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Hi guys, this is another cholesterol related question.

I got myself tested after LC-ing for six months or so (wasn't strictly paleo) and TC was 376 (HDL 81). Was consuming butter and cream but no CO. Reduced dairy fat consumption and added a little bit of CO: TC 280 (HDL 81). I was cooking with Olive Oil at this point. Decided to switch to CO for cooking as well and after a few months, got retested: TC 380 (HDL 84). No butter and cream was being consumed at this time.

It seems that my TC is correlated with total SFA consumption, whether it be from CO or dairy. HDL tends to max out at 80-ish at a certain level of consumption and beyond that, SFAs only raise my LDL. I have no idea whether this could be genetic (FH or ApoE). What I do know is that my thyroid is normal (T3 on low end of normal but TSH < 2), I supplement with a multi and some minerals and I don't do VLC. Carbs are 120g-240g depending on whether I train or not.

The only thing I can put my finger on is the SFAs. The LDL raising abilities of SFAs seem to apply to only a subset of the population of which I am a part. Aside from reducing SFA consumption to a more appropriate level to achieve a good TC/HDL ratio, I don't know what else I can do. I tried cutting down total fat and SFAs too much last year and the result was that TC dropped to 270-ish but HDL also tanked to 50-ish. It seems I need to eat high fat (mostly MUFA) with a certain amount of SFAs to have a good TC/HDL ratio. TC always stays high no matter what I do. Anyone here with a similar experience and some suggestions on what to do?

Note: My latest test results show TC: 330, HDL 81 (down from TC of 380 and HDL of 84) a few weeks after I decreased CO consumption and re-introduced Olive Oil for cooking. The response of my lipids to SFAs is so reliably predictable, it's scary.

EDIT: New Test results after a further (slight) reduction in Coconut Oil; TC 309, HDL 84, TG 62, LDL (Iranian) 178 (down from 206).

It seems I just need to continue what I'm doing, i.e. watch total SFA consumption from dairy and Coconut Oil and hopefully I'll get TC below 300 again whilst maintaining the excellent HDL.

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Patiently waits for Travis Culp to pipe in about butter elevating lipid profile... In the meantime, check out his post: paleohacks.com/questions/105064/… – April S.♦ May 8 2012 at 8:07
See, that's one of the points I make. I have consumed very little dairy fat, no butter and cream at all since the first test result. The high TC and LDL seem to be correlated with SFA intake in general, not dairy fat specifically. I'd like to know if this sensitivity to SFAs could be due to FH or is it because of ApoE or some other factor. Or is it just that some people respond this way to high SFA intake regardless. I find it hard to believe that everyone reporting high cholesterol on high fat/Paleo/LC has FH. – Carnivore May 8 2012 at 9:31
welcome to the ApoE4 club. What was track record with seasonal infections? paleohacks.com/questions/115605/… – matthew May 8 2012 at 11:52
ApoE4 may be the reason. No infections or illness for over two years, i.e. when I first started eating a cyclic ketogenic diet (later transitioned to paleo-ish foods and carb cycling ala Leangains, but with a heavier fat intake on training days). – Carnivore May 9 2012 at 10:15

3 Answers

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The central issue or flaw in all these discussions is the validity of surrogates/proxies. What is the real performance we are trying to improve? The use of TC as a surrogate for heart health and the subsequent validation of PUFA intake led to a gratuitous experiment with the world's health we are still suffering and participating in. And probably all because at the time Ancel Keyes did not have the instruments to measure Omega 3 and 6 levels but could readily quantify TC plus it turned a reagent yellow. Raw milk, cream and butter were successfully used to treat heart conditions 100 years ago.

Focusing on HDL and TG/HDL might be a better and more constructive perspective.

The SCFAs (is that what you refer to as SFA? SFA means shit for all to me, hehehe) your body needs most are those produced by fermentation in the gut from dietary fiber. Like salt deficiency this can be another pitfall of Paleo diets. Born-again paleo diets are too refined. Eat more dirt, more coarse and unpurified foods. Paleo meat would have more blood in it, and hair and skin attached, and leaves and dirt and so on...Psyllium husk is a good probiotic fiber that has been shown to increase concentration in the gut of butyrate, the preferred energy source of colonocytes (including the GALT, the gut associated lymph tissue cells that constitute 70+% of human immune system.) Take psyllium straight or in capsule form, not the artificially sweetened or sugar added Metamucil style.

