To read more about heart disease and cholesterol, check out this eBook on the Diet–Heart Myth.
It’s hard to overstate the impact that cardiovascular disease (CVD) has in the U.S.. Consider the following:
- Cardiovascular disease affects 65 million Americans.
- Close to one million Americans have a heart attack each year.
- In the U.S., one person dies every 39 seconds of cardiovascular disease.
- 1 of 3 deaths that occurs in the U.S. is caused by cardiovascular disease.
- 1 in 3 Americans have metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance.
- The total cost of cardiovascular disease in 2008 was estimated at $300 billion.
To put that last statistic in perspective, the World Health Organization has estimated that ending world hunger would cost approximately $195 billion. One might argue that the $300 billion we spend on treating cardiovascular disease in the U.S. is a necessary expenditure; however, a recent study which looked at the relationship between heart disease and lifestyle suggested that 90% of CVD is caused by modifiable diet and lifestyle factors. (1)
Unfortunately, cardiovascular disease is one of the most misdiagnosed and mistreated conditions in medicine. We’ve learned a tremendous amount about what causes heart disease over the past decade, but the medical establishment is still operating on outdated science from 40-50 years ago.
In this 4-part series, I’m going to debunk 3 common myths about heart disease:
- Eating cholesterol and saturated fat raises cholesterol levels in the blood.
- High cholesterol in the blood is the cause of heart disease.
- Statins save lives in healthy people without heart disease.
In the fourth and final article in the series, I’ll discuss strategies for naturally protecting yourself against heart disease and improving your heart health.
Myth #1: Eating Cholesterol and Saturated Fat Raises Cholesterol Levels in the Blood.
Most of us grew up being told that foods like red meat, eggs and bacon raise our cholesterol levels. This idea is so deeply ingrained in our cultural psyche that few people even question it. But is it really true?
The diet-heart hypothesis—which holds that eating cholesterol and saturated fat raises cholesterol in our blood—originated with studies in both animals and humans more than half a century ago. However, more recent (and higher quality) evidence doesn’t support it.
Cholesterol and saturated fat: dietary enemies or innocent victims of bad science?
On any given day, we have between 1,100 and 1,700 milligrams of cholesterol in our body. 25% of that comes from our diet, and 75% is produced inside of our bodies by the liver. Much of the cholesterol that’s found in food can’t be absorbed by our bodies, and most of the cholesterol in our gut was first synthesized in body cells and ended up in the gut via the liver and gall bladder. The body tightly regulates the amount of cholesterol in the blood by controlling internal production; when cholesterol intake in the diet goes down, the body makes more. When cholesterol intake in the diet goes up, the body makes less.
This explains why well-designed cholesterol feeding studies (where they feed volunteers 2-4 eggs a day and measure their cholesterol) show that dietary cholesterol has very little impact on blood cholesterol levels in about 75% of the population. The remaining 25% of the population are referred to as “hyper-responders”. In this group, dietary cholesterol does modestly increase both LDL (“bad cholesterol” and HDL (“good cholesterol”), but it does not affect the ratio of LDL to HDL or increase the risk of heart disease. (2)
In other words, eating cholesterol isn’t going to give you a heart attack. You can ditch the egg-white omelettes and start eating yolks again. That’s a good thing, since all of the 13 essential nutrients eggs contain are found in the yolk. Egg yolks are an especially good source of choline, a B-vitamin that plays important roles in everything from neurotransmitter production to detoxification to maintenance of healthy cells. (3) Studies show that up to 90% of Americans don’t get enough choline, which can lead to fatigue, insomnia, poor kidney function, memory problems and nerve-muscle imbalances. (4)
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What about saturated fat? It’s true that some studies show that saturated fat intake raises blood cholesterol levels. But these studies are almost always short-term, lasting only a few weeks. (5) Longer-term studies have not shown an association between saturated fat intake and blood cholesterol levels. In fact, of all of the long-term studies examining this issue, only one of them showed a clear association between saturated fat intake and cholesterol levels, and even that association was weak. (6)
Moreover, studies on low-carbohydrate diets (which tend to be high in saturated fat) suggest that they not only don’t raise blood cholesterol, they have several beneficial impacts on cardiovascular disease risk markers. For example, a meta-analysis of 17 low-carb diet trials covering 1,140 obese patients published in the journal Obesity Reviews found that low-carb diets neither increased nor decreased LDL cholesterol. However, they did find that low-carb diets were associated with significant decreases is body weight as well as improvements in several CV risk factors, including decreases in triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin and c-reactive protein, as well as an increase in HDL cholesterol. (7)
If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (8) A Japanese prospective study that followed 58,000 men for an average of 14 years found no association between saturated fat intake and heart disease, and an inverse association between saturated fat and stroke (i.e. those who ate more saturated fat had a lower risk of stroke). (9)
That said, just as not everyone responds to dietary cholesterol in the same manner, there’s some variation in how individuals respond to dietary saturated fat. If we took ten people, fed them a diet high in saturated fat, and measured their cholesterol levels, we’d see a range of responses that averages out to no net increase or decrease. (If dietary saturated fat does increase your total or LDL cholesterol, the more important question is whether that’s a problem. I’ll address that in the next article in this series.)
Another strike against the diet-heart hypothesis is that many of its original proponents haven’t believed it for at least two decades. In a letter to the New England Journal of Medicine in 1991, Ancel Keys, the founder of the diet-heart hypothesis said (10):
Dietary cholesterol has an important effect on the cholesterol level in the blood of chickens and rabbits, but many controlled experiments have shown that dietary cholesterol has a limited effect in humans. Adding cholesterol to a cholesterol-free diet raises the blood level in humans, but when added to an unrestricted diet, it has a minimal effect.
In a 2004 editorial in the Journal of American College of Cardiology, Sylvan Lee Weinberg, former president of the American College of Cardiology and outspoken proponent of the diet-heart hypothesis, said (11):
The low-fat, high-carbohydrate diet… may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type 2 diabetes, and metabolic syndromes. This diet can no longer be defended by appeal to the authority of prestigious medical organizations.
