • I also posted that link. Maybe they’re behind on approving posts.

      Steve wrote on June 26th, 2012
      • Only seems to be for comments with actual links in them.

        Travis Koger wrote on June 26th, 2012
      • The link has now been posted/approved above.

        Travis Koger wrote on June 26th, 2012
  30. This is an excellent article, with excellent well explained common-sense solutions. The deficiency of key micronutrients is covered very well by Mark. This is why the best chemical-free sustainable farmers supplement their animals with iodine and selenium (especially in the midwest). Those 2 things are about the only off-farm inputs required.

    David Marino wrote on June 26th, 2012
  31. Had my cholesterol levels test last week as part of annual check up, doctor could not believe the improvement and asked what I’d done…

    Let’s just say he’s now started reading up about the Primal way of living!!

    Patrice wrote on June 26th, 2012
  32. Hi Mark,

    I literally just read two articles on cholesterol in 5 minutes. The first was from Jonathan Bailor’s post (smarter science of slim), and then this article.

    So, he’s saying that we don’t need to worry about the LDLs rattan than our HDLs b/c having low LDLs is not as important as focusing on obtaining a high HDL reading…

    Thoughts?

    Cheers. Love your site!

    Sonia

    Sonia wrote on June 26th, 2012
  33. Rattan = rather ;)

    Sonia wrote on June 26th, 2012
  34. My total cholesterol inched up a little bit, enough to barely put me over 200… but I have super high HDL (over 80) both before and after, so I’m not worried… nor is my totally conventional wisdom doctor.

    jj wrote on June 26th, 2012
  35. well we have “cheap” blood tests avail once a yr so I’ve done them. in ’09 after 1 month primal (after 10yrs grain-laden vegetarian) my TC was 245 (TRI=88, HDL=79, LDL=148) in ’10 after a yr of mainly 80/20 my tc was 246 (TRI=66, HDL=86, LDL=147). My ratios are spot on. so I won’t be consulting any med professionals for those numbers :) I feel great, my weight avg has decreased by 10# and at 52 I feel way better than I did during my 30s & 40s :p

    peggy wrote on June 26th, 2012
  36. I’ve just had a lipid panel done and the doctor wanted to prescribe a statin medication because my serum cholesterol is 6.3mmol/L (I’m in the UK). But the rest of the results seem fine to me – HDL cholesterol 1.96mmol/L, Cholesterol/HDL ratio 3.2, triglycerides 0.8mmol/L and LDL cholesterol 4.0mmol/L.
    So I refused the statin on the grounds that I’ve lost 3 stone in weight following a low carb diet over the past ten months. Every day I walk briskly for 30 minutes before breakfast and again for 30 minutes before dinner. I was diagnosed with type 2 diabetes last July but my checkup last month revealed excellent blood sugar control and I’m well within normal range. In fact, I’m healthier and fitter now than I have been for twenty five years!
    He was puzzled and a bit defensive but he accepted my refusal and noted it on my records. I left the surgery without any meds ;-)

    Lois wrote on June 26th, 2012
    • Good on you!!
      Hold your ground! So many of these practioners rely on arbitrary lines and once we cross them, no matter what the context, they reach for the script pad. Myself, I would much prefer to ward off diabetes, and metabolic syndrome and all the horrible consequences of that, than subscribe to the dubious research surrounding the cholesterol/heart disease/statin scenario.
      Cheers

      Heather wrote on June 26th, 2012
  37. Very interesting post. Im in Aus and Im a bit unsure as to how our measurements relate to the measurement in US? The measurement I was given is mmol/L.

    I’ve been primal for the last 18months and theres no going back. I walk the dog most days (60mins), Rock climb at least twice a week (2hour sesh) and sometimes I’ll do a full body workout/weight vest/kettlebell etc. I’m also a Remedial Massage student 4 days a week. To give you a background of what I get up to.

    Had some blood work done a couple of weeks ago and was called back to the doctor because of ‘alarming’ cholesterol levels. They read as follows..

    Total Chol 7.7mmol/L
    HDL Chol 2.0 mmol/L
    LDL Chol 5.3 mmol/L
    Triglyceride 0.8 mmol/L

    The doctor told me I’m at a high risk of heart disease and if I don’t try very hard to change my diet I’ll have to take medication to lower my cholesterol. She couldn’t work it out though as I’m “not overweight, and seem very healthy”.
    She gave me an info sheet on ‘healthy eating’ as recommended by the government thats a bit of a laugh (Old school pyramid)

    I’m not worried about it, and if anything I’ve been working on raising my HDL even more.

    Im guessing if anything is a drama, its probably the fact that I don’t match my carb intake with my workout load. Probably tend to be a bit too much “low carb”

    Any thoughts?

