Cholesterol: We are dumb

126 Comments

You may all lose faith in me and my abilities to write the book after I tell you this story. I spent over a month outlining the project. After about 5 failed attempts to ge the book going. I’m not used to organizing this much material and it’s tough to keep everything straight. So, I finally sat down and just focussed on outlining the project. I felt like I had a pretty solid outline, ran it by several folks, everyone felt it as solid so I dug in! I did the intro chapter, covered insulin, was workign my way through fats and realized I forgot a ton of important material in my outline. Important things like…oh…say…cardiovascular disease. You know, heart attacks and stroke…the most common killers of North Americans. Yea, I’m an idiot. I have worked on this paleo diet stuff for so long that the heart disease issue is completely passe. It is such a forgone conclusion that a low carb paleo diet will protect you from CVD that I forgot to include it in the damn book. Well, almost. So I sat down and outlined what I wanted to say about CVD and started collecting references and I ran across some goodies. They illustrate that I am not the only idiot apparently!

The basics of the diet-heart hypothesis go like this: High cholesterol leads to atherosclerotic plaques that precipitate a clot which can result in a heart attack or stroke. This whole notion grew from a disease called Familial Hypercholesterolemia and subsequent experiments that involved feeding rabbits (herbivores) oxidized cholesterol. These critters do not eat ANY cholesterol so the fact oxidized cholesterol caused problems is not surprising but also completely unhelpful when talking about people. Anyway, 50 years to failed dietary recommendations to lower cholesterol have done nothing to  alleviate the CVD epidemic. In fact, the epidemic is rolling along bigger and badder than ever before. Well This Study was pretty interesting. It indicates that most people who suffer a heart attack have…low cholesterol! Now, everyone is in a fix to get folks on cholesterol lowering diets and statins to save them, but most heart attacks are in folks with…low cholesterol! Ok, doesn’t make any sense and it completely calls into question the notion that we need to reduce cholesterol levels…but why not give people statins and see how folks do on those. Well, interestingly, statins appear to decrease heart attack rates in people...with low cholesterol. The mechanism? Possibly a reduction in C-reactive protein (CRP), an indicator of systemic inflammation. Know what else reduces systemic inflammation? A paleo diet which controls insulin levels, removes gut irritating foods, balances omega-3/omega-6 fats. Add some vit-d and consistent good sleep and you have effectively turned off the type of inflammation underlying CVD, cancer and neurodegeneration.

Oh! Then there is the fact low cholesterol increases stroke rates!!

So, just to clarify:

1-Cholesterol supposedly causes CVD, But

2-Most heart attacks are actually occurring in people with low cholesterol, Yet

3-Doctors insist on cholesterol lowering protocols, including statins, Even though,

4-The benefit of statins has nothing to do with cholesterol, but rather it’s mild anti-inflammatory action, Which

5-Can be accomplished with simple dietary modifications and a few inexpensive supplements.

It would be funny if people were not dying from this stuff.

 

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  1. Clay
    October 29, 2009 at 11:09 pm

    Nice post. The cartoon has me confused. I know bacon and sausage are fatty but your cool with those. What meats should be avoided?

    • robbwolf
      October 30, 2009 at 1:33 am

      Clay-
      I only avoid meat that might try to make ME dinner!

  2. Stephen
    October 29, 2009 at 11:37 pm

    Good information here as always. I might have to write a post that refers to those studies you linked to.

    I know how you feel though about simply forgetting something that you’ve looked at for a long time and it’s just sort of embedded in your psyche. But for other people it’s like the biggest news since sliced bread started killing people. I find even simple things like “drink more water you’re probably dehydrated” seem like big news to many people. For some it’s a “well duh” experience for others it may be life changing or even saving.

    Stephen

  3. Steven Low
    October 30, 2009 at 1:20 am

    It would see that it would work both ways I guess.

    Low HDL levels and/or higher LDL levels seem to be “pre-risk” factors, but not enough to do anything by themselves.

    The qualifying agent is the inflammation, which is what is going to “glue” excess cholesterol and other molecules to the arteries (thus developing atherosclerosis or heart disease). Even with crappy levels of everything as long as there’s no inflammation the body can adapt and doesn’t develop as bad conditions.

    Also, I think it’s kinda funny how Vitamin D lowers cholesterol, LDL and helps increase HDL. Yet deficiency is rarely checked, especially for people with darker skin (who, by the way, are at a greater risk for heart disease and such). Same with exercise.

    What a fail.

    • robbwolf
      October 30, 2009 at 1:31 am

      Steven-
      this is also why we see increased rhabdo rates in darker skinned folks.

  4. Ben Wheeler
    October 30, 2009 at 1:42 am

    Robb,

    Good stuff man! The whole lipid phobia is definitely the biggest speed bump to get folks over when getting them on a paleo diet. “But doesn’t meat cause (insert disease)?”…umm NO! This post is simple, yet very effective! Glad you had time to share, but get back to that book!!!!!!! Nikki is gonna kill you if that thing ain’t done!

    Ben Wheeler

  5. clay
    October 30, 2009 at 2:47 am

    Ahh yes. It appears I should have studied the cartoon a little closer. D’oh

  6. Steve
    October 30, 2009 at 4:25 am

    Robb

    What are the supplements that can prevent CVD?

  7. patrick
    October 30, 2009 at 5:05 am

    Look to this site daily. Been on strict paleo for about 2 months now. Life is so good with this lifestyle change.

    Robb sounds like you need a good editor for your book!!

    • robbwolf
      October 30, 2009 at 4:26 pm

      Patrick-
      I’ve assembled a pretty solid support crew for the project but this is like passing a softball sized kidney stone!

  8. Nav
    October 30, 2009 at 7:20 am

    Dr Ron Rosedale has done a heap of good work on this area as well. There is a whole underground movement of people here in Aus that keep hoping that accurate information gets out there instead of the mass hypnosis dished out by the mainstream media. Thanks for contributing to the cause!
    In case you haven’t seen his work before, here’s a 10min you-tube clip that Dr Mercola posted of Dr Rosedale running through some very interesting things about cholesterol – http://www.youtube.com/watch?v=awA2fsa94MI

    Nav.

  9. Olin
    October 30, 2009 at 10:17 am

    Hey Robb, I attended your nutrition cert back in May. I have been doing pretty good low-carb Paleo, but have been having plenty of eggs, some red meat and some bacon (I know most Paleo types frown on the bacon) – all of which had not been part of my prior low-fat diet. I was getting great results since the cert but a little nervous because when I was younger I once had borderline high cholesterol. After 3 or 4 months I had blood work done, and my doctor said my cholesterol levels were fine. I explained my diet – he looked at little confused, and said keep doing whatever I’m doing. Something to be said for keeping systemic inflammation low after all!

  10. Ari Kestler
    October 30, 2009 at 12:46 pm

    Hi Robb,

    Just as an FYI…while I didn’t read the methods of the paper you linked stating that a lot of people with MIs have low cholesterol, just wanted to point out that in the acute setting when you see these people, i.e. 24-48 hours after an MI, the LDL is LOW secondary to the MI. It later rebounds back to whatever standard range it normally runs. Interesting, huh?. I’ve had numerous patients on my cardiac ICU rotation presenting with massive MIs, a lipid panel is drawn and their LDL is in the 60s – 70s. My attending loved to pimp residents/students with: Why is this person on statin? If not, Why should we start one, why shouldn’t we, etc… Initially, almost everyone says, no statin, their LDL is 70. WRONG. Their LDL is much HIGHER.

