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LDL goes rampant after 2 months paleo

by (20)
Updated September 16, 2014 at 7:15 PM
Created September 05, 2010 at 7:13 AM

My lipid panel before adopting a paleo-style diet:

  • HDL 40.6
  • LDL 110
  • Tryglicerides 39

After my two-months paleo:

  • HDL 65.6
  • LDL 318
  • Tryglicerides 68

Now, I know that LDL isn't the most precise indicator of CVD risk, but, anyways, could this be normal? My diet consisted mainly of conventionally raised meat (beef, pork), eggs ("free-range"), fish, butter & veggies, few fruits or other kind of dairy.

Could this be from too much saturated fat or animal protein? Is there something to worry with my lipid panel?

Cb9fa5a5d49b02fa532badb65b01e8a1
5 · January 05, 2011 at 2:48 AM

Robb Wolf also recommends supplementing with Alpha Lipoic Acid and CLA if you only have access to conventionally farmed meat.

75fc0701861b06be925ad42a6f9843ce
10 · December 20, 2010 at 5:19 PM

Try to do some workout, walk, etc. You need to burn the fat you intake. You get energy from fat, so burn it somehow, you will see the drop on the LDL.

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8858 · December 13, 2010 at 3:57 PM

What evidence do we have that high LDL is bad? My understanding is that there is very little support for this. The HDL being too low--now there's plenty of support showing that this is bad.

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361 · December 13, 2010 at 6:21 AM

Be careful bud. Your previous bloodwork looks pretty good.

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15583 · September 08, 2010 at 6:16 PM

It's possible that there's a subgroup of the population who have a response to SFA that's totally different to every-one else, but it's difficult to see why this would evolve. It seems more plausible, given that the "data" is anecdotes of freeliving subjects making multiple changes simultaneously, to suspect that something else might be involved. More important, in any case, is the fact that SFA isn't associated with CVD or actual mortality; worrying about cholesterol in isolation is a bit silly. [If only I could think of a snappy term for fetishism of blood lipids, as per "nutritionism."] ;)

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19220 · September 06, 2010 at 9:04 PM

Most research deals with population averages, hiding any individual responses. A few individuals seem to respond to high fat diets with big increases in LDL. This can be seen anecdotally in the comments on Stephan's post you linked. Maybe this is harmless, I think it is to early to say. Fiber is a normal part of the human diet, maybe it is contributes to normal lipids in some people. ugk's previous high carb diet did not seem to raise his tryglycerides.

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15583 · September 06, 2010 at 6:08 PM

Hi Matthew, while I agree we shouldn't assume that high-cho must be ok fine if we're paleo without evidece, I'd equally like to know what the evidence is for thinking SFA will raise LDL. Stephan (linked in my answer above) cites a fair few studies against the idea. When Dr Davis tried to say that "some people" experience increased LDL on SFA, Kurt Harris and Peter of Hyperlipid pretty convincingly demolished him. http://heartscanblog.blogspot.com/2010/02/genetic-vs-lifestyle-small-ldl.html Fibre will drain cholesterol, but why is this good? The extra carbs and o-6 will raise trigs and oxLDL.

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15583 · September 05, 2010 at 5:54 PM

Shockingly low triglycerides for a majority carb diet. Perhaps given the calorie-sparse food you were inadvertently calorie-restricting (sounds very similar to my pre-paleo diet), were you losing weight on your previous diet? If most of your protein was from fish, you probably were getting lots more o-3 previously. I would counsel against EVOO. It's 9.7g o-6 per 100g, almost identical to lard, the most omega-6y animal fat. You're just switching SFA for MUFA. If you want to read more about SFA and cholesterol http://wholehealthsource.blogspot.com/2009/12/dirty-little-secret-of-diet-heart.html

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20 · September 05, 2010 at 5:05 PM

Pre-paleo, I was basically on a low-fat diet, with "good carbs" & "good fats". So, low-fat dairy, rolled oats, chicken breast (without skin), fish, legumes, veggies & fruits. No red meat or anything high on SFA. Rarely grains (wheat-bran in my morning bowl of rolled oats, but not with regularity). I don't know really, because now I feel great. Maybe I had a disbalanced omega6/omega3 ratio? I will also try to follow Mellisa's and your advice, and try to reduce my pork intake, and add more EVOO and butter.

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20 · September 05, 2010 at 4:33 PM

I've been pretty low-carb, 0 sugar or grains, so it's not the case. I didn't IF, though, with regularity.

