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!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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162 thoughts on “Why Did My Cholesterol Go Up After Going Primal?”

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  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.

    1. 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!

  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. 🙂

    1. 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. 🙂

      1. 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?

    2. 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.

  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.

  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.

  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.

  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.

    1. 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 🙂

  7. My LDL was up since going primal, but the density was super low, meaning it’s the benign type.

  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.

    1. 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.

      1. 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.

    2. 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.

      1. 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!).

    3. 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.

    4. 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.

  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.

    1. I would love to have your low triglyceride count. THAT’S a nice number.

      1. 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!

  10. 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.

    1. I am reading “The Book of the Eskimo”. The Inuits kept their sled dogs hungry because they ran better if fasted.

    2. 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!

  11. Anne D

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

  12. 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.

    1. 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!

  13. 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.

  14. 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.

    1. 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.

      1. 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.

  15. 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.

    1. 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,

    2. You cannot have both low carb and low fat. Which did you mean?

  16. 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!

  17. 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.

  18. 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)

    1. 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.

    2. 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.

  19. 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.

    1. In American money(last time they were measured, anyway): Total,483; HDL,93; Tri,71.

  20. 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.

  21. 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…

    1. “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..

    2. 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!

      1. I’m in Phoenix too and would love to find a paleo friendly doctor.

        1. 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.

        2. 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 [email protected] 😉


    3. 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.

  22. 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!

    1. Agreed— everything I’ve read has indicated that the TG/HDL ratio is really the only thing to look at.

    2. 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!

  23. 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:


    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.

  24. 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 🙂


  25. 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.

  26. Mark what do you think about The Art And Science of Low Carbohydrate Performance?

    1. 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.

  27. 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.

    1. I also posted that link. Maybe they’re behind on approving posts.

  28. 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.

  29. 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!!

  30. 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…


    Cheers. Love your site!


  31. 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.

  32. 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

  33. 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 😉

    1. 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.

  34. 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?

    1. 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

    2. 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

  35. “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.

    1. 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?

    2. 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.”

  36. 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!

  37. 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.

  38. Wow, this was the perfect post for me! I’ve been Primal for a couple of months now and loving it. I’ve lost 47lbs so far and have never felt better. However, as of earlier this month, my cholesterol is also not looking so good. My HDL is low and my LDL is sky high. In fact, my doctor said my ratios are so bad that at this point she’s supposed to recommend statins (but she didn’t — I have an awesome doctor who is on-board with my Primal lifestyle and she is willing to watch my progress before freaking out.) Anyways, I did do a little research and discovered a few things that could be causing my elevated LDL, some of which Mark mentioned here. It’s nice to see it reaffirmed! I also discovered a few things that could be attributing to my slightly slow thyroid reading, but that’s another story. All in all, I’m not worrying too much at this point, and just continuing to do what I’m doing and trusting that in time, I will level out.

  39. Is 375 TC high enough to make you worry? LDL~260. Is this a case where statins may actually be a valid option?

  40. I’m in the UK and get regular bloods done due to arthritis meds….I was talking to the nurse about cholesterol while she took my last set and suggested that she could add the test on if I wanted….I was curious so agreed as they had my blood anyway 🙂

  41. I never had my cholesterol checked before I went Primal, so I have no basis for comparison. Actually, I’m glad to see that so many people have results like mine.

    Total: 228
    HDL: 104
    LDL: 112
    Trig: 50

    What was funnier was the reaction the woman who discussed my results with me had. She couldn’t stop talking about my amazing HDL numbers because the only people who ever came into the Naval Health Clinic with those numbers were the occasional admirals. To see an enlisted GIRL made her so happy she was beside herself.

    I am experimenting with a few of the things mentioned here. I can be prone to overtraining and under-carbing, but I recently decided to do a lot more slow-movement stuff and push harder during my intense workouts. So far, that’s left me feeling better on lower carbs.

    I’m kind of a grazer. I eat breakfast, I eat lunch, and then I come home, have a snack, and then sometimes graze until dinner. It’s always on veggies, but still, maybe I could use to do less of that.

    I’m also buying offal from a local farmer; just had some amazing Cajun Blackened Chicken Livers for lunch yesterday, and I thought I died and went to heaven. It’s going to become a regular part of my diet just due to budget constraints.

    I’ll be curious to see what my numbers turn out to be in a month or two when I go back for another test.