We’ve now established that eating cholesterol and saturated fat does not increase cholesterol levels in the blood for most people. In the next article, I’ll debunk the myth that high cholesterol in the blood is the cause of heart disease.
Cholesterol is just one of many factors that determine our cardiovascular health. Many studies suggest that inflammation, oxidative stress, and endothelial function play an even greater role in the pathogenesis of heart disease.
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When one goes to the doc and get their cholesterol checked, how should one interpret the numbers?
For total cholesterol:
• If your level is less than 140 mg/dL (3.6 mmol/L), then you have severely low cholesterol.
• If your level is at least 140 mg/dL (3.6 mmol/L), but less than 160 mg/dL (4.1 mmol/L), then you have low cholesterol.
• If your level is at least 160 mg/dL (4.1 mmol/L), but less than 200 mg/dL (5.2 mmol/L), then you have a healthy cholesterol level.
• If your level is at least 200 mg/dL (5.2 mmol/L), but less than 240 mg/dL (6.2 mmol/L), then you have borderline high cholesterol.
• If your level is at least 240 mg/dL (6.2 mmol/L), but less than 300 mg/dL (7.8 mmol/L), then you have high cholesterol.
• If your level is 300 mg/dL (7.8 mmol/L) or more, then you have severely high cholesterol.
For HDL-cholesterol:
• If your level is less than 20 mg/dL (0.5 mmol/L), then you have severely low HDL-cholesterol.
• If you are a male and your level is at least 20 mg/dL (0.5 mmol/L), but less than 40 mg/dL (1.0 mmol/L), then you have low HDL-cholesterol.
• If you are a female and your level is at least 20 mg/dL (0.5 mmol/L), but less than 50 mg/dL (1.3 mmol/L), then you have low HDL-cholesterol.
• If you are a male and your level is at least 40 mg/dL (1.0 mmol/L), but less than 60 mg/dL (1.6 mmol/L), then you have normal HDL-cholesterol.
• If you are a female and your level is at least 50 mg/dL (1.3 mmol/L), but less than 60 mg/dL (1.6 mmol/L), then you have normal HDL-cholesterol.
• If your level is at least 60 mg/dL (1.6 mmol/L), but less than 90 mg/dL (2.3 mmol/L), then you have high HDL-cholesterol (contrary to popular belief, this is not necessarily a good thing; although I don’t have enough sources to recommend lowering HDL-cholesterol).
• If your level is 90 mg/dL (2.3 mmol/L) or more, then you may have severely high HDL-cholesterol (again, I have found too few sources to say for sure that this is a bad thing [aka, “too much of a good thing”] and should be reduced to the normal level).
For triglycerides:
• If your level is less than 35 mg/dL (0.4 mmol/L), then you have severely low triglycerides.
• If your level is at least 35 mg/dL (0.4 mmol/L), but less than 50 mg/dL (0.6 mmol/L), then you have low triglycerides.
• If your level is at least 50 mg/dL (0.6 mmol/L), but less than 100 mg/dL (1.1 mmol/L), then you have an optimal triglyceride level.
• If your level is at least 50 mg/dL (0.6 mmol/L), but less than 150 mg/dL (1.7 mmol/L), then you have a healthy triglyceride level.
• If your level is at least 150 mg/dL (1.7 mmol/L), but less than 200 mg/dL (2.3 mmol/L), then you have borderline high triglycerides.
• If your level is at least 200 mg/dL (2.3 mmol/L), but less than 500 mg/dL (5.6 mmol/L), then you have high triglycerides.
• If your level is 500 mg/dL (5.6 mmol/L) or more, then you have severely high triglycerides.
As well as your specific values, you should also know your HDL/LDL ratio, HDL/total cholesterol ratio, and triglyceride/HDL ratio. Before computing these ratios, your HDL-cholesterol, LDL-cholesterol, triglycerides, and total cholesterol values should all be in mg/dL. If your blood lipid results are in mmol/L, you can convert these values to mg/dL here: http://www.onlineconversion.com/cholesterol.htm
For HDL/LDL ratio:
• If your ratio is no more than 0.3, then this is low.
• If your ratio is more than 0.3, but no more than 0.4, then this is acceptable.
• If your ratio is more than 0.4, then this is ideal.
For HDL/total cholesterol level:
• If your ratio is less than 0.10, then this is low.
• If your ratio is at least 0.10, but less than 0.24, then this is acceptable.
• If your ratio is 0.24 or more, then this is ideal.
For triglyceride/HDL ratio:
• If your ratio is no more than 2, then this is ideal.
• If your ratio is more than 2, but less than 4, then this is acceptable.
• If your ratio is at least 4, but less than 6, then this is high.
• If your ratio is 6 or more, then this is severely high.
Hi,
I know this is an old post, however, if you happen to see it…if your triglyceride and HDL ratio is below 2.
Actually, 1.6, what does this mean?
Chris, while I am aware of recent studies suggesting that modest reduction in dietary fat doesn’t do much, there are other studies very strongly suggesting that a major reduction in fat (as in only 10% of calories from fat) does a great deal, such as even reversing heart disease. I have in mind the published studies by Ornish and by Esselstyn, as well as the Okinawa centenarian studies, among others. What is your view on these?
Hi,after reading all the comments above my head hurts 🙂 Glad to have found this site and hope to learn and contribute. About a year and a half ago my Naturopathic Doctor (ND) diagnosed me with a number of “things,” including adrenal fatigue, MTHFR Gene Mutation (can’t process folate), low thyroid function, insulin resistance/pre-diabetes and high cholesterol.
In January 2014 my weight was 202 (I’m a 51 y/o male, 5’11”) and my lipid panel was “bad.” My ND told me to lose weight, and cut back on carbs else she would have to recommend a statin, and for an ND, that is almost unthinkable. I went on aHFLC diet for 4 months and got re-tested two weeks ago. My weight dropped from 202 to 176! Yeah, that is pretty cool, and I feel better. My HDL, VLDL, Insulin, Trigly, A1C and CRP got better on the HFLC diet. However, my TC and LDL got a lot worse. My ND freaked and threatened me with statins again. She suggested getting off the HFLC diet and switching to a Paleo diet. She also suggested that my low thyroid function could be the cause of these bad numbers and wrote me a script for Naturethroid (thyroid booster). So, now I’m confused and would appreciate any help. First, regarding the lipid panel, should I be concerned with higher TC and LDL?