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15583 · September 05, 2010 at 3:58 PM

I'm not surprised that you can have normal LDL on grassfed (which I agree is subtly preferable), what's interesting is whether you can on conventionl meat. Since none of the components that differ between grassfed and conventional are that significant for cholesterol (except extra o-3), it seems an article of faith rather than a genuine hypothesis, that grassfed makes a positive difference to LDL. Minimising o-6 is uncontroversially good though (although bad for your LDL numbers), so I also follow the lean cuts + butter policy.

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3651 · September 05, 2010 at 3:37 PM

your diet consisted of mainly the things listed above but did it also include sugar, wheat, other grain or any non-paleo things (a couple beers each night) with regularity? without a full picture of your actual diet its tough to figure out why your trigs and LDL would jump like that.

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9647 · September 05, 2010 at 3:34 PM

I second this. I've seen tons of lipid panels on paleo forums, and it's nearly always the case that HDL goes up, total LDL goes up, and triglycerides go down. Of course as CT says your trigs are still low, but it is noteworthy.

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9647 · September 05, 2010 at 3:31 PM

Wait, why would you drop your saturated fat intake? That's your primary fuel, ain't nothing wrong with it.

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20 · September 05, 2010 at 2:59 PM

No, I'm male, in my 20's. I shall recheck in a couple of months, supplement with vit. D & omega 3 & drop a bit my SFA intake... other advice?

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56596 · September 05, 2010 at 2:44 PM

Either way, even if those factors seem insignificant, grass fed meat IS different from factory farmed meat. I am a young woman with normal LDL. I almost never eat factory farmed meat.

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15583 · September 05, 2010 at 10:21 AM

"Most" of the fat from conventional meat won't be o-6. Even lard, the worst offender is 40 SFA: 45 MUFA: 10 o-6: 1 o-3, so about 8.5 times more SFA/MUFA:o-6. Grassfed meat, in fact, contains more PUFA:Fat, it's just a better omega-6 balance. PUFA wouldn't produce the above lipid changes anyway. O-6 can increase oxidised-LDL but it ought, if anything, to reduce total cholesterol. Cheap butter is pretty innocuous: 2.7g o-6 per 100g and 51g SFA+ 21gMUFA. You get a bit less vitamin A (not great quantities anyway), K2 and less CLA, but otherwise the differences are insignificant.

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13 Answers

E35e3d76547b18096a59c90029e7e107
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15583 · September 05, 2010 at 4:36 PM

The most important thing to know in trying to answer this is 'what were you eating before?'. The most surprising thing is the very low triglycerides previously, increasing significantly, but still low. Increased carbohydrate is one of the main drivers of increasing triglycerides, so it's a surprising result, since most people eat fewer carbs on a paleo diet (unless you were VLC beforehand). Alternatively, were you eating large amounts of omega-3, perhaps from flaxseed, previously, since this would depress triglyceride and cholesterol levels?

HDL increasing with increased saturated fat intake is unsurprising and a good thing. This just leaves increasing LDL as the surprising factor. A few possibilities present themselves. Had you had more normal (higher) triglyceride levels beforehad, I would wonder whether you're getting a misleadingly high LDL measurement due to the friedwald equation, which over-estimates LDL when subjects have unusually low triglycerides (as with low carb eating). Another possibility, is whether you were eating more cholesterol-reducing foods before you went paleo? It's possible that increased omega-6 decreases cholesterol, ditto plant sterols, increased soluble fibre etc could all artificially lower cholesterol. There's no reason to assume this is a good thing, indeed in the case of o-6, it is at least in part a bad thing, through increased oxidation of LDL.

I'm willing to be corrected, but I'm not aware of any hard links between animal protein and cholesterol (aside from tenuous associations at the population level). Animal products seem to have gotten associated with cholesterol in the minds of nutritionists on the basis of their SFA, but I don't know of the protein itself being significant.

It's possible that consumption of eggs could influence your cholesterol profile. While it is correct to note that the body easily adapts its cholesterol levels to increased dietary intake (it simply decreases its production of cholesterol, which far outweights dietary intake), there is some evidence that dietary intake increases the ratio of total cholesterol to HDL cholesterol. Thus, it might negatively offset the gains you get from increased SFA intake, in terms of higher HDL.

