Why Did My Cholesterol Go Up After Going Primal?
While 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!
Visit Mark’s Daily Apple Tomorrow to Grab Your Copy of the Upcoming Book The Primal Blueprint 90-Day Journal and Claim Your Free Gifts!
Posted By: Mark Sisson
On the menopause front: the section on iodine sent me to the kitchen, where I’ve been eating liver and kelp with every meal since I read this post, AND MY HOT FLASHES ARE GONE!
Due to hypertension, I’ve been avoiding table salt.
Previously, I was using a combination of fish oil, vitex (poor man’s progesterone), and black cohosh–the 2011 PDR for herbs/supplements says fish oil can raise your BG levels–sugar is what brings hot flashes on. I dumped the pills and am using food instead…and am surprised at the miracle Mark brought forth.
I printed out this whole article to take to my doctor, including the part about iodine (she says there’s nothing wrong with my thyroid, yet I get cold in 76 degrees). The cholesterol part is what I intend to use to justify my NOT going on statins like she’s been begging me to!
Although there is a belief that raising HDL is protective of artheriosclerotic development,particularly in the Paleo community, there is evidence that this may not be the case. From a recent study: “It’s been assumed that if a patient, or group of patients, did something to cause their HDL levels to go up, then you can safely assume that their risk of heart attack will go down,” said senior author Sekar Kathiresan, director of preventive cardiology at MGH, associate professor of medicine at Harvard Medical School, and an associate member of the Broad Institute. “This work fundamentally questions that.”
http://www.eurekalert.org/pub_releases/2012-05/biom-rhn051512.php
Read more: http://www.marksdailyapple.com/why-did-my-cholesterol-go-up-after-going-primal/#ixzz1z6XKHexI
My LDL is high but my HDL is good. I’m theorizing for me, the high cholesterol has a lot more to do with my stress level and lack of sleep in recent years (pregnancy and nursing a minimally-sleeping baby). I went to a medical grand rounds this morning on sleep and current research shows people who sleep under 6 hours/night are at a significantly higher risk for heart disease, and cardiac-caused death. It’s nothing MDA hasn’t covered before, but I’m hopeful it answers my high cholesterol question and that my numbers will improve once I’m out of the sleep-deprived little kid years.
Hey, Charles Grashow,
According to NMR site, http://www.theparticletest.com/get-the-test.html#understand-your-results
A LDL-P count of 1500 is at borderline high.
I suspect your result is common to LCHF eaters. Some say try increasing carb and other say meidcation. I myself is trying to find an answer.
my CHO has increased to almost 300 .
(HDL ~ 80, TG < 70) + hypothyroidism after switching diet.
Paul Jaminet also mentioned that hypothyroidism may be what raises cholesterol & suggested similar things.
i've been supplementing to reduce it.
Mark:
I had a 310 reading of total cholesterol yesterdat following a fasting blood test. Visited the doc following day. He wants to do the advanced lipid profile. The report showed a number for non-HDL. Are you familiar with this? My doc doesn’t seem to be worried about the 310 because the HDL us very high. Ur thoughts, please sir.
Good info! Thanks for sharing with us on your blog.
to kritina,
My post and numbers are right before your post. Check out the numbers. Due to digestive issues I have eliminated all milk, grains & legumes from my diet for years. I eat alot of veggies, nuts, meat, eggs & oil. I also limit my fruit. I also eat alot of fermented vegetables & soak all nuts.
When I was a previous vegan I stuck to the food pyramid. This is a great before & after.
momupthecreek
I love this blog post! really excellent approach to explaining the problem! good read..
A number of authors, including Gary Taubs (Good Calories, Bad Calories), have pointed-out recently that the connection between dietary intake and blood-serum cholesterol levels is virtually non-existent. Also, the connection between cholesterol and cardiac risk is not supported by evidence either. Only triglycerides have minor connection to heart-attack/stroke risks.
Eating primal can help triglyceride levels.
Concern over HDL/LDL levels etc. is a myth propagated by drug companies making multiple fortunes from statins and other cholesterol-reducing drugs. (The actual efficacy of statins on reducing cardiovascular/stroke incidence is the same as that for an aspirin regimen.)
The documentary “Fat Head” is available on Hulu.com and is about one man’s challenge to “Supersize Me.” By eating low-carb (and an essentially primal) diet, he loses weight and reduces all his important blood chemistry numbers — even while eating fast food all the time.