Marker Jan-14 May-14
Glucose, Serum 102 108
Insulin 12.7 10.2
TC 265 321
Triglyc 340 140
HDL 35 48
VLDL 68 28
LDL 162 245
A1C 5.9 5.7
CRP 6.91 5.6
Matt, you can do both HFLC and Paleo together. I think that’s generally a good idea because it will encourage you to eat more vegetables and the quality of meat you are eating may improve as well. Given your thyroid issue, talk with the ND about the benefits of organ meats like liver.
I wouldn’t worry too much just yet. If I were you, I’d get tested every couple months then only make new life changes after you get two or three consistent readings.
You will probably discover that your trigs will go down further and HDL will go up more as you continue your healthy lifestyle.
I think it’s also important that you get out and walk briskly at least 10 minutes daily. This also helps to reduce stress.
I’m no professional btw. I’ve just been eating a healthier lifestyle for about 15 months now.
Thomas, thanks for your advice — makes sense. I think you are right about Trigs continuing to go down and HDL going up. So, will continue the HFLC diet and add the Paleo component to it.
Now, the 64,000 question (that most of us have) is why is TC and LDL going up way over “conventional” guidelines and is there any good data to indicate this is something to be concerned or not concerned about? Okay, now off for that brisk walk!
Best, Matt
Matt,
I guess I’m one of those that’s a believer in the old way of lowering cholesterol. Mostly because I am actively watching it happen in my partner. He had a similar situation, except he treated it with exercise, portion control using the “MyFitnessPal” app on the iphone to maintain a daily caloric limit, and then doing low cholesterol/high fiber diet. (Which this article is saying is the no-no/myth.)
This is where I just can’t get behind the high fat low carb diet thought-process. I started us on that before he had a problem, and then all of the sudden his cholesterol is through the roof! I felt so bad because I got us into that diet and then he is having issues…so we listened to the old way of thinking instead, which is
1) exercise
2) low (bad) cholesterol diet
3) lots of fatty fish/olive oil/avocado/healthy fats
4) low fat dairy if any
5) oatmeal/whole grain bread/whole grain cereal
6) portion/calorie control
He did all of that, and everything is going into the normal ranges. We are still a little off on his LDL, but it’s went waaaay down. It is at 168 as of a few days ago so we are keeping it up.
He’s 37, and is 5’8″ and 160lbs now. Started at 190lbs.
The only advice I can say is to watch your testing, and see what works for you. I don’t buy the HFLC diet because it was bad for my man. But that could just be because of his personal chemistry, maybe? Maybe everyone is different. Frustrating.
Hi,My fasting blood cholesterol is nearly twice the normal for over 10 years.The doctor had insisted that I take the cholesterol lowering drug but I never did.
Been running half marathons for over 30 years now.I eat everything I wish,some junk food once in a while.No alcohol,no cigarette,no unnecessary stress.But avoiding sugars now, keeping slim and fit by exercising like I always did.This works for me and is not any kind of advice.
Great article.Thanks
This is such a scam.
Even if it were true that saturated fat and cholesterol aren’t the culprits of high cholesterol, this article doesn’t explain what the culprits ARE. If someone reads just this article alone, it looks as if it’s written by a knowledgeable author (although not a doctor), who is claiming that it’s perfectly safe to eat all the saturated fat and cholesterol you want without having to worry about risking your safety. Meanwhile, my boyfriend’s DOCTOR has suggested the exact opposite, and whenever he cuts the amount of saturated fat and cholesterol he eats, his (bad) cholesterol levels drop.
It’s irresponsible to go around saying things like “eating cholesterol isn’t going to give you a heart attack. You can ditch the egg-white omelettes and start eating yolks again” as a blanket statement and then withhold the information about how to protect against high cholesterol unless they read your other articles. Not to mention, there are no obvious links to the other articles, and when you look for them, you’re sent to a link to register for an e-book, which I’m sure at some point leads to a paid product or cost in some other way…
Please stick to acupuncture and do not write things that seem to present themselves as medical advice. Not everyone will do their homework before taking it to heart… literally, in this case. 🙁
Ryann T,
I recommend you research this topic before blindly accepting nutrition advice from an MD. This seems counterintuitive, but most MDs only get one or two semesters of nutrition education and that is influenced by dogma that has since had serious flaws exposed since it was introduced 50 years ago.
First, I’d recommend following the citation links in the article. I can also say I don’t pay for any content and was able to access his other articles. I’d also recommend looking for a two part documentary on YouTube aired a few months ago on the Australian Broadcasting Company. I don’t remember the name of the show and am on my tablet, but if you search within the comments here even, you’ll probably find a link. Also, check The Great Cholesterol Myth out of your local library. It has a lot of citations, so you may find yourself renewing it several times to give yourself enough time to track it down.
To give you the briefest summary of the main cause of cardiovascular disease, two words: chronic inflammation. This is damage done to the endothelial walls of arteries. Several things cause it, including oxidized LDL and elevated blood glucose (look up AGEs).
You don’t have to eat low carb high fat paleo to be healthy, but you do need to eat more vegetables than are normally consumed in a typical western diet, avoid added sugar, and seed oils. Do those, and you’ll have a great start to reducing inflammation.
Read, “Grain Brain” written by a neurologist, look at a few science mags from the last few months, New Scientist, American Scientist, etc. then read the first chapter of Nourishing Traditions… not ALL of the scientific research that has been done on these matters has been performed with rigid scientific non-biased approaches(note how certain interests held by those funding the FLAWED and heavily skewed papers on trans-fats and cholesterol affected the outcomes and therefore the data and what we have been falsely led to believe) Before ppl have the impulse to criticise the paleo diet and comment on cholesterol, they need to read more broadly; and that includes knowing how to judge whether a piece of research has been performed at rigorous scientific standards!