Another possibility is simply that something else has changed in your lifestyle since changing to paleo (less sleep, more stress, less exercise, for example). Cholesterol is a tool that your body uses to perform certain functions, not just an isolated consequence of our diet; if your body is damaged in some way it may well increase cholesterol to repair the damage. My own view is that cholesterol itself is just a marker for other things going on in the body and thus not worth worrying about in itself, reducing cholesterol artificially is unlikely to be a good thing.

E35e3d76547b18096a59c90029e7e107
15583 · September 05, 2010 at 5:54 PM

Shockingly low triglycerides for a majority carb diet. Perhaps given the calorie-sparse food you were inadvertently calorie-restricting (sounds very similar to my pre-paleo diet), were you losing weight on your previous diet? If most of your protein was from fish, you probably were getting lots more o-3 previously. I would counsel against EVOO. It's 9.7g o-6 per 100g, almost identical to lard, the most omega-6y animal fat. You're just switching SFA for MUFA. If you want to read more about SFA and cholesterol http://wholehealthsource.blogspot.com/2009/12/dirty-little-secret-of-diet-heart.html

67dbc3e50bd55e5ba4654bfdd6093365
20 · September 05, 2010 at 5:05 PM

Pre-paleo, I was basically on a low-fat diet, with "good carbs" & "good fats". So, low-fat dairy, rolled oats, chicken breast (without skin), fish, legumes, veggies & fruits. No red meat or anything high on SFA. Rarely grains (wheat-bran in my morning bowl of rolled oats, but not with regularity). I don't know really, because now I feel great. Maybe I had a disbalanced omega6/omega3 ratio? I will also try to follow Mellisa's and your advice, and try to reduce my pork intake, and add more EVOO and butter.

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9647 · September 05, 2010 at 3:57 PM

Kurt Harris: "If you don't believe the lipid (diet/heart) hypothesis (I don't), why are you having your total cholesterol even measured more than once? [...] As long as trigs are low and HDL is high, they indicate you are eating plenty of good fat but are otherwise fairly meaningless."

Harris has said however that a total cholesterol of 300 is a good upper limit for "normal," which means that if it is significantly above that you could have FH (familial hypercholesterolemia) or thyroid issues. I would guess you would first have to find the proper formula (Iranian?) for calculating LDL and total (I don't know how this works, to be honest, I haven't done it yet). But anyhow there are a lot of insights on this old thread from the PaNu forum, particularly Dr. Harris's October 15th response on the thread. Keep in mind of course that nothing on any of these websites counts as medical advice, etc., etc. And this material is from some time back; Dr. H's most recent blog post is on cholesterol, and it's an excellent read. Anyhow, all of this can give you some valuable perspective.

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11478 · September 05, 2010 at 5:57 PM

2 words: lab error

It's highly unlikely that a paleo lifestyle would increase your LDL by nearly 200%. Either the first or the second test result is probably wrong--or maybe they're both wrong, and your LDL is somewhere in the middle. A third test (by a different laboratory) will cast the deciding vote.

If the second test is wrong, then you have nothing to worry about.

If the first test is wrong, then I would get your LDL sub-fractions tested ( http://www.abclab.com/newsletter/LDL%20Newsletter%20Insert.pdf ). A paleo lifestyle usually favors large, fluffy LDL (low risk) vs. small, dense LDL (higher risk).

Also, I would get your thyroid levels (TSH, FT4, FT3) checked, and make sure you're getting enough iodine. It is rare for triglycerides to go up after adopting a paleo diet, so there may be something else going on, like decreased thyroid function.

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56596 · September 05, 2010 at 3:00 PM

I'm going to go with Robb Wolf here and say that grass-fed meat IS significantly different and perhaps we don't know all the ways it is yet. CLA differences, for example, are a relatively recent discovery.

I almost never eat factory farmed meat and here I am typing this as a young woman with normal LDL.

If you can't afford to buy grass-fed meat, Robb Wolf suggests going for leaner cuts and supplementing with fish oil. My own advice would be lean cuts + invest in GOOD grassfed butter/ghee/olive oil/lard to cook it in. Cut out factory-farmed pork entirely, lamb and beef are the least affected by poor feeding practices.

My LDL went from 90 to 101 when I increased my pork consumption. HDL also increased too though. n=1, but whatever.

Eventually I hope someone will study the differences between paleos eating grass-fed and those not. I suspect us grass-feds have better numbers.

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15583 · September 05, 2010 at 3:58 PM

I'm not surprised that you can have normal LDL on grassfed (which I agree is subtly preferable), what's interesting is whether you can on conventionl meat. Since none of the components that differ between grassfed and conventional are that significant for cholesterol (except extra o-3), it seems an article of faith rather than a genuine hypothesis, that grassfed makes a positive difference to LDL. Minimising o-6 is uncontroversially good though (although bad for your LDL numbers), so I also follow the lean cuts + butter policy.