I don’t believe the “you’re losing weight” reason is accurate.
Triglycerides in the adipocytes (fat cells) must be broken down into their fatty acid and glycerol components to enter the blood stream. Once in the blood stream, they remain as free fatty acids (carried by serum albumin) and glycerol until used by tissue for energy or packaged back as a triglyceride by the liver (mainly). This repackaging is not substantial enough to cause high triglyceride levels in the blood – if your liver is pumping out an elevated level of triglycerides, your fat cells won’t be releasing any fatty acids.
The overwhelming cause of higher triglyceride levels in the blood is due to ingestion of carbs (even protein) and the resulting (relatively) high levels of insulin signalling your liver to convert the carbs to fatty acids package up thes fatty acids (esterification of fatty acids) into triglycerides, primarily for transport to the fat cells. This corresponds with your reasoning behind “constant grazing” – a constantly fed state will cause a constantly elevated level of insulin, causing the liver to constantly package up those fatty acids into triglycerides at a higher rate as well as synthesizing fatty acids and packaging them into triglycerides from other compounds (i.e. carbs).
So after a year of Paleo, I’m down 80# (28.6% my original weight) and feel amazing. I was hoping that my numbers would prove the same thing!
Now, I’m thankful for an understanding and supportive doctor, but we were both surprised to see that my total Cholesterol went up (207 to 243) at my year checkup, after having gone down a bit mid-year. My triglycerides, though, went from 251 to 85. She says to keep doing what I’m doing (don’t have to tell me twice) and that we’ll check in another 6 months.
After reading these responses, I checked my ratios and I put any fears or worries to rest:
My TC/HDL ratio went from 5.5 to 4.4 (“at risk” to “good”)
My HDL/LDL ratio went from .3 to .32 (“good” to “good”)
My TG/HDL ratio went from 6.76 to 1.54 (“very high risk” to “ideal”)
I love how this makes me feel – and I love knowing that I’m doing such GREAT THINGS for myself.
Excellent post Mark.
I would also suggest that sunbathing will diminish your cholesterol. It has been studied and there’s a link between the two. There’s even a evidence that statins increase calcidiol. (http://www.ncbi.nlm.nih.gov/pubmed/19543962)
I’d recommend David Grimes’ book called ‘Vitamin D and Cholesterol: The Importance of the Sun’.
It is really an enlightening read.
LDL cholesterol will increase if you decrease intake of carbohydrates and increase intake of fats because of improvement in the distribution of LDL particle size as LDL becomes larger and less atherogenic. The total number of LDL particles, however (as estimated by apo B) remains about the same.
For example, in a Berkely study, (pubmed 8299884) healthy men alternated between a diet with 24% fat and one with 46% fat for six week periods and their LDL was 17% higher, on average, on the high fat diet than on the low fat diet.
The response of the men to different amounts of dietary fat was not uniform. About half the men had pattern A particle distribution (non-atherogenic) on both high and low fat diets and their ratio of TG/HDL was 2.1 on the low fat diet and 1.5 on the high fat diet indicating improved particle distribution on the high fat diet. LDL increased by 12%.
About 35% of the men had pattern A distribution on high fat (TG/HDL = 2.0) and Pattern B distribution on the low
fat (TG/HDL = 4.0)diet. LDL increased by 14% on high fat.
About 17% of men had Pattern B distribution on both high and low fat diets. LDL increased by 21% on the high fat diet. These are guys with a genetically influenced atherogenic profile.
So when you switch to a paleo diet that is higher in fat and lower in carbs there is bound to be some increase in LDL due to improvement in the pattern of particle distribution.
The most important factor is not LDL level, but the ratio of TG/HDL which is a more accurate measure of CHD risk as it is an indication of inflammation.
On a different subject, I highly recommend the book “How Statin Drugs Really Lower Cholesterol and kill you one cell at a time.” While there are many good books on the toxic effects of statins, this is the best book I have found that describes how statins actually work.
Thank you for the book recommendation and interesting comment, Jack!
I went primal/modified with Nourished Traditions Sally Fallon cook book. One year now.