The only positive thing gleaned for us from Grain Brain was to avoid Statins.
Me and my partner tried the Grain Brain diet after hearing about it on NPR and the result we saw was my man’s cholesterol shooting up through the roof. We were not happy with it.
We received advice from a friend who got her degree in Nutritional Science from Purdue…she’s not some fancy TV personality or anything, but she did get his cholesterol down from what the HFLC diet seemed to screw up.
We used the methods described as “myth” above. We did go against the MD’s (and the Cardiologist’s) recommendation for taking a Statin. That is one thing he does NOT want to do, and I don’t blame him.
Chris I have a talk radio show. Would love to have you on the show to talk about cholesterol. I’ve been on board for over 2 years about this myth. The major role this essential nutrient plays!
Feel free to cal me if you’d like to discuss further.
(702)286-5486
You are doing the public a dis-service by stating that cholesterol is not related to heart disease. Exactly what levels increase the risk is not known but it appears that everyone with levels below 150 with LDL below 100 have not had heart disease in any study.
There are studies that show saturated fat in meat raises cholesterol therefore if it makes it over 150 it means you just increased your risk of heart disease.
Here are many studies that you are welcome to try to refute:
http://en.wikipedia.org/wiki/Saturated_fat_and_cardiovascular_disease_controversy
“There are studies that show saturated fat in meat raises cholesterol therefore if it makes it over 150 it means you just increased your risk of heart disease.”
… and decreased your risk of trauma, cancer, hemorrhagic stroke, respiratory and infectious diseases, suicide, depression, impulsivity, aggression, reduced brain function, dementia, etc. Bringing your cholesterol up above 150 (or even better, 160) will reduce your risk of these health problems more than it increases your risk of heart disease — thereby reducing your all-cause risk of mortality.
Also, there was at least one study in which people had heart attacks with total cholesterol below 150 — the MRFIT study. See my last comment for details.
As well, while saturated fat does raise LDL-cholesterol, it also raises HDL-cholesterol and lowers triglycerides. Here is one of my sources on this: http://www.more.com/health/healthy-eating/saturated-fat-good
Difficult to find one article with more BS in it than this one.
You totally fail to explain how people go on a whole plant-based diet and get their cholesterol levels below 150 and their LDL well below 100. You also fail to explain how during the study of 45,000 nurses in the Framingham Study there was not one person that got heart disease in 25 years with cholesterol below 150.
Studying cholesterol levels between 180 to 255 and saying cholesterol makes no difference is more of ignorance than science.
Obviously, those people who go on the plant based diet bring their cholesterol down because they are eliminating processed food, factory-produced fats, and added sugar. I assume that most people who go on plant based diets choose fresh and unprocessed vegetables, rather than processed vegetables such as fries.
However, people with total cholesterol values below 150 are not exempt from heart disease — and especially not health problems in general, as driving your total cholesterol below 160 can create serious health risks of its own. You quote the Framingham Study, in which there was supposedly no heart disease with total cholesterol below 150 in 25 years; however, how do you explain the fact that in the MRFIT study, which included 350,977 men and lasted six years, there were almost 50 deaths from CVD out of every 10,000 men with total cholesterol of 140-159, and slightly more than 50 deaths from CVD out of every 10,000 men with total cholesterol below 140? How do you explain the fact that there were more strokes in these groups than in any other group studied, even slightly more than the 280-299 group and the 300+ group? You can see the chart for yourself here: http://1.bp.blogspot.com/-BrNwqzHAwFw/UX6xKNueesI/AAAAAAAAApo/qNHDJ-3xx_c/s1600/mrfit_mortality_in_350,977_men_aged_35-57.png
And even though people with total cholesterol in the 140-159 range have the lowest risk of heart disease, they do not have the lowest risk of mortality from all causes — people in the 180-199 range are the ones with the lowest all-cause mortality rates. Why, you may wonder? Because when you drive your cholesterol down to dangerously low levels (less than 160 mg/dL), you significantly increase your risk of dying from other causes, such as trauma, cancer, hemorrhagic stroke, respiratory and infectious diseases, and suicide, and you also increase your risk of depression, impulsivity, and aggression. Sound fun? I don’t think so. Oh, and don’t forget about poor brain function and dementia.
Where do I access the other 3 articles in this series? I can’t find any links.
Gwen —
Go to the top of the page and click on “articles” to the right of the header “Chris Kresser Health for the 21st Century.” You will see a list of his articles starting with the most recent. This article is currently on page 31; however, it will continue to go to later pages as more articles continue to be published.
To help you out, here are some links to some of his articles in the Diet-Heart Myth series:
http://chriskresser.com/the-diet-heart-myth-why-everyone-should-know-their-ldl-particle-number
http://chriskresser.com/what-causes-elevated-ldl-particle-number
http://chriskresser.com/the-diet-heart-myth-statins-dont-save-lives-in-people-without-heart-disease
http://chriskresser.com/the-diet-heart-myth-how-to-prevent-and-reverse-heart-disease-naturally
What do you mean all 13 of the essential nutrients are found in the yolk? I know the yolk has more, but the white has some too.
My assumption is that while there are some nutrients in the white, the same nutrients are probably also found in the yolk — and then some.
Great overview and I am living proof you are right on target! Over 2 years ago I had a bad C Diff infection and at the same time was placed on a rxn low fat diet. The decent into Hades was horrible to say the least. Nobody was putting two and two together until I ended up in the ER with chest pain. They ran a cholesterol panel my levels came in at 108 with the system marking it very low…..though nobody informed. I only found out after hunting down my medical records. Needless to say every system in my body was slowly going up in flames from the GI, sex hormones, and brain function just to name a few. Luckily, I started my own research and paid for a conn. doctor to help me recover. I am still ill, but do not feel as if I am at death’s door anymore. Thank you for spreading the word about cholesterol NOT being the villain! I just wish most physicians would stop with the low fat / low cholesterol diets……way dangerous from my personal experience.