    Doesn’t change much of what you said, just wanted to point it out…

    • robbwolf
      October 30, 2009 at 4:20 pm

      ARI!!
      I ran across this for the first time from Uffe Ravnskov I wonder if his information reflects this? I remember also that at the point of an MI the level of circulating IGF are remarkably low, and some therapies have been recommended using IGF. Interestingly however the IGF level has typically been high (due to elevated insulin), then drop prior to the MI.

      Really interesting stuff. How long does it take to get a plasma change in LDL of that magnitude? Is the liver changing it’s metabolism in the days leadng up to the MI? The hours?

  11. Kurt Gottselig
    October 30, 2009 at 4:48 pm

    Rob:

    I’d like to thank you for that seminar you did in Bozeman. MT recently. I didn’t attend but my wife did and did she ever come away with a pile of notes and great ideas. She’s instituted some changes in our diet based on that seminar and I’m feeling fantastic.

    I’d like to mention that eating Paleo (it’s not a diet for us) has had some unintended but welcome side effects. The tinnitus in my right ear has come under control and the ringing has stopped. Also, my sinuses have cleared up considerably.

    I know this is the result of Paleo since we were on a 30 day challenge and after I went back to my old habits for a couple of days and the ringing came back. I’ve since gone straight paleo again and stopped the ringing. I’ve had this for nearly 4 years and I can tell you that utter silence is a blessing.

    • robbwolf
      October 30, 2009 at 8:48 pm

      Kurt-
      The tinnitus thing is interesting. It is largely a sodium issue. Total sodium load AND acid base balance are the primary cause of tinnitus. Interestingly, a well know crossfit personality is prone to decrying various elements of the paleo diet, citing the sodium issue as being “unfounded and pseudo-scientific…”

      Well, not really if you actually take the time to research the topic. So, I guess from some perspectives, your tinnitus resolution is “all in your head”!! And I guess the 50-60 other folks who have reported the same tinnitus resolution are suffering some kind of paleo hypnosis.

    • Penny
      June 3, 2012 at 4:59 pm

      the tinnitus comment has me interested as I have tinnitus in both my ears.

  12. Ryan Murakoshi
    October 30, 2009 at 5:55 pm

    Robb

    Norwegian fish oil? Any different from what I can get out of the Costco brand?
    Great cartoon.

    • robbwolf
      October 30, 2009 at 8:45 pm

      Ryan-

      Nordic naturals is VERY good quality. folks who have a fish allergy are typically able to take this brand (read the label to double check). It is more purified than the costco variety…but im not sure that matters for most folks, especially when the price point is considered.

  13. randy@crossfitdenver.com
    October 30, 2009 at 7:14 pm

    that cartoon is awesome so is the information, thanks! i too am confused though….always thought pachyderm was rated high on the paleo scale right up there with turkey breast, wild caught salmon and tyrannosaurus filet :)

  14. Kyle S.l
    October 30, 2009 at 8:46 pm

    You’re a genius. I posted a question on p-menu a few years ago regarding cholesterol. You told me where to look for info. I try to tell people the benefits of this paleo thing, but normally not taken very seriously. No matter how much evidence you put forward people refuse to believe fat and cholesterol won’t kill you. Or is it they don’t want to believe that the sugar/grains do?

    • robbwolf
      October 31, 2009 at 2:23 pm

      Kyle-
      I think it’s more the latter. It’s tough for folks to give up their carbs.

  15. patrick
    October 30, 2009 at 10:26 pm

    From what you are tackling I would figure you are passing one the size of a medicine ball. I look forward to reading it when published!

  16. ron
    October 31, 2009 at 1:51 pm

    Low cholesterol is healthy, that’s if one earned it threw eating a low fat diet, not by taking drugs. Satins are harmful.
    The Japanese diets are very high in salt. The real danger from a hemorrhagic stroke, is people who have low cholesterol and also eat a high salt diet.
    People who have high cholesterol and eat a high salt diet, the higher cholesterol will help prevent the stroke but not the heart attack.

    http://www.diseaseproof.com/archives/stroke-salt-hemorrhagic-stroke-risk.html

  17. Matt
    October 31, 2009 at 2:10 pm

    Even when the evidence is staring them in the face, they don’t get it:

    “Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk in most who could benefit,” said Dr. Gregg C. Fonarow, Eliot Corday Professor of Cardiovascular Medicine and Science at the David Geffen School of Medicine at UCLA and the study’s principal investigator.

  18. Mike OD - Fitness Spotlight
    October 31, 2009 at 3:28 pm

    Robb,

    Reminds me of the cholesterol curve (http://bit.ly/3S170M)….the whole curve (which modern medicine neglects to show). Seems that at 140 and under people are at the same high risk for death just like 240+…..more eggs please. I think it mentions that it is also high rate of suicide when cholest is too low.

    Another thing…..more people on statins….more people with too low cholesterol…..more people with brain disorders such as depression and Alzheimers….coincidence????

  19. Mike OD - Fitness Spotlight
    October 31, 2009 at 3:30 pm

    Sorry….link got messed up in the last post on the cholesterol curve:

    http://bit.ly/3S170M

  20. keith
    October 31, 2009 at 5:14 pm

    could you post the studies that are pertinent to your argument. i would like to read them. you make some great points and i would like to learn more about the science you support. i go to medical school here in albuquerque, and we are definitely learning that LDL is bad and that we need to control them in our patients. you have a differently angle though, and i would like to know what is going on in your brain and others who support this style. thanks for your time.

    keith

  21. Strong Lil Pony!
    October 31, 2009 at 7:01 pm

    Hey Robb-
    I work in cardiac rehab as an exercise physiologist in a large metropolitan hospital. Have started to feel increasingly uncomfortable with co-workers parroting the standard CAD “heart healthy diet” so instead of challenging them in front of patients (which I know is unprofessional, but a few times I really felt I HAD to for the sake of the patient- and I was reprimanded) so I have taken to printing out various studies from you/ Eades/ modern forager to help build my case.

    Worst was yesterday with diabetic patient who had pre-exercise BG of 94. Was told to give her snack, as her BG “was too low to exercise”. Felt like I was ordered to poison her- HAD to give her 8 oz of orange juice and a package of graham crackers :( She changed her mind and said she would rather go to cafeteria to eat, could she eat a muffin. The diabetic educator said yes, same time I said no. I backpedaled, suggesting half the muffin, then said even better would be egg whites with spinach (trying to be AHA “healthy”/ mainstream) with some fresh fruit – and I was told later I do NOT know what I am talking about and please leave diabetic counseling to the certified educator. 2 hrs later: her pre exercise BG was 234. Her post exercise BG was 205. Guess what meal she ate? :( It made me sad. Angry.

