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?

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!

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. 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.

    Chiara wrote on January 16th, 2013
  2. 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.

    Deborah Pucci wrote on January 16th, 2013
  3. 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?

    Donald Sibley wrote on January 27th, 2013
  4. Sub’d

    Donald Sibley wrote on January 27th, 2013
  5. 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

    Dave wrote on April 20th, 2013
  6. As a current paleo/primal lover, I am seriously scared to go back to the doctor to get my cholesterol checked.

    I’m pretty sure I have genetically high cholesterol.

    The ONLY time when my cholesterol was LOW, was when I was on a strict vegan diet for 3 months and training for a 10mile run.

    Pretty sure veganism was the main reason becuase I had been running prior to that.

    My sister in law switched to a vegan diet after her cholesterol was high and that brought it down.

    vegan diet really isn’t sustainable for me and = weight gain, yet it brought my numbers DOWN.

    conflicted…

    Sarah Webster wrote on June 11th, 2013
  7. Hi All,

    I’m not sure if this is the right place to post. Please forgive me if it is not and point me to the right place.

    I’ve been eating paleo for a year now and last week had a non fasting blood test to measure Cholesterol levels. The number (UK) was 11.1 and I nearly fell off my chair.

    Today I had another blood sample taken after a fast so I am looking forward to seeing the breakdown.

    Does anyone on the list know a good LCHF friendly UK nutritionist I can work with to understand the potential high LDLs and how to get the potential inflammation or vascular damage sorted? At the moment I am assuming the reason for the high LDLs or total is down to nutrition.

    Eeeek!!!

    Sheyne

    Sheyne Bauermeister wrote on June 20th, 2013
  8. I had issues with heart problems and high LDL and Im only 29.
    The heart issues almost went away but Im still a bit worried..

    Salt and seafood sound a bit out of the question but I guess I need to try them sometimes..

    An informative article anyway again!

    Mikko wrote on June 23rd, 2013
  9. Yeah, after initially being thrilled with my numbers after taking them a few months after starting Paleo, (HDL almost doubled to 67, LDL slightly increased 122, TC slightly increased to 188 and Trig’s greatly reduced to 60)…a year later and my profile is not good. TC=241, HDL=57, LDL=157. But what was concerning was that the number of my small diameter LDL particles was well above the normal range and put me at high risk. I thought the paleo way of eating was supposed to increase the size. If it wasnt for that last number I would not have been concerned, but this now worries me and maybe I need to cut back on the fat or introduce more carbs?

    My docs wants me to start on Red Yeast Rice. Im going for a NMR lipid profile test this week to get a more definitive answer.

    Mike Anders wrote on July 17th, 2013
  10. I had my blood checked 3 months ago and my numbers look like this:

    Age: 37
    Weight: 73 kg (161 lbs)
    LDL-C: 208
    HDL-C: 52
    Triglycerides: 157

    I did a lot of reading, came across this site, and went primal and have been reasonably strict in sticking to it. I did no exercise before this test and no exercise for the next 3 months in order to see how well the primal diet works. Results 3 months later:

    Weight: 67 kg (148 lbs)
    LDL-C: 291
    HDL-C: 58
    Triglycerides: 96

    Well I lost weight effortlessly which is good, HDL up, TC up but my LDL is super high and I’m a bit worried despite all that I have read here. Should I be?

    Coremus wrote on July 23rd, 2013
    • Hi
      Can’t see your TC but here’s what I’ve leaned. Im not sure just how much fat ur ingesting either. I for one wasn’t consuming a whole lot so that didn’t account for my recent drastic numbers. I had the NMR done. Look at my post just above and my numbers have now jumped up another 50 odd points in just 3 weeks with no diet change.
      TC-281
      LDL- 211
      HDL-66
      TG -49
      Total particle count of LDL-P-1979

      I’m now accepting that this is probably Familial Hypercholesterolemia. My father died of.a stroke at age 45 and his mother at age 56 which is probably what they had.
      This condition can lie dormant and then suddenly come out of dormancy which is what I’ve read accounts for many of the cases. I wonder if these folks that suddenly have escalating high numbers, are not folks in this scenario and the Paleo way of eating kicks starts this genetic trait out of dormancy. Just a theory. But with my family history and now these numbers, looks like I will have to abandon the Paleo way of eating and satin therapy is probably in the cards for me. And I’ll be left wondering what would have happened if I had just stuck to my high carb low fat diet all along.

      My numbers were actually steady for 6 months and I suspect I’ve been fairly lucky to catch this that just started a couple of months ago. I just don’t know at this point where my numbers are going to stop going up and stabilize at.