My doctor is freaked out because she has never seen numbers like mine. Total 308/HDL 104/Trig 37…excellent ration but she wants me to go to cardiologist, no history of heart problems. I’m 59, workout and walk etc…now my stress is up due to her reaction. I have taken statins and they really make me sick…so I went modified primal. Total went up but HDL up and Trig way down!!i’m thinking of staying away from docs…very fit and healthy except for the numbers! also a breast cancer thriver!! Thanks Mark love you information.
+ 1,000 for Nourishing Traditions! Got a copy of it years ago, and it pretty much laid the groundwork for going Primal without me even realizing it. Although, I did bring out the sugar last week, to make the sweet potato soda for a party – it was quite popular with the ‘I like to try strange new things’ crowd.
Well, I’ve got nothing to say about cholesterol, because I’ve never bothered to check it – I’ll stop hijacking the forum now.
Interesting reading. My wife (40) just had her annual physical and we were placing bets on what her cholesterol might be. Last year it was 160. We have been following the primal eating plan for 6 weeks now…She came back today with blood results and it was at 207! I don’t have all of the details of good to bad, but she was pretty floored.
So what did her doctor say? (My doc too). Told her stop eating eggs (just the whites, cut back on all fats, increase fiber, etc. This was a great post, but I need to learn more on this as well.
New to paleo- 30 days
51 years young and workout regularly.
So here are my numbers – I expected them to be high but was shocked at how high. I have to admit I was thrown a bit off stride. The ratios seem good though and my HDL seems pretty solid.
Any reason for concern?
Total 327
Triglycerides 72
HDL 119
LDL 160
NMR particle size test pending
I should mention. I was not truly fasted at the time of the blood draw as required. I had 3T coconut oil and hiked 2 hours early that morning. Would this impact the lipid profile?
Greg
Cholesterol helps repair damaged cells as far as I’m aware. So when you go Primal, you remove all the crap that was damaging your cells, because there is no more interference, your body creates more cholesterol because for the first time in your life your body is free to send out as many helpers to repair all the crap you’ve been doing to your body when you weren’t primal!
Another reason could be is that your body was always producing the same amount of cholesterol, except when you were not primal the cholesterol was being used up to constantly to repair cells that were constantly being damaged, as soon as you go primal your body heals all your cells but your cholesterol creating mechanism has not caught up, so it keeps producing the same amount as before you were primal for a while, eventually it levels out and balances…
Firefighters are used to there being 100 fires so they have been sending out 100 firefighters for 20-30 years, suddenly there are only 20 fires, but because there have gotten used to there being 100 fires for so long the firefighters automatically send out 100 firefighters anyway untill they get used to the fact that there are only 20 now. :p
I’ve gone primal in the past 4 months (no grains and processed foods, lots of protein, good fat (including saturated), and veggies, lifting heavy things).
I’ve always had high cholesterol and all “bad stuff” and haven’t checked in at least 2 years since I’ve lost at least 25lbs and gotten a lot leaner.
Earlier today I had my cholesterol checked with HIGH expectations
Some numbers were good
1. Triglycerides (109) [they've always been high because I used to eat a lot of processed food such as chips and ramen]
2. HDL (74.2)
But to my extreme disappointment:
1. My total cholesterol has gone sky high (488)
2. My LDL as well (392)
From this post, I’m guessing my problems are the ff: micronutrient deficiency, activity levels not matching carb intake (ive gone really low carb), and not moving frequently at a slow pace
I will try to address these problems in the next month and update you.
I have had some cholesterol issue in the past about 10 years ago or more. They have been okay every since until now. I have been been doing low carb, low fat, high protein and low sugar for a year now. Went to the doctor for my yearly bloodwork and my numbers are both out of control. I am stunned. He has actually put me on Lovastatin since I also have had HBP for several years now.
Freaked out this morning as I retrieved the results from a blood test for life insurance. I’ve been on Primal for 6 months. I went from 176 lbs to 160 lbs between August and November and have maintained since then. My TC is 292 with LDL-195, HDL-82, and Tri at 71. I’ve been reading comments and this seems really high compared with others. I lift 2-3 times a week, and sprint at least once. Taking iodine, going to increase copper and selenium, cut down on snacking and increase slow movement. Will this be enough?
Sub’d
Hi
I stopped fructose 6 weeks ago and tested my bloods on the day and then 6 weeks later. I dropped my triglycerides 35% raised HDL 20% but the LDLs up nearly 30%.. Is this normal in the short term?
Cheers Dave skinnyfatman.org