    Lost 2 patients this week to complications from CAD/DM, had 2 peri-exercise code blues, resulted in ER admissions. This isn’t funny. These people think they are doing the best they can. They are TRYING so hard to eat well, do the right thing. I have been able to make small dents -proud of the fact that I have been able to get most of my patients on fish-oil, CoQ 10, vit D- I had to make a presentation to my boss with all kinds of studies for back up. Except for the diabetic educator, I have support from the entire staff and a reputation for my holistic approach. I even gave a patient some reiki ( I am reiki practitioner) and nobody said anything, so maybe things are slowly changing. Let’s hope.

    On a personal note- I have having blood drawn AGAIN on Monday, as one month post rhabdo my creatinin levels are still high. BUN is normal, GFR is low (but thats always estimated) Nephrologist thinks lupus may be playing a part ( I had a pos ANA last year). Everything I read about protein and kidneys scare me- that I should be eating a low protein diet to reduce the load on my kidneys. Do you have any research you could direct me to that will quell my fears of battering my kidneys with too much protein by-product?

    Thanks for all that you do.

    • robbwolf
      November 2, 2009 at 5:37 pm

      SLP-
      that is a serious bummer. Good on ya for trying to help folks though.

      Zone protein levels are pretty damn low but seem adequate for most folks for performance and health. If you were on say, 10 blocks, that is only 77g. I THINK that would be fine and actually well within the guidelines they have set for you.

      Keep me posted.

  22. Mark
    October 31, 2009 at 9:49 pm

    Robb,

    Now I feel like an idiot! I’ve been on Paleo for about 1-1/2 yrs, take a couple tblsp per day of Nordic Naturals Cod Liver Oil…but have NOT been supplementing with Vit-D. In fact, at the onset of my change to a Paleo diet, which was done for the expressed purpose of dropping Vytorin, I trashed all the vitamin supplements in the cupboard.

    So I have to ask — should I take a chelated type, one with cal/mag as well? How many IU’s?

    Thanks,
    Mark

    • robbwolf
      November 2, 2009 at 5:35 pm

      Mark-
      don’t sweat it, it was news to me. Fond out about it while having dinner with Welbourn and Prof. Cordain. I’d shoot for about 5,000iu of d3/day, add a magnesium product light Night Calm. Magnesium is critical for proper vit-d activity. Buggar the calcium.

  23. kit laughlin
    October 31, 2009 at 10:52 pm

    Great stuff. I remember last year, after being advised by the GP to have fasting cholesterol levels checked (he thought that my “cholesterol was a bit high”), the test results came back and the HDL levels were almost the same as the LDLs… and he asked ‘how did you do this?”

    I replied, “a relatively high fat diet, with most of the non-animal protein fats coming from nuts and avocados, and low consumption of refined carbs.”

    His response? “Hmmmm… I don’t understand that, but keep doing what you’re doing!”

    • robbwolf
      November 1, 2009 at 12:39 pm

      Kit-
      funny enough, If I sat that doc down with a biochem text we could walk through why that is. They all ahd the same education I did, They just forgot a bunch of it I guess!

  24. Steve
    November 1, 2009 at 1:30 am

    Thanks Robb

    I have been taking Fish oil for years, eating paleo for 8 weeks, and just started taking Vitamin D because my Doctor told I have low blood levels of Vitamin D.

    I heard niacin can raise your HDL. Also iodine and Vitamin K are important for heart health too. Do you any of these three supplements are important?

    • robbwolf
      November 1, 2009 at 12:37 pm

      Steve-
      I think they are duper important but a standard paleo diet should cover your bases there.

  25. Ian
    November 1, 2009 at 6:21 pm

    Robb,.

    is there a huge difference between brands of fish oil? i take the 900 mg epa/dha/capsule from sam’s club. 4/day so i get 3.6 g epa/dha/day.

    also this is off topic, but do you ever have cheat meals? if so how often?

    • robbwolf
      November 2, 2009 at 5:33 pm

      Ian-
      there are differences, but most club brand fish oil is pretty similar.

      I guess I do…If i want some dark chocolate covered almonds or some carne asada tacos, I go for it. I honestly just don;t want that stuff very often. I “never” have gluten containing items as that ruins me for several days. I get sufficient cross-contamination just being on the road.

  26. ron
    November 2, 2009 at 12:21 am

    “Low cholesterol is healthy, that’s if one earned it threw eating a low fat diet, not by taking drugs. Satins are harmful.
    The Japanese diets are very high in salt. The real danger from a hemorrhagic stroke, is people who have low cholesterol and also eat a high salt diet.
    People who have high cholesterol and eat a high salt diet, the higher cholesterol will help prevent the stroke but not the heart attack.”

    correction
    My post should have said,
    Nut, seeds and avocado will lower your cholesterol. Low Cholesterol can be very healthy and will not cause strokes. Taking Satin drugs to lower to lower cholestrol is harmful.
    The study that robb links to was a Japanese study. Japanese diets are very high in salt. Eating a diet high in salt along with having high low cholesterol will lead to strokes. Vegetarians have to be very careful of this.
    A diet high in animal products will raise cholesterol levels and increases the chance of heart attacks. The study that Robb initially quotes states this. Their cholesterol recommendation levels were to high, the study is suggesting that their recommendation levels should be lower to lower the risks of heart disease.
    Lowering the total cholesterol levels below 150 , eating very low amounts of salt, will lead to greater health and very little chance heart problems.
    here is a link to more info,
    http://www.diseaseproof.com/archives/stroke-salt-hemorrhagic-stroke-risk.html

    • robbwolf
      November 2, 2009 at 5:31 pm

      Ron-
      I tend to disagree on the cholesterol issue. We see populations with high cholesterol and super low CVD, we see low cholesterol pops with quite high CVD. I do agee that excessive sodium is a problem.

  27. Eric
    November 2, 2009 at 4:22 am

    Robb-

    Off subject, but I remember one of your previous posts mentioning how the attendees at your cert had definitely done the pre-cert reading ahead of time. I’m coming to your cert at CF Marina next Saturday and haven’t gotten anything aside from the confirmation email from CFHQ–am I missing out on something?

  28. Steve
    November 2, 2009 at 5:53 am

    Robb

    Thanks for taking time to answer my questions. BTW I found your site by the way of Melissa Urban’s site.

    Again Thanks.

  29. NikkiT
    November 2, 2009 at 9:49 pm

    I strongly believe in the value of paleo-style nutrition. It seems likely that it is the best diet for increased longevity and optimal nutrition. But we live in the real world, where 1/3 of the population is obese. These patients have benefitted and will benefit enormously from statins and the scientists who work to understand them.

    To use the terms “idiots” when referring to the developers of body of science that has saved countless lives seems a bit contrarian. The field of medicine adopts changes slowly and carefully, and only after outcomes research has been carried out. Ideas that “make sense” are not always true- either that high LDL is the sole cause of CAD or that it has no link at all. And the community is not unaware of the mixed effects of statins- this is the reason the FDA now requires new dyslipidemia drugs to prove efficacy in terms of hospitalizations and deaths rather than changes in cholesterol alone.

    The linked article summarizes an interesting study, and Robb’s interpretation of the data is pretty divergent from that of the study’s authors. I would argue that the results of the study don’t really contribute to our understanding of LDL’s significance at all. The established observation by ER doctors, known for over 30 years, is that LDL measurements taken within 24-hours of an acute coronary event will fall well below those of the same patient when tested days later as an outpatient (see http://www.medscape.com/viewarticle/409780 for further citations). So these values are not a patient’s “true” cholesterol reading.