Oh my g.o.s.h.!!!! These days if you want to be ‘healthy’ you either need to be a M.D. or have a Ph.D in nutrition! All of these conflicting comments make me want to poke a stick in my eye, or eat dirt. But what kind of dirt? Brown, red, black, white? Is one better than the other? i”m sure there’s a dirt expert out there who can confuse me with all my options. I’m more inclined to be like money mogul Warren Buffet, and do the exact opposite of what the ‘experts’ tell me to do. So bring on the sat. fat. Hello butter, and bacon! Goodbye canola and safflower oil. Hello whole wheat bread that has been soured, soaked, or sprouted. Goodbye highly processed rice cakes, and granola bars, and all the gluten free garbage. In other words, I’m just going to eat real food, prepare it properly (grains need to be prepared before consumption – just ask Cortez) and not over think this. Just remember eggs, chocolate and sat, fat were once labeled “bad” for you. The experts of nutrition don’t know their own silly business. But they do make a lot of money anyway, don’t they?!
Alas, we have to become hyper-educated on this topic and sift through the conflicting info we find. I think many of us have had a high cholesterol report, with the doctor threatening statins! I have told many doctors to let me try diet and exercise first. It works, somewhat, but my tc has never been under 225 no matter what I do. The docs say I “make” too much, thus I need statins. Let me tell you, this is just not true! I read Kowalski’s books, The 8 week Cholesterol Cure and The New 8 Week Cholesterol Cure and was convinced niacin, a cheap, otc vitamin, could help. In 1 year my TC has gone from 313 to 238, with all levels in the normal range except ldl. I ‘m still working on it, still taking a slo- release niacin, as the immediate release form causes extreme flushing. I’m not pushing any brand, some take the immediate release and adjust to the flushing. “No flush” brands, btw, do NOT effect cholesterol, don’t waste your $! It’s a shame more docs don’t try this regimen before statins. Taking the slow or extended release niacin does require liver toxicity testing periodically. All the dietary changes and exercise over the years have not changed any of my numbers as drastically as niacin has. I suggest talking to your doc about it. Cheers!!!
Mark,
Great article, I’m on board, zero carbs except veg, moderate prot, high fat, 9 weeks now. Everything is better, except joint pain, hands, feet, knees. It’s holding back my ability to exercise, and generally painful all day, and disturbing my sleep to the point it’s non-restorative. Any tips?
Thanks,
Greg
You don’t need to eliminate all carbs; you just need to balance. It is recommended that you consume 45% to 65% of your calories from carbs. However, I personally try to avoid an intake of 60% or more calories from carbs, with preference to 55% or less (although this is not hard for me). If you can get your intake to less than 50%, that’s even better; however, you should not cut to less than 45% of your calories from carbohydrates, because carbs have essential functions as well.
As far as protein is concerned, the recommendation is 10% to 35% of total calories. Ideal is probably around 15% to 20% and even better may be 20% to 25% or so.
For fat, it used to be recommended that you consume 25% to 35% of your calories from fat; although apparently that has been changed to 20% to 30% (although I don’t agree with this change). In my opinion, the closer you get to 30+% calories from fat, the better; although you should not worry if you consume 30% to 40% of your calories from fat. More than 40-45% may be excessive, as your carbs and/or protein will fall short of the essential minimum, and even if you consume 45% carbs, if 41% to 45% of your calories come from fat, you are only consuming 10% to 14% of your calories from protein, and while this is okay, it is better to aim for 15% or more of your calories from protein, as I said before.
I don’t know if a carbohydrate deficiency causes pain as you are experiencing, but if you think it’s not the cause, or it does not improve after balancing your diet as I said before, see a doctor. I am not telling you to stop balancing your diet as mentioned above; continue to consume the balanced diet regardless of whether the pain improves or not, as this will help to improve your overall health.
Please reply to this when you get it figured out by what you added to get back to a good night’s sleep and no joint/muscle pain. I haven’t had a good night’s sleep for three months since I started low carb and am losing weight I do not want to lose. I stopped taking magnesium and that helped a great deal with my joint/muscle pain but still can’t sleep. I am adding in more carbs but that’s not helping the sleep. I really need to get this figured out.
See a doctor. As I said in my previous comment to this post, if you think the low carb diet is not the cause of the pain, or it does not improve after increasing the carbs to a balanced level (45% to 65% of total calories), you should see a doctor. A doctor can help to determine the cause of the pain and possible treatment options.
I’m surprised I didn’t think of this earlier, but if you are having trouble sleeping, you can take melatonin. This supplement is completely safe and you only need to take 3 mg tablets. If this doesn’t help, try cutting the tablet in half (melatonin is actually less effective if you take more; backwards of what you would think). In my experience, whenever I have a hard time getting to sleep and then take a melatonin, I fall asleep faster. Even when it has taken me about 4 to 6 hours to get to sleep (4 to 6 hours laying in bed with my eyes closed before getting to sleep), melatonin has helped me to get to sleep within a half hour after taking it, or shortly after going to bed, whichever is later. Keep in mind that even though it takes about half an hour for it to kick in when I take it, the time is likely to vary from person to person, so it may help you faster, slower, or just as fast as it helps me. However, it will help you to get to sleep and sleep well.
Thanks for your input. I tried melatonin. That stuff is scary. Fi rst 5 mg, then 1 mg, then 1/2 mg. I’m actually too tired to remember what was so scary about it. I got more sleep but couldn’t function during the day, something like that. My doctor is useless, I said I couldn’t sleep months ago. Checked my hormones and said they were fine. Now listening to the Thyroid Summit for the last 6 days I got some insight that my Free T4 is low and I need some progesterone. While waiting to save up to get a lab test for my thyroid and hormones on my own, I’ll try some progesterone cream.
Don’t tell me you took all those doses in the same day — good way to knock yourself out for about 20 hours or so. When I said to take a smaller dose if it doesn’t help, I meant the next day; not to add the smaller dose onto what you already took that same day. That’s 6½ milligrams of melatonin, more than twice what I take in a single day — no wonder you couldn’t function during the day!