    Oldmate wrote on June 26th, 2012
    • You can compare your results by converting mg/do = 18 x mmol/L. However everyone is different, and you trig to hdl ratio is .4 ,wow!
      My total cholesterol last year was 8(!) which was a bit of a surprise, but my ratio then was .76, so I refuse to worry about it. My doc said I had the worst figures in her practice, and I told her someone had to! I am still loosing weight (slowly), so I am not retesting cholesterol until I stabilise

      Heather wrote on June 26th, 2012
    • Oldmate, I am also so similar to you! In Australia, had my bloods done last week. Doctor just couldn’t get over my results. I went in loaded up with Robb Wolf’s category numbers and got the mmol/L instead of US mg/L instead. I am 24, female, 5’7ish, 50kg (BMI 18.5). Always been lean and athletic. Primal since Feb 2012. I eat fat, meat, eggs, liver and greens like a cave woman:

      Total cholesterol: 8.6 mmol/L
      HDL: 2.7 mmol/L (Boom!)
      Trigs: 0.8
      LDL: 5.5
      VLDL: 0.4 (Boom!)
      Bloodtype: B+

      Doc looked at the size of me and the amount of cholesterol I produce and just laughs in confusion. LDL is above recommended average, but with normal Trigs, low VLDL and outstanding HDL, I’m convinced I mut be Pattern A LDL puffy.

      Paleo for life. I have never felt this good: I ‘speak’ so much more coherent and have tonnes of energy. Cellulite has gone too.. Even when I was this weight and playing netball 6 times a week back in high school I had cellulite. Cutting sugar, carbs, grains and gluten out… It just works. I am lucky my B+ blood lets me tolerate dairy. I love cheese and raw cream!

      Does anyone think I should be worried about those bloods though? I am being retested for ‘lower LDL’ readin in 3 months…. Thanks guys

      Lauren B wrote on September 29th, 2012
  38. “If it’s LDL you’re worried about, total particle count is the thing to watch. Standard lipid panels, including LDL-C (amount of cholesterol inside the particles) and total cholesterol, can certainly give you an idea of your particle count, but you might want to read up on advanced lipid tests…”

    The argument for “advanced testing” and that “it’s all about particle count,” was just destroyed this week in JAMA. It’s comforting, but it’s just not true, with deep apologies to Dayspring, Attia et al.

    Please carefully read:

    “The Emerging Risk Factors Collaboration1 makes the point that apolipoproteins are of limited value in reclassifying individuals among arbitrary risk categories, ie, low-risk, intermediate-risk, and high-risk. In fact, net reclassification improvements were less than 1% with the addition of each of these markers (ie, apolipoprotein B, lipoprotein(a), and lipoprotein-associated phospholipase A2 mass) to risk scores based on conventional risk factors.” Use of Emerging Lipoprotein Risk Factors in Assessment of Cardiovascular Risk, JAMA. 2012;307(23):2540-2542. doi:10.1001/jama.2012.6896.

    HighlySkeptical wrote on June 26th, 2012
    • That’s pulled from the issue editorial, and the guy sounds like a shill for the statin manufacturers (q.v. the last paragraph).

      He also says, “The 2 most powerful risk factors for CVD are age and sex, and once these are added to multivariate analysis, the inclusion of other factors carries progressively smaller predictive power.” Then why add them in? Don’t you would want to separate them out: e.g., consider only men of a narrow age range, and test the predictors there? Any statisticians here that could comment on this?

      BillP wrote on June 26th, 2012
    • It was hardly destroyed. That’s somewhat exaggerated according to Dr. Allan Sinderman.

      “The current study published in JAMA does not create a compelling case to abandon the use of advanced lipid testing in favor of standard testing. It suffers from many methodological flaws and, upon careful examination in the context of the entire body of literature, actually reinforces the need for lipoprotein testing in all but a select few patients.”

      Steve wrote on June 26th, 2012
  39. Thank you Mark! You hit the nail on the head – I am a problem grazer. Not eating grains etc, but just always snacking. I needed to see it in black and white and now it’s up to me to make a correction.You are a God send!

    Lorraine Rossing wrote on June 26th, 2012
  40. 3 months after going slow-carb, my GP was enthralled by my lipid panel – negligible triglycerides, normal LDL, super high HDL. He said “whatever it is you’re doing, keep doing it”, and I did, for about a year total.

    All the beans became bothersome though, and around the beginning of 2012 I just naturally transitioned to a pretty primal diet, which after some reading I tweaked and optimized to match the primal footprint. My next check, about a year after the first, was very different though.

    My HDL had gone up a little, my triglycerides hadn’t increased at all, but my LDL had skyrocketed. My GP was very concerned, and even hinted at requiring treatment. I asked about LDL particle density & size, but he said “it doesn’t matter”…

    This was very distressing, because I’ve never been leaner, fitter, stronger, or had a better sense of well being than I have now. So I’ve chosen to cautiously continue my lifestyle of primal eating, 5-6 hours/week of martial arts, and lifting kettlebells a few times a week. I’ve reduced the amount of eggs I was eating, increased salmon & fish oil, cut down on nuts, and have wakame seaweed in my morning frittata every other day. But I’m not going to worry too much about my “high” cholesterol.

    Hopefully I’ll prove my doctor wrong, but if I drop dead from a heart attack, at least it will be while I’m the fittest I’ve ever been, not languishing from the effects of the “healthy” food pyramid that I have no desire of returning to.

    Mark Beattie wrote on June 26th, 2012

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