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19220 · September 06, 2010 at 3:03 PM

First as Ed says it is possible for it to be an error in your lab test. However I will assume this is not the cause. The ldl number is probably not very precise as the standard equations do not work well with low tryglicerides, however I suspect your ldl will still be very high however it is calculated.

You were eating a low fat high carb diet and you have switched to what looks like a diet high in fat. A low fat diet can have a detrimental effect on cholesterol levels in some people. This does not seem to be the case with you as your first profile looked ok.

You will now be eating a lot more satruated fat, I think this is the most likely reason for your sudden rise in Ldl cholesterol. Individuals vary a great deal in their cholesterol response to dietary saturated fats and also dietary cholesterol. Many people will see little change or even a reduction in cholesterol levels after increasing fat and animal products and big improvements in Hdl. A few others such as yourself respond with large increases in Ldl cholesterol.

People will argue about wether high Ldl cholesterol is harmful or not and about particle size. I think it is a risk factor but only one among several other factors. The fact that members of traditional hunter-gatherer societies had lower cholesterol levels than average modern people leads me to suspect than a diet that raises cholesterol further above high western levels is not replicating an ancestral diet.

If you want to lower your Ldl it would probably not be to hard. A paleo style diet does not have to be low carb and high in saturated fat. You could eat more green and starchy vegetables, fruits and nuts. Soluble fibre found in these is common in paleo diets and also lowers cholesterol. Just eat a moderate amount of saturated fat. Use olive oil for some of your fat and less butter. Animal protein does not raise your cholesterol. Eat less of the very fatty conventionally raised meats.

Of course you can also ignore it and choose to believe that high ldl cholesterol levels are totally harmless

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15583 · September 08, 2010 at 6:16 PM

It's possible that there's a subgroup of the population who have a response to SFA that's totally different to every-one else, but it's difficult to see why this would evolve. It seems more plausible, given that the "data" is anecdotes of freeliving subjects making multiple changes simultaneously, to suspect that something else might be involved. More important, in any case, is the fact that SFA isn't associated with CVD or actual mortality; worrying about cholesterol in isolation is a bit silly. [If only I could think of a snappy term for fetishism of blood lipids, as per "nutritionism."] ;)

0bc6cbb653cdc5e82400f6da920f11eb
19220 · September 06, 2010 at 9:04 PM

Most research deals with population averages, hiding any individual responses. A few individuals seem to respond to high fat diets with big increases in LDL. This can be seen anecdotally in the comments on Stephan's post you linked. Maybe this is harmless, I think it is to early to say. Fiber is a normal part of the human diet, maybe it is contributes to normal lipids in some people. ugk's previous high carb diet did not seem to raise his tryglycerides.

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15583 · September 06, 2010 at 6:08 PM

Hi Matthew, while I agree we shouldn't assume that high-cho must be ok fine if we're paleo without evidece, I'd equally like to know what the evidence is for thinking SFA will raise LDL. Stephan (linked in my answer above) cites a fair few studies against the idea. When Dr Davis tried to say that "some people" experience increased LDL on SFA, Kurt Harris and Peter of Hyperlipid pretty convincingly demolished him. http://heartscanblog.blogspot.com/2010/02/genetic-vs-lifestyle-small-ldl.html Fibre will drain cholesterol, but why is this good? The extra carbs and o-6 will raise trigs and oxLDL.

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2604 · September 05, 2010 at 1:22 PM

Of more concern to me is the increase in Triglycerides - although thankfully this is still very low. Definitely worthwhile getting another test (direct measurement) in a few months and looking again.

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9647 · September 05, 2010 at 3:34 PM

I second this. I've seen tons of lipid panels on paleo forums, and it's nearly always the case that HDL goes up, total LDL goes up, and triglycerides go down. Of course as CT says your trigs are still low, but it is noteworthy.

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2369 · September 05, 2010 at 1:05 PM

The cholesterol numbers you have reported do not tell the entire picture. Is your LDL the small, dense type (bad) or large, fluffy type (good)? With higher HDL and low triglycerides, the LDL is probably large and fluffy which does no harm. I would ask for the VAP cholesterol test which will give you much more information about what is really happening. Since LDL is calculated, you might also want to use the Iranian formula (easily found with google) and see what the numbers actually are.