Paleo butchering and diet would also include some digesta, the partially digested GI contents. Like Laps who might enjoy eating the lichens in reindeer stomachs.

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And paleo butchering and cuisine would include the organs and depending the animal also some digesta, the intestine contents, just like Laps might enjoy eating some of the partly digested lichens in reindeer stomach. – Whiskers White Nov 14 at 15:50
I thought the comment did not post so rewrote in the edit. Another comment: I had blood lipids screens two days apart ten years ago. The only difference was the first time I had a cup of green tea before going in to the clinic. The green tea raised my TC by 40 points to 220, and HDL and TG each by 30 points. I guess my heart was just as healthy the first time as it was two days later. – Whiskers White Nov 14 at 16:02
OK, now I get it! You mean saturated fatty acids. But when I went off on that rant about false proxies and SCFAs it's still relevant to neo-Paleo diets. In addition to vinegar, milk and cream are good dietary sources of SCFAs, the name butyrate comes from butter where it was first identified (up to 4%.) And many born-again Paleo eaters who have immune reactions should consider the dietary fiber and GALT connection. – Whiskers White Nov 14 at 16:15
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Carnivore, I have what seems to be the same exaggerated response to sat fat. My highest ever TC occurred during an experimental raising my SFA intake from Av 21 g / day to 29 g /day. I keep a meticulous food and exercise journal.

BTW, I am the 1st male on my father's side in 3 generations of CHD issues to live past my 65th birthday.

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Thanks for your answer, Dan. Could you elaborate on what sort of rise occurred by raising SFA intake? I must admit that my SFA intake is much higher than this, even now. Haven't calculated exactly how much I'm taking in but it's definitely higher than 29g. My typical day's menu includes 500g beef (cooked in olive oil), a can of sardines, 1 tablespoon of coconut oil, 3 boiled eggs, 40g Lindt 85% Dark Chocolate, an ounce of almonds, 120g of cheese (low fat), 300-500ml of skimmed milk. Aside from this, I also eat salad veggies and fruits/potatoes which don't really contribute to SFA intake. – Carnivore May 14 2012 at 7:23
Just did a rough calculation for my average SFA intake. It's around 65g per day. – Carnivore May 14 2012 at 10:58
This is after the reduction which came from replacing Coconut Oil with Olive Oil for cooking and limiting total intake of Coconut Oil to 1 tablespoon per day. – Carnivore May 14 2012 at 11:00
Oct 2011, SFA = 21g/day, TC=175, HDL=78 Jan 2012, SFA = 29g/day, TC=320, HDL=101 Mar 2012, SFA = 14g/day, TC=243, HDL=91 May 2012, SFA = 20g/day, TC=220, HDL=86 As you can see, SFA does not tell the whole story. I think my fish oil supps also affect non-HDL-c (reduction) and the effect depends on brand, form (EE vs TG), and how much fat is ingested along w the fish oil. I also think hard exercise breaks down muscle tissue, causing cholesterol recycling to take place which increases lipoprotein transport requirements. – Dan H. May 14 2012 at 16:35
Dan, I'd be interested to know how much dietary cholesterol you ate the day prior to each of these tests. For myself increased dietary cholesterol intake (700mg-1gm day) significantly reduces both TC and LDL (-30%). – Dave_B May 18 2012 at 9:27
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I just now saw these.

@Dave: did you mean to say that for you, INCREASED dietary cholesterol the day before the test REDUCES TC and LDLc? How many times has this happened?

Sorry, I don't know why that got bolded and big and why the post doesn't appear indented under the others. ... and I can't seem to make it unbolded,

@Mambo: Thanks for the suggestions. My other numbers are good: In Nov, 2010, Lp(a) was in the lowest quartile: 9, CRP was also lowest quartile (0.11), my 2011 Ferritin was 89.

@Carnivore: Thanks for the extra test info. It helps me make sense out of my numbers. I eat high fat (50% of calories), but am VERY careful to get most of it from MUFAs: lotsa avocados and I use Spectrum high oleic sunflower oil to add fat to meals. I try to keep animal fat as low as possible. Also, I get some omega-6 from cashews, and I think that might help keep my LDL down. Is this all a mistake? Who knows? but having my TC over 300 concerns me.

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