  42. I wish my parents’ doctor would get his act together and stop pushing back statins on my mother who stopped taking them when her memory started to get affected early last year. They would change him in a heartbeat but there is a dearth of doctors here and waiting lists are insanely long. My mother’s total cholesterol increased by 50 points but that is because her HDL increased, her Triglycerides dropped but her LDL increased (the Trig/HDL ratio indicates that it’s pretty much the large fluffy neutral LDL particle, not the small dense one).
    The FDA issuing warning labels on statins re memory loss helped my mother’s case with her doctor but he still not completely on board.

  43. I think it is interesting reading the comments how varied everybody’s cholesterol levels are. They are as varied as the levels among those who eat a more standard diet. Perhaps the whole idea that there is a diet that can create the cholesterol levels doctors would prefer to see is suspect. Since most of us feel so incredibly healthy eating this way, that ought to count for more than lab numbers with weak correlations to actual illness.

  44. I never realized Cholesterol repairs muscles, will switch from lifting weight to aerobics.

  45. Great article,had my annual checkup Chol 274, Tri 183, LDL 208, HDL 37. I’ve only cut out grains for about 3 months so far.
    I’m on some medications for life, but this information helps,and maybe I can get myself off the others. Hopefully, next year the results will be different.

  46. My numbers are pretty good both from a primal standpoint and from a traditional CW standpoint.

    After one year paleo I had this result last summer:

    total: 176
    HDL 59 (ish, can’t remember exactly it was high in the 50s)
    LDL 112
    Triglycerides 49

    My doctor was pretty happy with it.

    I actually worry my total might be too low, but I’m not doing anything specific about it. I still have a tiny spare tire to contend with so I started the Whole 30 last week with my wife. On day 11, So far so good. Only real difference has been the excision of dairy and alcohol.

    I’m 5’7″, moderately muscular and currently weigh 179 I don’t know what my Cholesterol numbers were back before paleo, when I was 225 and raw vegan because I was honestly too scared to test. I’m thinking about getting another test this summer to see where I’m at after year two. If it’s again good, I’ll probably not bother with it for a while.

    You’d think I have great genes but I’d beg to differ. We have heart disease, diabetes, obesity, and cancer in abundance in the various wings of my family.


  47. I have been fighting high trglycerides for 10 years and going primal is the first thing that has gotten them down!

  48. I’ve been putting off having my numbers rechecked, for fear of having the numbers be higher. In August 2011, I had my worst results ever: TC was 240+, TG were very high (I forget the exact #, but it was awful), HDL were the lowest they’ve ever been (below 60). My GP has wanted me on a statin for years, but as an under-40 year old female, I’ve been very resistant (still not taking any).

    I found this website in January 2012, and have gradually been transitioning to this eating style while lifting very heavy weights w/a trainer twice a week. I have dropped 25 pounds since January, and in thinking back to what I was eating in August, I would say that all of the “healthy” grains were contributing to the numbers, especially the TG. I was living on oatmeal, quinoa, and starchy vegetables, with very little meat and fat. I was hungry all the time, but weighed more than 200 pounds at 5’3″, with a 42 inch waist.

    Yesterday I made an appointment to have my annual physical in a few weeks. I still have some anxiety about how the numbers will come out, but I need to test the hypothesis in order to consider this a self-experiment. We’ll see how it goes!

    1. And, for what its worth, my waist is now under 35 inches, which may be a better indicator of health!

  49. Hey Mark @lowcarblearning,

    Read your blog entry on your cholesterol panel results.
    Standard Lipid Panel results provide cholesterol concentration, not details such as particle count on individual markers. Your latest TG/HDL ratio of .69 is ideal, from which one can infer size pattern A in your LDL particles and good cardio health.

    According to Dayspring and others, the inference has a 20% chance of discordance, in that you may have an excessively high LDL-P particle count. Too many particles of LDL (even pattern A) is the root cause of arterial clogging.

    NMR Lipoprofile outcome can confirm the TG/HDL inference.

  50. I haven’t even had a lipid panel done in almost 10 years. I don’t see the point.

  51. NMR test done on 5/10/12

    HDL-C 59
    Trig 36
    Total Cholesterol 254
    LDL-C 168

    LDL-P (particle #) 1500
    Small LDL-P 127
    Large LDL-P 1373

    LDL Size 21.1

    LP-IR (Insulin Resistance) 6 S/B <=45

    TGL/HDL = .61

    SO – do I have too many particles even though they're large and buoyant??