    The post takes a stance against statins that I think would be at odds with most cardiologists’ recommendations. Yes, good diet will give you many of the benefits of statins, but there have been many, very large placebo controlled clinical trials that have shown the clear benefit of statin treatment in terms of hard outcomes (deaths, hospitalizations). These improvements are likely to be due to a combination of the anti-inflammatory effects and anti-hyperlipidemic effects of theses drugs. Finally, nobody in the field believes the cholesterol is the sole cause of CVD. There are many risk factors for CVD, including hypertension, diabetes, low HDL, high LDL and smoking.

    That said, I do encourage the questioning of science dogma- this is what scientists do as well and it encourages a civil debate that challenges the status quo. I’ve found your articles enlightening and I thank you for helping to bring the ideas of paleo eating to a large audience.

    Cheers,
    NikkiT

    • robbwolf
      November 3, 2009 at 2:01 am

      NikkiT-
      If you dig through the comments we have a doc on ER rotation that mentioned the decreased LDL levels post MI. Really interestign stuff but it opens a whole host of other questions which I mentioned there. This also does not address the epidimiologic findings of low cholesterol populations still having relatively high CVD. Things like C-reactive protein and other markers of systemic inflammation seem like better bets to track.

      This looks a bit like the decrease in IGF and it;s dip in MI’s. Interestingly, the dip in IGF is thought to be a causitive factor in the MI, yet the dip in LDL is NOT? That’s interesting!

      Statins DO appear to prevent some forms of cardiac death, but at often remarkably high cost (rhabdo, cancer risks). This when we have safe alternatives such as fish oil seems a bit irrisponsible.

  30. Julianne
    November 3, 2009 at 12:20 am

    SLP,
    It might be useful to show the recommendations from the Joslin Insitute of Diabetes (affiliated with Harvard), they pretty much recommend Zone ratio for diabetics and obese. They say this approach has the most science to back it up. Pity other diabetic educators aren’t listening.

    http://www.joslin.org/Files/Nutrition_ClinGuide.pdf

    http://www.joslin.org/1083_2162.asp

    This study was also interesting – done in NZ, where the Zone diet (compared to Atkins and standard high carb) got best results for prediabetic overweight women, it was a year long.
    http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=3605474

    The study also concluded that the Zone diet “may be the best overall approach to reducing the risk of cardiovascular disease and Type 2 diabetes”.

    Personally I think diabetics need to go lower carb and eat paleo choices, but at least authorities are now going this far.

    • robbwolf
      November 3, 2009 at 1:53 am

      Julianne-
      Agreed, but nice find there! I need to ship that to HQ, they will love it.

  31. ron
    November 3, 2009 at 2:08 am

    robb,
    I know you must have covered this before,
    You can easily disagree with me, but do you also disagree with Dr Cordian,

    “Nov 17, 2008 … Loren Cordain has written another gem of a paper on the subject. Studying the blood cholesterol levels of hunter-gatherers, Cordain concludes that total cholesterol should range between 70 and 140 mg/dl, while the harmful LDL cholesterol should be between 50 and 70 mg/dl. …”

    • robbwolf
      November 3, 2009 at 5:35 pm

      Ron-
      I just had dinner with Cordain about a month ago. There is no contradiction here,the paper you reference is indicative of MOST hunter gatherer populations studied, but not ALL. Prof. Cordain is quite clear that LDL is but a bit player in the whole CVD issue and it’s part is only made significant when other systemic inflammation markers are also elevated. This is his departure from something like a low-carb diet built around things like cheese. We have a net insulin load, altered acid/base balance, a shift in n-3/n-6 AND increased LDL count (and likely population distribution towards the small-dense-oxidizable LDL form).

      Now, what I see in our clinical practice is folks emulating a low-ish carbs paleo diet and getting “good” blood lipid markers from nearly anyones perspective. A few folks end up with some slightly elevated LDL (but with a shit towards large variety), but we are seeing triglycerides, CRP, A1c all plummet. That net effect is all good.

      I guess where I’m coming from is there are bigger fish to fry than LDL. Emulating a standard paleo diet fries those fish well!

  32. NikkiT
    November 3, 2009 at 4:40 am

    Robb,

    Thanks for replying. This is certainly a subject of much debate at the moment. I think the possible benefit of omega-3 supplementation is only now beginning to be understood. What the field lacks at the moment is a clear head-to-head comparison of statins alone vs statins + n-3 vs n-3 alone. This would complement the current research, which shows that omega-3 fatty acids improve outcomes when added to statin therapy (The JELIS study, Lancet 2007). In this study, the effects of n-3 supplementation were particularly large for the subset of patients with impaired glucose metabolism, which I think you would find interesting.

    Omega-3 fatty acids have shown some promise both in reducing inflammation as well as in modulating sodium and calcium currents in myocytes and reducing thrombosis. The last two functions could effectively reduce the incidence of atrial and ventricular fibrillations and stroke, two of the largest risk factors for sudden death in patients with CAD and/or heart failure. The latest review I saw showed a clear dose-dependant relationship between n-3 amount and reduced CV events. Whether these pathways are redundant with those targeted by statins remains to be seen.

    I think clinicians have been wary in the past of prescribing n-3 supplementation post-MI because of the concern about hemorrhage when combined with aspirin or warfarin (both common CV therapies). These concerns have been laid to rest though, and more and more clinical trials are testing the effects of combining n-3s with standard first-line therapies.

    Thanks for a great discussion!
    NikkiT

    • robbwolf
      November 3, 2009 at 5:21 pm

      Nikki!!!
      Do you have any info on the Warfarin/N-3 interactions? We have a number of clients who are on Warfarin and, like you said, their docs are reticent to sign off on increased N-3’s. I have had in the back of my head a study that would demonstrate similar improvements on a coag-panel as asprin and warfarin but I have no idea if this work has been done.

      I would not be surprised if the statins are working on different pathways in general. They are anti-inflammatory and decrease fibrinogen and modify calcium signaling, as you indicated. From the perspective of “First, do no harm” I think it’s an easy sell to use N-3 therapy in favor of most of our current tools.

      THANK YOU for the input and great info.

  33. Julianne
    November 3, 2009 at 8:30 am

    Hi Robb,
    Completely different topic: endometriosis.
    I have had a few clients currently with this. I have put them on Zone with paleo choices plus lots of omega 3, as it appears there that women with this are prone to autoimmune problems, and endo may have some immune dysfunction.
    Have you had clients with this, and if so, how have they responded to paleo etc?
    Do you have any other recommendations?

    • robbwolf
      November 3, 2009 at 5:15 pm

      Julianne-
      Low-carb paleo (using half the carb blocks recommended by the Zone, like in 42 ways to skin the zone) is a great way to go. Endometriosis is an insulin metabolism issue but it can have collateral problems including elevated cortisol AND depressed thyroid. We’ve seen a number of women benefit from 150mcg of iodine/day (this is actually a very modest dose, right at the RDA).
      Sleep is critical. this is where someone with a Biosignature background can help get to the bottom of what is going on. Good blood work and an adrenal stress index (ASI) can slow be helpful.