Okay, let me reiterate. Try taking one 3 mg tablet of melatonin (or half of a 5 mg tablet) about half an hour before going to bed. If it does not help as you would like, cut it in half and take half of a 3 mg tablet, or a quarter of a 5 mg tablet, THE NEXT DAY. Don’t take more than one dose in the same day; if a certain dose does not sufficiently help, reduce the dose for the next day.
Also, if your current doctor is not helping you, you may need to find a different doctor. You don’t have to stop going to your current doctor altogether; but you may want to see another doctor who may be able to better identify the problem.
Chris is exactly right – there is no association between saturated fat and heart disease. Here is the definitive article from Annals of Internal Medicine, over 600,000 patients in this analysis.
http://annals.org/article.aspx?articleid=1846638&resultClick=3
Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis
Ann Intern Med. 2014;160(6):398-406-406. doi:10.7326/M13-1788
Sorry didn’t check script – meant to put ‘ I am sure that people with FH would show a higher than average TC no matter what normal diet they have and so if your baseline TC was lowish before altering your diet surely FH is not likely indicated.
Hi Richard, sounds to me as though you are really healthy and have found a doctor who does not just want to just shove Statin meds on you – which is a real bonus. You mention 2 other docs who would have you on Statins like a shot, well I would guess 9 out of 10 would but that doesn’t mean they are right as we well know.
My TC is also 7.1 but no doctor has even suggested concern because my HDL ratio is 2. something or other.
When on a standard diet my TC was 4 – I am sure that people with would show a higher than average TC no matter what normal diet they have and so if your TC base line was lowish and has now risen, maybe your body needed the access to more fat and 7.1 is your totally healthy range for cholesterol.
Also as Chris has mentioned before, serum blood lipid measurement is just a snapshot in one moment in time and to gain a true picture the blood sample would have to be taken several times during the week.
Perhaps you were fighting an infection when your blood was drawn and so LDL would be kept in the blood for defence.
Perhaps your thyroid is not working optimally hence not enough LDL receptors on cell wall stimulated for LDL to deposit cholesterol and so LDL remains high in blood stream. You possibly could be exercising too much and exhausting body affecting production of thyroid hormone and so number of LDL receptors. But you would have symptoms – feeling cold, hairloss more than normal etc. in which case eat a few more healthy carbs.
Just be happy with your health and dont worry about cholesterol numbers.
I listened to an enlightening interview with an English doctor who had studied at Cambridge. She had a colleague who was actually at the event in Europe where decisions were being made re the launch of statin drugs. There was some private debate going on as to what level of TC it should be suggested a statin drug should be used. Apparantly many figures were being bandied about for consideration. She overheard 2 of the leading figures on the panel in conversation state that they couldn’t consider a figure higher than 5 TC or they wouldn’t get enough people qualify to be put on the statin drug. This is the basis upon which our medical care is founded.
I am totally confused by this entire debate. I’m pretty certain I have familial hypercholesterolemia….as does my healthy 85 yo mother who was diagnosed with high cholestrol (but a HDL/LDL ratio of 3.4) at 40 and, after about 5 years of trying to lower her cholestrol, gave up and ignored it.
NOTHING in this thread has helped me to understand if I should be concerned about my situation of not.
Hi Richard, does this analysis and explanation by Chris Masterjohn help
http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html
Seems to me that when everything is functioning well, cholesterol numbers/oxidised LDL is not an issue.
How do we get our body to function well?
Nourish it.
Seems to me that my only risk factor is my 7.1mmol/l (274mg/dl) high total cholesterol reading. My HDL/LDL ratio is 3.4. My Trigylcerides are only 0.1mmol/l (8mg/dl). I am 180cm (5’11″), weigh 68kgs (150lbs), have 9% bodyfat, BP of 95/45 and a resting pulse of 48bpm. I exercise very regularly (gym & running 4-5 times a week). I eat eat a very normal (but far from “vegan” diet), but changing my diet (and I’ve tried this several times) seems to have next to no impact on my total cholesterol reading.
My doctor thinks putting me on statins would be a mistake…but other doctors I know would have had me on them. I’ve have thought of getting a scan to see if I actually have any signs of atherosclerosis though! But I don’t get breathless exercising, I feel really fit.
From what you say (HDL/LDL ratio of 3.4; triglycerides of 8 mg/dL; total cholesterol of 274 mg/dL), I estimate that your HDL-cholesterol is about 211 mg/dL and your LDL-cholesterol is about 62 mg/dL. That means that you have extremely high HDL-cholesterol, low LDL-cholesterol, and severely low triglycerides. A safe value would be from 40 mg/dL to 89 mg/dL for HDL-cholesterol, 70 mg/dL to 99 mg/dL for LDL-cholesterol, 50 mg/dL to 149 mg/dL for triglycerides, and 160 mg/dL to 199 mg/dL for total cholesterol.
Also, be careful — 9% body fat indicates that you are underweight if you are under 19 or over 39 (not inclusive). You should also be aware that your blood pressure of 95/45 mmHg indicates that you may have isolated diastolic hypotension (low diastolic blood pressure). A normal blood pressure would be from 90/60 mmHg to 119/79 mmHg.
Underweight? Balonney. My BMI is 21 (which is pretty much where my BMI has been since I was 20 years old). That’s not “underweight”…it’s right in a healthy weight range according to every chart I’ve seen. The reason I’m not “fat” is that a) I’m naturally lean, b) I exercise regularly c) I eat well.
Triglycerides be too low? How do I boost them? Eat worse? Eat MORE fat??!! LOL Now I’m really getting confused.
Bottomline is….am I about to have a heart attack? My doc clearly doesn’t think so….but I’ve had two other docs recommending statins….and I suspect they were wrong to do this.