    1. Ratios are as important and maybe more important than total numbers. Your ratios are actually pretty decent.

      Your Total Cholesterol/HDL ratio is: 4.31 – (preferably under 5.0, ideally under 3.5) GOOD
      Your HDL/LDL ratio is: 0.351 – (preferably over 0.3, ideally over 0.4) GOOD
      Your triglycerides/HDL ratio is: 2.288 – (preferably under 4, ideally under 2) NORMAL

      Plus – the Large LDL (which is the majority of the LDL) is associated with lower risk of atherogenesis.

      The other things that we don’t see here though are: is this an initial reading? If not – how is it different than other readings?

      Another thought – what kind of balance do you have in your diet? Even though protein and fat are great – we really should probably be consuming a relatively large quantity of plants too….which will change a lipid panel dramatically.

      Oh yeah – and genetic background makes some difference. If you’re ancestrally from a relatively extreme northern hemisphere location (think really short summers) you’ll make more cholesterol naturally – because it’s a precursor to Vit. D (and lots of hormones). It’s there to take advantage of any possible sun for conversion to Vit. D. Diet only goes so far to change that….

  52. Gee could it also maybe because you are eating more meat which is the only thing we eat that contains bad cholesterol?

    1. How dare you use common sense and scientific facts! Thanks to you, Mark will be selling one less book this week and will have to wait a WHOLE 24 HOURS more until he can buy his new porche.

  53. At 22 I was a vegan with a cholesterol over 215 with bad ratios.
    At 45 paleo I’m 167 total cholesterol, 59 triglyc., 60 HDL, 96 LDL.
    I’ve owned my own flock of chickens & for 15 years i’ve eaten 2-5 eggs every day. I have a high fat diet consistant with weston price & paleo. People have told me for years not to eat so many eggs & have tried to offer egg beaters. The proof is in the bloodwork.

  54. Looks like I have more bio research to do. If the people who are arguing against me (the people closest to me who have watched me do well eating this way and insist I’m still wrong) get a hold of this, they’ll totally go off saying that these unfounded “solutions” to rising serum numbers are just a way to deflect the fact that bacon and butter will kill us all. Therefore, I have more reading to do.

    I wondered myself what would happen if my numbers went up. Panic, probably. I’m having a significant amount of trouble building strong arguments against conventional diet advice as it is. I’ve stuck to the “credible” sources trying to develop a concise, mechanistically sound explanation of the physiological reasons why reducing carbohydrates in general and grains in particular is a good idea, because as a future medical professional and an insufferable know-it-all I have to have more than the usual fat=fat, carbs=fat explanations that most people are satisfied with. I need physiological functions, cell metabolism, and chemical mechanisms!

    I’ve read Wheat Belly, by a cardiologist. “Circumstantial,” my fiance says about the patient cases cited.

    I’ve read The Paleo Solution, by a research biochemist. “They just want to sell a book and make money,” my mother says.

    I’ve read the Paleo Diet, by a PhD. “Not a real doctor.”

    I have designs on The Art and Science of Low Carbohydrate Living, by an RD, PhD and an MD, PhD, and the Protein Power books by the dynamic MD duo. “They aren’t really trying to help, they just want to sell a book and make MORE money.”

    I also plan on reading some of the top books my vegan friend recommends, to assess the claims made there, because if I only read Paleo resources seeking validation of Paleo, then I’m just as bad as the “bad science” people who form a conclusion first, then seek out data to support the conclusion instead of forming a hypothesis and seeking and assessing all data to accept or reject that hypothesis. (I also believe that the main argument of one MD–that tons of vegetables are key to health because of all the phytochemicals and other goodies we don’t get on a SAD–is fundamentally correct… I just think that the blame for too little plant matter in the diet falls on a crapton of starchy carbs and not on the animal products we supposedly gorge on.)

    I guess I’ll get to that when I’m done with my six weeks of accelerated premed summer courses…

    1. I don’t think anyone who is trying to sell you a glossy book is credible when peer reviewed dietary guidelines are available for free. A credible health site would clearly mark its advertisements for its products as ‘ADVERTISEMENT’ or better yet, not have any.

      I totally promote thinking critically (Where would science be if we didn’t) but please don’t bother reading all the peer reviewed stuff promoting a grain based diet without an open mind. That is not how science works either. Read everything critically, think of the motivation for writing, but do it without bias.