  34. Tristy
    November 3, 2009 at 4:27 pm

    Robb…as always, thank you for all the information you put out there for us! Quick question about fish oil…would you recommend it for a diabetic and if so, how much?

    • robbwolf
      November 3, 2009 at 5:11 pm

      Tristy-
      Absolutely! the minimum dose would be about .5g/10lbs of body weight/day of EPA/DHA. This may SEEM like a lot but this is right in line with recommendations form Barry Sears, Poliquin and many others.

  35. Tristy
    November 3, 2009 at 6:22 pm

    Thanks so much Robb! I have recently met a Type 1 who has lost his health insurance and is struggling to afford all his meds. In the 2 weeks I have known him, I haven’t shut up about Paleo and the lifestyle changes he could make that would benefit him. So, he has agreed to give it a shot. I am so excited about this journey he is about to take! We are going to keep a daily journal, so we can track his progress. (If you’d like, I will document it all and pass it on to you) He has also suffered from depression most of his life, so I am excited to see the changes that happen on that side of things as well!
    I know you hear, “Thank You” a lot, but it comes from the bottom of my heart. You have inspired me to live a healthier life and in turn, I am spreading your message to anyone who will listen! I have now converted both my roommates, my dad and stepmom have just started a 30 trial run, and countless On-Rampers and clients tell me their success stories daily!! I love seeing all these results! Thank you!!

    • robbwolf
      November 3, 2009 at 11:22 pm

      tristy-
      never hear enough thank you’s! Please do keep me psoted and let me know if I can help in any way.

  36. Ian
    November 3, 2009 at 6:54 pm

    wow! .5g/10 lbs bw of epa/dha! That is alot, but I guess I have read that Poliquin has his clients on 45g fish oil/day, which comes out to like 12g/day. Do you take that much Robb? I’m on 4.5g/day right now (175-180 lbs, 6-8% bf). Do you think doubling that would help insulin sensitivity? I’d like to lean up a bit more and add some strength….

    • robbwolf
      November 3, 2009 at 11:21 pm

      Ian-
      there is for sure an optimum dose for n-3’s and too much CAN buggar strength and performance gains. there are some subjective measures like your poop sinking or flaoting (or loose stools) but nothing really solid. this is something I’m looking for some better guidelines for folks.

  37. Mark
    November 3, 2009 at 10:27 pm

    Robb,

    Huge hats off to you for your generosity in providing your time and knowledge on this stuff! It amazes me…seriously.

    By the way, lost in the discussion of statins is the resulting reduction in CoQ10 levels.

    Oh, and I would love to grab a beer with Dr Cordain and ask him about the need for supplements when paleo-ing (ok, not really a word). His books recommend them, but I question their bio-availability and large, single-dose forms. I guess I could marginally sign off on a Cal/Mag/Zinc supplement or perhaps even a B-complex, since Paleo doesn’t seem to afford much in the way of these. But vitamin C? Really?

    Maybe Paleo Foods should come up with a vitamin-enriched Patron?!?! :-)

    Thanks again for all that you do, Robb.

  38. Julianne
    November 3, 2009 at 11:26 pm

    Robb,
    Thanks, I’ll do that.
    Found this article on iodine which I thought, is a good overview.
    http://www.hacres.com/diet/articles/Iodine.pdf

  39. Jesse
    November 4, 2009 at 3:39 am

    Great stuff Robb. Quick question. I have a client who complains of acne when dosing with Omega-3’s. Onset is in a few weeks after starting taking fish oi supplement. Any concerns or information on the topic. Cannot find too much reliable information on the topic.

    Best regards,
    Jesse

    • robbwolf
      November 4, 2009 at 4:05 pm

      Jesse-
      Yes, we have seen this in one client. I’m not sure exactly what is going on here. I forgot to ask Scotty Hagnass, OPT and IDO about this…those guys know fracking EVERYTHING. I’ll ping them and see what they think. Undoubtedly there is an overproduction of EGF (epithelial growth factor) but we usually only see this in high insulin states. These folks MIGHT need some GLA from primrose or borage oil to balance things out. This is where my understanding on the clinical side breaks down and without blood work I do not know of a good way to figure out what is happening.

  40. Zach Frankhouser
    November 4, 2009 at 9:35 pm

    A few questions raised by this post and the ensuing comments:

    A little context for my questions: I eat meat and fruits and vegetables strictly about 6 days a week. Meat sources are typically grocery store bought grain-fed beef, chicken, and pork with eggs and/ or fish for breakfast and lunch meat for snacks. I’ve had good results athletically with these choices, but I have concerns about my long term health, especially related to my meat choices. I know that grass-fed, hormone free, etc is best but my wallet won’t allow for that. I wonder how much long term damage I’m doing with fatty salty meats if I’m balancing it with fruits and veggies, fish oil, and vitamin D.

    1. My concern about sodium is because I eat alot of lunch meat and use some salt on my food at meals. Correct me if I’m wrong, but in Good Calories, Bad Calories Taubes makes the point that high sodium does not cause hypertension like everyone thinks it does and that the body will regulate its mineral levels fairly easily with no permanent damage. Cordain seems to be anti-sodium mostly due to acid overload. Any other reasons to avoid sodium long term? What about additional sodium for athletes, especially sweaty beasts like me? What are some signs of too much sodium intake?

    2. I understand the acid/alkaline balance idea of the paleo diet and how it relates to calcium. If you’ve removed dairy from your diet, I understand that you can get calcium from several vegetable sources, but unless you are eating collard greens and spinach in huge amounts each day, it’s pretty hard to get anywhere close to the amount of calcium in dairy. How much calcium does the body need to function optimally (is the number different from the USDA prescribed 1000mg/day) ? With the relatively low amounts of calcium in a dairy-less diet, how does one ensure that they are not leaching bone calcium just to keep blood levels maintained, especially if they are eating large amounts of meat, salted or not? In an earlier post I saw you advise against calcium supplementation. I’d like to avoid supplementation beyond a Centrum as well, but I am concerned about my long term bone health and short term athletic performance as it relates to calcium.

    3. In this post you’ve covered cholesterol in the body and how it is not a good indicator for heart disease. If one is supplementing with fish oil to balance the Omega-6s in fatty grain fed beef, are there still dangers in eating large amounts of fatty, grain fed meats from the saturated fats?

    Sorry to write a book here, I understand that each of these topics might be better suited to a message board post, but I thought they might each be relevant to the post and comments.

    • robbwolf
      November 9, 2009 at 6:51 pm

      Zach-
      I’ll try to tackle this in the podcast…tough to answer all this in one crack amigo!

  41. Julianne
    November 4, 2009 at 9:40 pm

    Re fish oil and pimples.
    I found that the type of fish oil supplement seems to make a difference.
    When I switched from standard purified oil (which increased my spots) to Sears high concentrate omegaRx the pimples reduced.
    May be something to do with other oils that are removed during the concentration process.
    Not sure.

  42. Jesse
    November 5, 2009 at 3:25 am

    Thanks so much Robb. Let me know if there is anything more that you find out. It would be greatly appreciated. You have been my number one reference for any nutritional information. Thanks for the amazing site!

    Jesse

  43. Jesse
    November 5, 2009 at 1:45 pm

    Robb,

    Here is a follow up with my client about the fish oil. This may have some implications.