      Mike wrote on July 24th, 2013
  11. I just had my blood work completed and have been strictly primal since Aug. 9, 2013. My cholesterol total has gone UP!!!
    total: 243
    LDL- C = 147
    HDL -C = 90
    Triglycerides = 32
    So what gives? I’ve recently started losing weight, down from 155 to about 137, and it still feels like I am losing. I was going to cut out eggs for breakfast and bacon :( boo and go to tuna fish :(
    Should i freak out … or try and remain calm…. I am freaking…..advice is appreciated.

    Mary wrote on November 12th, 2013
    • You should not freak, because your TC is not all that high, your HDL is great, and TG very low. However you should try to get a particle test, either NMR LP or apoB.
      I am similar to you with TC and LDL rising, HDL high, TG low, on a HFLC diet. High LDL confirmed by apoB test. According to Dayspring, a subset of people on HFLC will develop high LDL-P/apoB, possible due to the high intake of SF. After much consideration, I am trying the following: reduce long-chain saturated fat intake, increase MUFA & PUFA, increase fiber, add back some fruit (I have no IR), and have a thorough thyroid check. I also had a complete metabolic panel, which showed no inflammation by several biomarkers; and a coronary calcium scan showed zero. So the question remains whether one should be concerned about a high apoB or LDL-P in the absence of other risk factors.
      I wish those who posted last year would post updates.

      Jo wrote on November 24th, 2013
  12. I wouldn’t be worrying about it if I wasn’t seeking a new life insurance policy . . .

    Donald Sibley wrote on November 24th, 2013
  13. I had my blood work done in March, 2013 and although my total cholesterol was 216, everything else seemed ok. I started Paleo in April. I hiked 4 days of Appalachian trail, walked a marathon and try to walk about 200 miles a month. Running days are over, but do a lot of Yoga and am pretty active. Age is 65. I was diagnosed with neuro endocrine cancer and had part of my pancreas removed in June, 2013. I feel great. Had lost about 10 pounds before surgery and then quickly lost about 20 pounds recovering from surgery. I am still Paleo – about 70/30% but just had my blood work done. Total cholesterol is now 248, triglycerides are 162 and LDL is 158. I appreciate all of these comments but am still pretty concerned about my blood work. Is it possible that my surgery and quick weight loss played a role in this? Thank you for any feedback you can give me. Just know that I feel wonderful and love Paleo!

    Debi Beard wrote on January 10th, 2014
    • Hi Debi, what was your LDL to begin with? Often times your total cholesterol will increase due to an increase in your HDL (which is a good thing!). The goal is to achieve a good cholesterol ratio, which means you want a high HDL to help offset your LDL.

      LDL is a challenge to change through diet alone, and research has shown that LDL levels have a lot to do with your genetics. The best way to decrease your LDL is through exercise (or medication – as a last resort).

      To put it simply, instead of focusing on decreasing your LDL, focus on increasing your intake of healthy fats (think olive oil, eggs yolks, coconut oil and nuts) to achieve a better cholesterol ratio.

      Hope this helps!

      Nicole Elle wrote on January 10th, 2014
      • Post studies which show high HDL is protective especially in the face of high LDL.

        To tell a person whose LDL is 158 to eat MORE fat is just plain stupid.

        charles grashow wrote on January 10th, 2014
  14. Just before starting a Paleo medical study, bloodwork was drawn. At the completion, bloodwork again. The before & after results have shocked me! My main concern is that I started with my LDLP at 1451 & saw it increase to 1894! Everything else changed, & not for the better! I honestly do not want to go back to grains & dairy, but it also do not want to continue to eat this way & worry about a stroke with such a high risk number. I also get horrible stomach pains from time to time, lasting up to a week. I have had gallbladder tests & an endoscopy which came back normal. I am not sure where to go from here… Any suggestions on how to bring that LDLP number DOWN?

    BJ wrote on February 19th, 2014
  15. Have been primal for over a year now. Do smart savage exercise (short, explosive and functional), sprint once a week, skip meals now and then. walk a lot. I eat about 55 eggs a week. 1 fruit a day, small amounts of rice and sweet potatoes. Eat Grass fed, hormone free and anti-biotic free meat. Fresh veg, salmon oil supplements, full cream greek yogurt and avocado. Use butter and coconut oil for cooking. Make homemade protein shakes after exercise )butter, eggs, raw cacao, banana and coconut oil)
    had my bloods done and I was disappointed to say the least:
    total cholesterol: 320
    TG: 22
    HDL: 61
    LDL: 248

    I don’t have access to a test for particle size unfortunately. I’m so shocked because I base almost everything on ancestral/primal eating, sleeping, exercise and play. CRP is 1 and HbA1c is 5.1%

    can anyone comment on this? or has anyone seen similar results?
    kinda stressing because I am a Dietitian trying to educate patients as well as other doctors on high fat low carb..but these results don’t seem convincing ( But I do realize that Cholesterol totals give very limited information) And after reading Grain Brain, it seems a higher cholesterol level means better brain health!

    kind regards
    Nielen

    Nielen wrote on June 5th, 2014

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