  55. I’ve had two blood work ups done within the past year. The first test showed total lipids and LDL just slightly above the maximum end of the reference range.

    The second test (compared against the first test) showed an increase in total lipds, a slight increase in LDL, a huge increase in HDL (where most of my total lipid increase came from), risk ratio went way down, and triglycerides moved up 3 points.

    I can live with that. =)

  56. Very nice post, as always Mark. My father is currently suffering from high cholesterol, and this article is one which I will show to him, in the hope that nutrition will help his health issues.

  57. I can’t understand sth- on Friday there was a story about 2 athletes who train very hard and don’t use any carbs, and now Mark says if we train intensively- we should eat carbs- who is right? I am confused when I read contradictory info.

  58. 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!

  59. 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.”


    Read more: https://www.marksdailyapple.com/why-did-my-cholesterol-go-up-after-going-primal/#ixzz1z6XKHexI

  60. 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.

  61. 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.

  62. 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.

  63. 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.


  64. 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.)

  65. 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.

  66. 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).

  67. 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.

  68. 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.

  69. 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.

    1. Thank you for the book recommendation and interesting comment, Jack!

  70. 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. + 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.

  71. 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.

  72. 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

  73. 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?


  74. 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

  75. 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.

    1. Hi, I have about the same total cholesterol like yours. I have gone ketogenic diet for 2 months and my blood result freak me out. I would like to know after you addressing your issues, has your cholesterol panels become better?

  76. 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.

  77. 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?

  78. 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

  79. 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.


  80. 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.



  81. 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!

  82. 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.

  83. 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?

    1. 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.
      LDL- 211
      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.

  84. 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.

    1. 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.

  85. I wouldn’t be worrying about it if I wasn’t seeking a new life insurance policy . . .

  86. 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!

    1. 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!

      1. 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.

  87. 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?

  88. 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

  89. Really helpful post. I am very sedentary after cancer & a severe stroke. I have lost 10kg in 4 months on Paleo with low intensity exercise (recumbent exercise bike). On a recent health check my triglycerides were up slightly – now reassured. My INR was up also but I realise his is due to increase in Vitamin K. I feel great and have no food cravings. This is now my new lifestyle as i head toward my new goals.

    Thanks Mark, fantastic.

  90. I know this is an old post, so I how sometimes still paying attention to it. I’m finding my cholesterol levels to be elevated after going to a paleo lifestyle. I’m fighting several auto immune symptoms that make energy a issue. Talking with a functional medicine md to start working on hormone/vitamin/thyroid deficiencies. But I’d like to start being more active asap. I ride horses, and am wondering if long walks on a horse with some trotting/catering interspersed would be equivalent to a long walk on foot. I have better places to ride than walk and realistically the ponies need exercise too XD

  91. Thank you for this post. I’m currently experiencing weight loss and while triglycerides/HDL ratio is very good, my LDL-P is high. My biggest wonder is if my cholesterol needs time to even itself out. But this article has given me a few options for actions to take as well.

  92. My boyfriend has hereditary high cholesterol. He has always exercised every day, and has never been overweight. He does long-distance swimming, intense hikes, pilates. We have been eating primal for years. His doctor expressed concern recently about his high cholesterol numbers, but he refused to take a statin, partly based on my research from this website and others like Mercola that say to not worry about high cholesterol numbers if you are healthy. Instead he went on a supplement called red yeast rice that he got from his naturopathic doctor. I Iooked up red yeast rice and apparently it has a very similar effect to statins. Well ten days ago he had a major stroke, caused by a cholesterol plaque in his artery. He has temporarily lost the use of his left side. He is only in his 50s. We told the neurologist at the hospital that he has been taking red yeast rice, and he said that supplement doesn’t work on the hereditary form of high cholesterol. On top of all of this, a friend of ours who had very high cholesterol cut his numbers to normal after going vegan. Until this stroke happened we thought it was ridiculous the he went vegan, we believed so much in the whole paleo primal lifestyle. My boyfriend had been telling me for a few weeks that he didn’t feel so good after having red meat, that he wanted to cut back. But I didn’t really listen. With my advice and the advice of his naturopath he cut his sugar and grains more instead, stopping most fruit and rice.

    I’m writing this so that it may help others to be more careful than I was when someone has alarming numbers from their doctor. Everyone’s body is different, and some people need to be careful than others. I feel like I’ve been an ass and contributed to this disaster.