    “Here’s an interesting fact to consider about that… As I told you I have PTSD (Post Traumatic Stress Disorder) – and General Anxiety Disorder. At Duke University Medical Center, I went through a battery of tests & such when it was first diagnosed. Blood work, psychologocal analysis, TONS of questionaires & etc. I was fortunate enough to get to work with the director of the program at Duke – he was just incredible (Dr. Jonathon Davidson). All of that to say… One of the things I learned about anxiety disorder is that most people (who have general anxiety disorder) produce more sebacious fluids in general. It’s like your body’s always on high alert, or overdrive. I think that’s why I’m so sensitive to a lot of odd things. Will tell you more if you’re interested. BTW,I just had a great workout!

    Julie”

    • robbwolf
      November 5, 2009 at 6:42 pm

      Jesse-
      the advice I got back from OPT and Scotty hagnass was to reduce fish oil to 1g/day, hopefully seeing no acne, then slowly increasing up to about 4g/day for maintenance. That buildup should be about .5g/day for week each time to evaluate.

      Given what you just shared, I’d say she has some obvious cortisol overproduction. THIS by itself can push things towards insulin resistance and shifts the whole system towards the pro-inflammatory side. If I were her, I’d track down a doc well versed in cortisol management. I have a link to Garret Smith in my recent training update, he may be able to help remotely or you may know a naturopath/MD who is savvy to this stuff.

  44. Hugh MacEachran
    November 5, 2009 at 3:16 pm

    Hey Robb, as you most likely know, correlation is not causation. When the study shows that most people who have heart attacks have low cholesterol, is their cholesterol low due to the drugs or is it normally low in those people? Really great article, I love these articles revealing the truths nutrition and health!

    • robbwolf
      November 5, 2009 at 6:37 pm

      Hugh-
      Great point and i do not know. As you notice in the comments, there may be some kind of physiological shift that happens before/during/after the MI which makes the LDL appear artificially low. I raises many interesting questions and has honestly re-ignited an interest on my part with regards to the CVD side of all this.

  45. Julianne
    November 6, 2009 at 1:28 am

    I haven’t looked at the actual original studies, but this headline and article could be of interest:
    “Low total cholesterol levels could be sign of cancer”
    http://www.nbr.co.nz/node/114468

  46. Jesse
    November 6, 2009 at 3:27 pm

    Hey Robb, in an ironic twist to the comments the other Jesse made, I started taking fish oil about a month and a half ago, and the reductions in inflammation have gotten rid of the last bit of appreciable acne that I’ve had nagging me for years. It also reduces the size of bug bites I’ve gotten to approximately a quarter of their size. I used to swell up horribly from even mosquitoes, but now it’s no big deal.

    Thanks and keep up the awesome work!

  47. AmyP
    November 6, 2009 at 8:31 pm

    I am skimming through the article posted by Julianne above. Um…

    “Dr. Flechas has seen that iodine reverses polycystic ovarian syndrome”

    DING! Robb, I have PCOS and you previously told me that some women see beneficial results from taking iodine. I cannot, for the life of me find it anywhere. They don’t sell iodine pills at nutrition supplement stores, health stores, grocery stores. I have searched for iodine online and only found it in pill form along with a multitude of other “thyroid enhancing vitamins”, which I don’t really know are necessary. Any input on a good iodine supplement I can take, and where to find it?

    • robbwolf
      November 7, 2009 at 1:03 am

      Amy-
      you shouldnbe able to find something through like Solaray or a similAr company. Let me know if you track that down.

  48. NikkiT
    November 7, 2009 at 1:36 am

    Robb,
    If you can send me an email address, I can email you some of the relevant articles (pdfs) I have on hand re oral anticoagulant therapy and n-3 supplementation. Some of them are recently published so you may or not be able to see the full articles online depending on whether you have institutional access.
    You can find a fairly comprehensive, although dated (2004), NIH doc on the subject of n-3 treatment openly available at :
    http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=A137995.
    NikkiT

  49. Steve
    November 8, 2009 at 12:28 am

    Amy

    I am taking a product called Terry Naturally Tri-Iodine.

    Here is a link for the product:

    http://www.nourishingfoods.com/terry-naturally-tri-iodine-90-capsules.html

  50. ron
    November 9, 2009 at 2:46 pm

    Dr ralph cinque, who has posted on Robbs board in the past, made comments about the Finnish study that Julianne posted a link to in his health newsletter blog today. I agree with Dr Cinque, here is what he had to say

    “Dr. Cinque’s comments: For years, those who have disputed the cholesterol hypothesis have pointed to the troubling statistic linking low cholesterol with cancer as proof that demonizing cholesterol is altogether wrong. And those who have advocated low-cholesterol or no-cholesterol diets, such as Nathan Pritiking, Neal Barnard, and John Mcdougall, haven’t addressed the issue- that I know of. Perhaps they have, but I am not aware of it. And it’s amusing that the medical establishment tries to debunk the idea that low cholesterol could cause cancer- but not because they’re championing starch-based diets but rather because they are hawking cholesterol-lowering drugs. What good would it be to take something to prevent heart disease if it also causes cancer? And, animal research with statins has indeed shown a troubling rise in cancer incidence among animals getting statins, and some human studies have also found the same. Is it because statins are carcinogenic in themselves or is it simply that they are very effective at lowering cholesterol, which (theoretically) protects against cancer? I can’t answer all the questions being raised, but I will say that I think it’s unlikely that low cholesterol achieved through diet causes cancer. All bets are off when it comes to the drugs. Note that even cancer patients who eat a standard American diet (and that includes most cancer patients in the US) tend to have lower cholesterol. When you have cancer, your liver doesn’t work as well, so it doesn’t make as much cholesterol, and your digestive system doesn’t work as well, and so it doesn’t absorb as much cholesterol. Plus, cancer patients, being very sick, tend to lose their appetite and eat less food, and eating less food tends to lower cholesterol. And that, collectively, is why cancer patients tend to have lower cholesterol.”

  51. ron
    November 9, 2009 at 2:57 pm

    [Just in case this board doesn't allow quotes, I am re posting my comment with the link.]
    Dr ralph cinque, who has posted on Robbs board in the past, made comments about the Finnish study that Julianne posted a link to in his health newsletter blog today. I agree with Dr Cinque, that it’s unlikely that low cholesterol achieved through diet causes cancer.
    Here is what he had to say.

    http://www.1to1vitamins.com/news/2009/artl7746.html

  52. Mark
    November 9, 2009 at 8:13 pm

    Hey Robb,

    While I know it’s not true Paleo and one would be better off not chancing it but do you think sprouted grain products (yup, we’re talking Ezekial bread here) are a decent choice? I would think that it’s better than gluten free stuff.

    Also I’d be curious to know if you have ever read any of Matt Stone’s stuff at http://180degreehealth.blogspot.com/ His position is basically eating enough of the right foods (mostly Paleo, he includes dairy, rice, potatoes and some sprouted grains) to repair the metabolism. Once the metabolism is repaired, the body will regulate to where it should be. Makes sense to me as he is a big believer in that proper digestion is the origin of health.