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470 · January 16, 2013 at 11:01 PM

A fatty liver could be right-sizing, thereby releasing lipids into the bloodstream.

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50 · January 16, 2013 at 10:46 PM

"Is your LDL the small, dense type (bad) or large, fluffy type (good)? With higher HDL and low triglycerides, the LDL is probably large and fluffy which does no harm."

Where is everybody who says this getting this information? I believe that an LDL of 318 is always going to be a concern no matter if it's fluffy or pellet-like or anything else. Maybe I'm wrong? I would urge you to consider everything that is said here and to seek other information as well. Take care and keep us updated!

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361 · December 13, 2010 at 6:29 AM

The following is just my experience and probably not an answer to your question. I am 24 male. Before starting Paleo, I realized I have high cholesterol, especially high LDL around 150. It looks somewhat genetic. As usual most of the people on the net say fat has nothing to do with cho blah blah but I did a low sat fat diet and my LDL dropped. Then I introduced eggs (not the free range though) and ate 3 per day for two months. Guess what, my cho was back to being high. So I found a direct correlation between my sat fat intake and cho levels. Now note that people here will tell you sat fat is good as long as they are healthy, so take all the advices with a pinch of salt and do some independent research and 'listen to your body'.

I am somewhat scared how my numbers would be now after more than a month of Paleo.

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8858 · December 13, 2010 at 3:57 PM

What evidence do we have that high LDL is bad? My understanding is that there is very little support for this. The HDL being too low--now there's plenty of support showing that this is bad.

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892 · September 05, 2010 at 2:13 PM

Are you perchance female and relatively young? My LDL is crazy high(didn't check it pre-paleo though) and I've done some looking around... I've met a surprising number of women in the paleo blogosphere with very high LDL. Considering that young, healthy women probably rarely get their cholesterol checked, I'm starting to wonder if it's actually normal for us to have higher LDL. Or maybe there are underlying inflammation issues, I dunno. Anyway, see my answer on this thread: http://paleohacks.com/questions/3906/very-high-total-cholesterol/3912#3912

ETA: VERY interesting blog post by Chris Masterjohn on this. It's possibly that your lipids could (hopefully temporarily) increase while your body heals itself of fatty liver disease.

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9647 · September 05, 2010 at 3:31 PM

Wait, why would you drop your saturated fat intake? That's your primary fuel, ain't nothing wrong with it.

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20 · September 05, 2010 at 2:59 PM

No, I'm male, in my 20's. I shall recheck in a couple of months, supplement with vit. D & omega 3 & drop a bit my SFA intake... other advice?

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766 · September 05, 2010 at 7:45 AM

If by conventionally raised meats you are meaning regular supermarket meat, fed corn and antibiotics then this is not surprising at all. Most of the fat you are taking in from that is polyunsaturated omega 6 which is not the type of fat that is considered good for you on a paleo diet.

You should either switch to 100% grass-fed meat, or at the very least only buy the leanest cuts of conventional and supplement with copious amounts of fish oil.

Same goes for your butter and dairy, if its cheap butter, its not going to do you much good.

Cb9fa5a5d49b02fa532badb65b01e8a1
5 · January 05, 2011 at 2:48 AM

Robb Wolf also recommends supplementing with Alpha Lipoic Acid and CLA if you only have access to conventionally farmed meat.

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56596 · September 05, 2010 at 2:44 PM

Either way, even if those factors seem insignificant, grass fed meat IS different from factory farmed meat. I am a young woman with normal LDL. I almost never eat factory farmed meat.

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15583 · September 05, 2010 at 10:21 AM

"Most" of the fat from conventional meat won't be o-6. Even lard, the worst offender is 40 SFA: 45 MUFA: 10 o-6: 1 o-3, so about 8.5 times more SFA/MUFA:o-6. Grassfed meat, in fact, contains more PUFA:Fat, it's just a better omega-6 balance. PUFA wouldn't produce the above lipid changes anyway. O-6 can increase oxidised-LDL but it ought, if anything, to reduce total cholesterol. Cheap butter is pretty innocuous: 2.7g o-6 per 100g and 51g SFA+ 21gMUFA. You get a bit less vitamin A (not great quantities anyway), K2 and less CLA, but otherwise the differences are insignificant.

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20 · January 17, 2013 at 12:36 AM

My advice to you would be to go off Paleo immediately, and return to your former, excellent eating habits.

Your lipid panel looks horrifying.

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