No, your BMI does not indicate that you are underweight. However, your body fat percentage does if you are under the age of 19 or over 39. You say your BMI has been 21 since you were 20 years old, so that rules out the under 19 part; however, if you are over 39, you would still be classed as underweight at 9% body fat. A healthy body fat percentage would be 8% to 19% for males ages 20 to 39, 11% to 22% for males ages 40 to 59, and 13% to 25% for males ages 60 and older. Therefore, with a body fat percentage of 9%, you would be classed as underweight if you are 40 or older, and severely underweight if you are 60 or older. However, if you are in the 20 to 39 age range, that body fat percentage is perfectly fine.
Considering you say you are lean and exercise regularly, I am surprised that you don’t know that body fat classifications are more accurate than body mass index. BMI is just a general screening tool that makes no attempt to differentiate between muscularity and bone structure. It combines the healthy range for a set “large bone structure” and “small bone structure” and everything in between, making for a healthy range much larger than what one’s actual healthy range would be, and making no attempt to take muscle mass into consideration, therefore assuming that you are a sedentary person with barely any muscle. For example, if you have 8% body fat at a BMI of 18.5, you would have 32% body fat at a BMI of 25, and if you have 20% body fat at a BMI of 25, a BMI of 20 would represent 0% body fat. Based on the height and weight you mentioned above, I estimate that you have a BMI of 20.9, so at your current height and lean mass weight you would be healthy at a BMI of 20.7 to 23.8 if you are 20 to 39, 21.4 to 24.7 if you are 40 to 59, or 21.9 to 25.7 if you are 60 or older.
Another example of how BMI is inaccurate is my own measurements. At 5’11½” and 218.6 pounds, my BMI is 30.1; however, nobody would dare call me obese. In fact, whenever I tell someone my weight, only the other people in the weight room can see how I weigh this much. Despite my BMI of 30.1, my body fat percentage is 17%, which is within the healthy range for a male my age (18 years → healthy body fat percentage = 10% to 19%).
As far as your triglycerides are concerned, from what I’ve read, carbs increase your triglycerides long term, while fats only raise your triglycerides after a meal. I don’t know if it is limited to refined carbs or includes all carbs, but that is what I have read about it. However, since a diet low in fats is listed as a cause of low triglycerides, the articles are probably just trying to say that dietary fat will not give you high triglycerides, so you might be able to get up to a healthy level by consuming a diet high in healthy fats. In fact, while my total cholesterol value is dangerously low, my triglycerides value is just within the healthy range — at 51 mg/dL (compared to a healthy range of 50 mg/dL to 149 mg/dL) — and my diet is on average 34% fat. Further, the only thing that ever makes my body fat percentage exceed the 19% limit is sleep deprivation in and of itself. My body fat percentage cycles between underweight status (sometimes severe) and the maximum healthy body fat percentage, but never exceeds the maximum percentage except when I am sleep deprived.
How to raise your LDL-cholesterol to the healthy range? Unfortunately, I cannot say. I have no idea how to raise LDL-cholesterol or total cholesterol to the healthy range.
If you are fine with the risk of malabsorption of fat soluble vitamins, which can result in malnutrition, or even poor energy output (as triglycerides are responsible for extra energy when needed), then don’t worry about your low triglyceride level. If you are not fine with these risks, then try to increase your triglycerides to the healthy range. If you are fine with a 15.7-fold increase in cancer risk as well as an increased risk of fever, sepsis, trauma, hemorrhagic stroke, respiratory and infectious diseases, depression, anxiety, impulsivity, and aggression, then don’t worry about your low LDL-cholesterol level. If you are not fine with these risks, then find out how to increase your LDL-cholesterol to the healthy range of 70 mg/dL to 99 mg/dL. Unfortunately, I do not know how to raise the LDL-cholesterol level, so I can not help you on that.
Appreciate your long considered response. But what we have here is doctors looking at my high “total cholesterol” and leaping to the conclusion that I should be on statins, when what you are saying that my (healthy) fat intake may not be high enough!!! So they are trying to medicate me for a problem that I probably don’t have with a mediation that has known (and nasty)side-effects,,,and people wonder why we don’t take everything the medical profession say seriously.
Oh….and I’m 55 years old and I’m well aware about how misleading BMI is as an obesity indicator. I do quite like having a 6 pack at 55 though 🙂
It’s good that you aren’t taking the statins. Stay with your doctor and don’t go to the other doctors who are trying to recommend statins; you don’t need a doctor lecturing you that “you are going to have a heart attack if you don’t take this (harmful and unnecessary) medicine,” especially since you obviously have barely any risk of heart disease. I’ve read articles about those cholesterol lowering drugs and they are so dangerous it’s scary. Cholesterol is actually not the enemy at all; the only reason high cholesterol can be linked to heart disease is because your liver deposits cholesterol into your blood to heal the inflammation that can cause heart disease (although your liver does the same to try to heal other problems as well). So you can see why it can cause problems when your liver does not put out enough cholesterol (resulting in low cholesterol) and only indicative of potential problems if your liver puts out a lot of cholesterol (resulting in high cholesterol); although it could be as simple as an injury or something — not necessarily heart disease. However, the health experts like to blame cholesterol for the heart attacks that are unsuccessfully prevented by cholesterol (as the inflammation obviously adds up faster than the cholesterol can heal it), so they prescribe drugs to eliminate the cholesterol rather than addressing the root of the problem — talk about scary!
Overall, I don’t think you should worry about heart disease. Aside from your total cholesterol, your only cholesterol value that is excessive is your HDL (as HDL supposedly does not protect against heart disease anymore once it reaches 90 mg/dL); however, as long as you keep exercising and limit added sugar, hydrogenated fats, and processed foods, the chances of you having heart disease are very slim. The only cholesterol values you currently need to worry about are your triglycerides and LDL-cholesterol — and those need to be higher to prevent other health problems as I have mentioned before that are risks of low triglycerides and low LDL-cholesterol.
Concerning healthy fats, don’t fall for the myth that saturated fat is unhealthy — that myth has been busted in many articles, such as the article above and even this one: http://www.eatnakednow.com/cooknaked/2011/09/22/the-skinny-on-saturated-fat-six-important-roles-for-this-maligned-nutrient/ . It’s trans fat that you need to watch out for — specifically factory-processed, or hydrogenated, trans fat. Anything with the term “hydrogenated,” “fractionated oils,” “shortening,” or “lard” anywhere in the ingredients is a red flag. These are all different ways of saying that a product contains hydrogenated ingredients.