    Thanks as Always,
    Mark

    • Robb Wolf
      November 9, 2009 at 2:08 pm

      Mark-
      Call me a paleo extremist but sprouting grains is an attempt to take a food that is bad for us and make it slightly less so. Considering things like yams, sweet potatoes and fruit offer non of the gut irritation of grains I’m not really in a position to recommend them other than occasionally and even then I;d stick with corn/rice options for the most part. But, it;s always open for experimentation. I just don;t see many folks go back to a grain based diet once they have really given paleo a shot.

  53. Mark
    November 9, 2009 at 2:30 pm

    Thanks Robb. If I may ask a follow-up, is there something structurally that make sweet potatoes/yams ok to eat but not white potatoes? Or is there not much of a difference? I want to say it has something to do saponins, just a shot in the dark there.

  54. ron
    November 9, 2009 at 3:10 pm

    Above Robb posted a link in answer to one of my comments, it didn’t work. here is the correct link. It was about dietary fat and CVD
    http://www.thepaleodiet.com/articles/Dietary%20Fat%20Quality%20%20CHD%20August%202009.pdf
    I will read it later.

  55. Mark
    November 9, 2009 at 3:41 pm

    Thanks again Robb.

  56. AmyP
    November 10, 2009 at 8:25 am

    Steve,

    Thanks for the link!!! I will give that a shot

  57. Julianne
    November 11, 2009 at 12:57 pm

    RE sprouted grains:
    Here is an answer from Loren Cordain on his new paleo diet blog
    http://thepaleodiet.blogspot.com/2009/11/paleo-diet-q-111009.html

    “Yes, sprouted grains and beans are a much healthier option. When we ‘sprout grains’ we are allowing the seed to germinate and a shoot will emerge from the seed. This is the part that is cut off and eaten. Therefore, the seed itself is not actually consumed (as is the case with whole grains and wheat flours where the seed proteins and starches are milled and eaten). Since lectins are packaged along with the seed to protect against predation, once the seed sprouts, the lectin concentration diminishes within a couple days. In a week’s time the sprouts should have no residual lectins.

    Gliadin and glutenin are the dominate proteins located in the endosperm of the seed. The starchy endosperm is located alongside the embryo (germ) within the seed, and provides nutrients the embryo needs as it is sprouting and growing. Therefore, there should be no gliadin or glutenin proteins in the sprout, but rather primarily non-digestible cellulous (dietary fiber). One can consume sprouted grains and beans without fear of anti-nutrients. However, keep in mind that these are still nutritionally poor in terms of micronutrients. Leafy greens and other vegetables contribute high fiber AND a higher concentration of nutrients-grains are still ‘nutritional lightweights’.

    I would like to amend my earlier statement: We can consume GRAIN sprouts without fear of anti-nutrients. However, legume sprouts still appear to contain considerable concentrations of saponins–the secondary compounds responsible for increasing gut permeability. Alfalfa sprouts (which are actually in the pea family) have an especially high concentration.”

  58. RatherRipped
    November 14, 2009 at 7:38 am

    This discussion on CVD and cholesterol is adding confussion to my life.

    Joined CF one year ago and took the (8 week) Paleo Challenge in June. That was an incredible success for me, good stuff. One side effect was a loss of 15lbs plus, which was not necessarily a goal.

    The problem, my cholesterol soared from 225 to 300. My Triglicerids were excellent and my hdl (75) good and ldl (215) bad. How can it be said that high cholesterol is safe? Every doctor I have met “freaked” at those numbers – want to put me statins. I refuse.

    One question I have is eggs. I was eating 3 per day. I was also eating bacon once or twice a week. Otherwise I worked hard to comply. I don’t understand what, in the Paleo Diet, could cause this problem. To abandon the diet would mean cheese, grains – along with hypo-glycimia and legumes.

    The doctor wants no meat, skim milk and some grains. “There is no such thing as ‘good’ fat” according to the doc. But other than the numbers, the benifits from eating Paleo have been tremendous for me. Any thoughts would be helpful.

    • Robb Wolf
      November 17, 2009 at 6:52 am

      Rather Ripped-
      I’d recommend reading Uffe Ravnskov’s book the cholesterol myths:
      http://www.ravnskov.nu/cholesterol.htm

      You likely have some other genetic factors at play here but like you pointed out, our other dietary options are not going to improve the situation.

  59. JC
    November 19, 2009 at 1:27 pm

    Robb is that Night Calm the same as Nature Calm? I purchased it from Amazon over the weekend, started dosing last night.

  60. Ryan Holmes
    December 23, 2009 at 3:54 pm

    Robb,

    I have been taking Cod Liver Oil for some time now (will change to reg fish since hearing podcast 2?) My wife noticed a nice oil slick in the john with my urine. I am 6’2″ 220# and taking maybe 1- 2 tablespoons of the Nordic Naturals a day. I just saw the rainbow shine myself last night….cause for concern? Just got blood work back as well low TG 53, 216 total cholesterol, VLDL 11, LDL 141, HDL 64, and 3.4 CHOL/HDL ratio. My wife is a bit worried but after reading a bunch here and the first 3 podcasts i am thinking commit a bit more to the paleo ie. leaner meats and I am doing alright. I will ask the doc about that LDL ratio and the TG.

    Thank You for this amazing resource!

    • Robb Wolf
      December 23, 2009 at 8:23 pm

      Ryan-
      We would have soem REALLY wacky stuff going on if you are peeing out fats! Any other supps?

    • Michelle Smith
      September 10, 2013 at 9:54 pm

      I’d guess that the urine is pulling residue from the toilet bowl left over from scum/feces. I’d be worried if it were actually in the urine.

  61. Ryan Holmes
    December 23, 2009 at 10:34 pm

    No other supps really, multi vitamin thats about it. Occasional protein powder. One abnormal kidney number as well, not very off, getting it retested though.

  62. Brian B
    January 17, 2010 at 5:51 pm

    Robb,
    I was fortunate enough to attend your CF Nutrition Cert at BTB Atlanta last November. At the time, you mentioned that you planned to “re-check” the Costco Kirklands brand fish oil to make sure it was still up to par – quality wise. Have you done this yet? If so, what did you find? I’ve been using this brand since it seems to be the most economical I’ve seen so far.

    On another note, my wife & I went totally Paleo 1-1-10 and are seeing a BIG difference. We had been on the Zone…lost weight, but didn’t have the increase in energy that we are experiencing with Paleo. Plus, your comments about “quality over quantity” just make more sense. And I’d rather look like you than Barry Sears any day. We’ve made use of the recipes on http://www.everydaypaleo.com site that your trainer setup…so tell her thanks.

    Thanks again for all that you do on this and other sites…you’ve helped me “see the light” when it comes to nutrition. Please finish the book!!!Thanks!!
    Brian

    • Robb Wolf
      January 19, 2010 at 9:57 am

      Hey Brian!
      I have not followed up on this. Someone else posted a comment that the Kirkland brand had to change the label claims due to variables stemming from the fish used. That makes sense but I have not followed it up. I still see people benefitting from the Kirkland brand, it’s inexpensive…so I tend to run with that.

      I’m stoked you have seen benefit from a qualitative shift in your chow. Pseudo-science wins again!!

  63. Allison
    March 22, 2010 at 9:59 am

    1) Statins have a LOT to do with cholesterol. Statins block endogenous cholesterol synthesis by the body.

    2) No wonder people who fall within the “guidelines” for cholesterol levels are having heart attacks and developing athero … the guidelines are too high. Those were the main points that your first two referenced articles were making. People think they have good LDL levels because their number falls within a certain range. There’s no magic cut off. Historically, changes to the acceptable ranges have been to decrease the margins. And those changes have been made by trial and error. Americans are still dying from athero with the current guidelines. I would venture to say that the guidelines will certainly be reduced again. Additionally, those people analyzed in the studies you linked to had really low HDL levels. And according to numerous studies, HDL levels are more predictive of developing athero than strictly LDL levels.

  64. alexG
    June 29, 2011 at 7:06 pm

    hey robb,

    im 16 and do crossfit, I eat 3 eggs a day and eat paleo. My mother thinks that i have really high cholesterol because of the eggs and that i’m going to have a heart attack one day. I keep telling her this info but she gets mad saying that high cholesterol is very bad and that she is a nurse and she knows. so, is eating 3 eggs a day bad for me?

    thanks, alex

  65. Judy Dean
    March 24, 2014 at 1:27 pm

    Hi

    My husband is 75. 2 years ago he had a couple of strokes that have left scars on his brain. He appears very healthy, playing golf once or twice a week and finding it hard to sit still for long. He takes statins and BP medication as well as aspirin, and is keen to stop taking these – particularly the aspirin and statins. His cholesterol level was down to about 2 recently, and his BP remains acceptable to the doctor. He likes to drink red wine, and frequently overdoes it, drinking possibly 5 bottles a week, with occasional top-ups of Armagnac. I am trying to make our diet as Paleo as I can, but he craves sugar in the form of ice cream and chocolate. I can find very little information on the web for older people in this situation, and would value some advice.

    Thanks

  66. Concerned mom
    September 17, 2014 at 1:01 pm

    Concerned mom
    I have an important question I really hope you can help me answer. I have a 9 year old son with giant heart aneurysms caused by Kawasaki disease. He is suppose to be on Aspirin everyday for the rest of his life, but it is so hard for me to do as we are a pretty low Pharma family. His cardiologist has given the ok for me to only give him a few aspirin a week if I trade it for some foods/supplements that will help do the same as aspirin. I am so frustrated because I am one that needs to follow a plan, and I can’t seem to find any on the internet. Can you steer me in the right direction so I can get my son off aspirin all together.

    • Robb Wolf
      September 17, 2014 at 1:06 pm

      Fish oil has some similar effects, but you’d have to work closely with your doc as to how that could be incorporated.

  67. Ewan
    October 2, 2014 at 8:03 pm

    Dear Robb — I’ve been following the Paleo diet strictly for the last four years. I enjoy the diet, learning about food, cooking, and everything else involved. The effects on my body composition were fairly immediate and long lasting.

    But I now have serious concerns about my health. I’ve always been a border line high cholesterol case: total cholesterol levels in the 220 range, but with relatively high HDL (good) cholesterol — usually 50+.

    I had my bloodwork done a week or so ago. My total cholesterol levels measured 263. My HDL measured 58. The little table on the lab results presents the following info regarding Total cholesterol/HDL ratio: average risk of heat disease for men is 5.0; a ratio of 2:1 (total:HDL) is associated with a CVD risk of 9.6; 3:1 ratio with CVD risk of 23.4. The table ends there, with my nearly 5:1 ratio off the chart, and presumably continuing to rise expontentially.

    Other studies (Framingham) suggest that average cholesterol levels in the US (210mg/dl) predict a 50% chance of premature death due to atherosclerosis, and bumping up from 200mg/dl to 260mg/dl (ie, my realm) increases the chance of premature death 500%. Disturbing. (For ref: my triglyceride levels: 50; VDL cholesterol: 10; and if it’s relevant, I was diagnosed with a slow thyroid, though within statistical error (TSH 4.865); and I’m a 33yr old male. I can provide a few more details about eating habits in recent years and months while I’ve lived abroad and moved around the world, eating what was available.)

    The doctor said if I didn’t make any lifestyle changes, he would strongly urge me to take statins. I said I’d make 2 changes: 1. I laid out my diet without using the word “paleo”. He told me instead to eat lean proteins, and cut the pork/bacon/red meat/butter/animal fat, and avoid carbs. 2. I haven’t been able to exercise since January due to injury, and I said I’d resume exercising under a program that would accommodate my (hip) injury. Basically: a low saturated fat paleo diet + exercise.

    I guess my question is this: my cholesterol levels appear to be off the charts, so…. should I be worried for my life (literally)? The Framingham study has suggested that there is no known case of heart disease (heart attack) occurring in a person with cholesterol levels under 150mg (though does not much discuss whether people with such low cholesterol die early of other causes). I was willing to tolerate higher cholesterol levels on the paleo diet, but these recent results seem to cross a dangerous threshold.

    A few related questions:
    1. If cholesterol is not the primary indicator we should test for susceptability to CVD, what is? And how can we get that checked?

    2. Is there anything inherently wrong with a low saturated fat paleo diet? (I’m thinking I’ll be left with veggies, chicken, fish/crustaceans, and heaps of nuts and avocadoes to get energy/calories from somewhere. I’m going to continue eating eggs.)

    3. I hope this doesn’t come across as rude, but I’d like to play devil’s advocate: given all the uncertainties and contradictory evidence and studies about health and nutrition, it seems at the very least that we risk courting danger by running high cholesterol levels. Massive sectors of the American medical community (a medical community deemed to be the world’s premier) link CVD with saturated fats consumption and high cholesterol levels. Are all these people, with all their funding and research and studies, wrong? Why might so many people be wrong? Presumably somewhere along the line, the medical establishment in this country has produced a few sensible, logical, scientific minds who have looked at the evidence objectively, so why, if the CVD-cholesterol link is a cannard, why has it persisted? In similar fashion, given the uncertainty, why shouldn’t we hedge our bets and aim for low (or moderately low) cholesterol? Wouldn’t that just be prudent, since we don’t really know? (For any readers, I fear that on another forum this would be the point in the conversation where we would dive into conspiracy theories about vested interests with ulterior motives in the agriculture community lying to us, through USDA and FDA, about what we should eat; a lot of this holds merit. But also consider the size and strength of the beef lobby in this country — they would surely have an interest in playing up the health benefits of red meat and playing down the risks of saturated fat/cholesterol. I hope the conversation can stick to medical science and not economics.)

    Sorry for the length of this post. I’ve devoted a considerable portion of my life and resources to this diet, and take these issues seriously. I think the paleo diet offers phenomenal prescriptions for how to eat healthy, with its emphasis on whole foods, raised properly, and consumption of real foods (as opposed to boxed and processed kinds). I’ve relied on the recommendations of this website repeatedly over the years, referred countless people to it, and will continue to do so because I think it is excellent, thoughtful, and conducive to good health. I also apologize if my questions are answered elsewhere: Robb is a prolific writer who has devoted a huge amount of his own life to these subjects, and I couldn’t possibly sift through everything. If the answers are to be found in already-existing products, I would be deeply appreciative to be pointed in the right direction.

    Thanks for all your work and efforts, and for this lively discussion.

    Best regards,

    Ewan

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