Where the body fat percentage is concerned, if you’d rather stay at your current body fat percentage, just realize that it is below the healthy range and will be severely low once you turn 60. However, if you ever start experiencing health problems as a result of having a body fat percentage too low, you might want to consider getting up to 11% body fat, or 13% if you experience health problems due to a low body fat percentage after your 60th birthday.
Richard Houlton — I found out first-hand that fruit juice may be able to raise your triglycerides. Based on my results, it seems that you can get your triglycerides up to the optimal range if you consume 12 ounces of fruit juice per day for 13 to 28 days. Do not continue this for more than 44 days, however, or you may end up with elevated triglycerides. Keep in mind that as you raise your triglycerides, you may reduce your HDL-cholesterol; however, in your current situation that is not a problem as it would probably take 43 days to even get your HDL-cholesterol below 200 this way (assuming your body responds the same as my body did to fruit juice — in my case — 100% pure orange juice), so you will still be well above average for HDL-cholesterol.
Hi to all from down under – Australia.
After decades of healthy eating (I thought) and staying as fit as possible I started my Paleo journey for amazing results and still improving. This article however is music to my ears I have had an elevated cholesterol for many years which has been managed with statins.
I hope with a Paleo lifestyle I can change that.
Can saturated fat and dietary cholesterol help to raise cholesterol levels if you already have a total cholesterol below the minimum healthy amount? If not, what would you recommend for people like me who have low cholesterol?
How do you explain why people who adopt a plant based low fat diet have in all cases reversed their angina symptoms and started to unblock their coronary arteries. Here is the proof
http://www.heartattackproof.com/resolving_cade.htm
Aye – “the proof is in the pudding” as they say
My guess is that since heart disease is a result of inflammation and not cholesterol, those people were able to reverse their angina symptoms and unblock their coronary arteries because they ate less added sugar, less hydrogenated fat (e.g. trans fat), and less processed foods.
It’s a good thought, John. A good guess. Except it doesn’t play out in reality. People’s arteries do clear a little if they lose weight – by any means, but if it’s a high fat diet, all studies show that they plateau within a year, weight begins to slowly increase while sticking to their low processed food but high fat and protein diet, and cholesterol then rises rapidly as do arterial problems. These doctors reversing heart disease find cutting sugar and reducing processed foods (ie. trans fats) simply comes no where near close enough to do the trick. It simply doesn’t work. It’s not my opinion – the research just shows that approach is not even in the ball park for reducing heart disease – even though it is a good start towards better habits. I wish that was all it took, but it isn’t.
Are you trying to tell me that high amounts of added sugar and trans fat are not bad for you? Also, do the studies you quote break down the fat mass and lean mass changes, or just total weight change? It is possible that there is a calorie surplus after the plateau that goes as lean mass and not fat. I know from my personal experience that while I eat a lot of fat, there have been times when I have gained a significant amount of weight while losing fat, whether I exercised or not.
When people go on high fat diets, they need to be careful that very little of that fat is hydrogenated fat. Those people who got arterial problems on a high fat diet were probably eating a lot of hydrogenated fat. And also, people who eat plant based diets usually don’t eat a lot of processed foods. I have never heard of processed fruits or vegetables (with the exception of fries, which come from potatoes – a vegetable) — or any kind of plant based diet that was highly processed for that matter. I’m guessing that added sugars and natural sugars (such as the sugar in fruits) are not the same as far as heart disease risk is concerned. Even my health science professor has said that it is not. Hence the fact that I said that they ate less added sugars — not sugars in general — and that is why they were able to reverse their angina symptoms. For example, both apples and pepsi are high in sugar — apples have 84% of their calories from sugar, and pepsi has 100% of its calories from sugar. Although these are both well above the recommended 25% maximum, I’m sure we can all agree that the natural sugars in apples are much better for you than the added sugars in pepsi. If added sugars are not bad for you, then there is literally nothing else wrong with soda and we can all drink as much soda as we please and not have any resulting health problems.
Hi Mary, I have no idea what my heart attack risk is, all I can say is that starting a paleo (no grains/sugar)/hi natural sat fat diet resulted in me losing 28lbs-a pound a day for a month then my weight stabilized at 7stone-the weight that I had always been in my twenties. I hadn’t really considered myself overweight and others considered me thin (just dressed to hide the lack of waist )I had just put weight on around the waist with age.
2yrs later still on paleo/hsat fat/no grain/sugar diet I couldnt put weight on eating this way, if I wanted to.
So just wanted to refute at least in my case that the ‘weight begins to slowly increase and then cholesterol rises rapidly.’
From what I have studied it seems to be the industrial seed oils (the PUFA’s) that we have been conned into consuming since the 1970’s that are unstable out of but also in our bodies, causing free radical damage, having an inflammatory effect and displacing cholesterol in our cells causing lack of function. And that even 4years after deliberately not consuming PUFA’s other than what occurs naturally within food our cells will still be releasing PUFA’s causing an inflammatory process within the body.
We know that it is oxidised LDL and inflammation that promotes plaque formation and one form of heart disease.
Our cells need cholesterol it is vital, we make it in order to function, including LDL – if LDL hangs around in the blood stream long enough to be oxidised it is not the fault of LDL but lack of correct system function. LDL needs to deposit cholesterol into the cell by docking with receptors, too few receptors (in part thyroid misfunction) = LDL left hanging around to be oxidised.
Infection = LDL required to neutralise pathogens so may be prioritised to remain in the blood stream. Not the fault of LDL, the fault of chronic infection.
Seems to me we should not be worried about cholesterol numbers, a recent obsession but do our best to remain or become healthy by following a healthy lifestyle including eating natural foods from healthily raised animals and plants.
See Chris Masterjohn’s analysis of cholesterol and heart disease.
Sorry forgot to post link
http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html