I think cholesterol may be a concern but not because it is a cause of problems, but because it is a symptom of problems. First of all, lets get facts straight, no good studies have ever shown that cholesterol intake has anything other than a tiny transient effect on blood cholesterol levels. Most cholesterol in your blood is made by your body and does not come from food. Your body has a set point of approx where it likes to maintain the level of cholesterol and it will try to maintain that level regardless of what amount of cholesterol you actually eat. Similarly, evidence is lacking that sat fat raises cholesterol. There just isn't good evidence that sat fat is bad in any way and some studies show it as being good. So let us not get confused with a large host of incorrect statements all thrown out at once. Cholesterol and sat fat intake have not been reliably correlated with cholesterol levels.

Now I do suspect that cholesterol levels are but one of thousands of biomarkers that are affected by the health of any individual and I am not at all surprised that the blood cholesterol levels of healthier populations are not the same as those of sicker populations. However, also remember that many healthy natives who eat tons of sat fat, also have low cholesterol, so again, it's not about sat fat intake. Lets just put that one to rest.

I do think it's about health. But again, cholesterol is but one of hundreds of markers that are effected by health. Also keep in mind that most cholesterol lowering drugs were found to be dangerous and not advantageous. Only statins finally succeeded and then perhaps only becuase of their anti inflammatory effects. Remember that even though statins lower cholesterol, they only have a very mild effect on lifespan and then only for middle aged men with pre existing heart conditions. They have not shown any advantage for any other group. One might ask what kind of rip off scam it is to put any other group on these meds when no advantage has been shown and serious side effects are well known.

Also, low cholesterol is correlated with death in the elderly. If you are old, stats show you have better chances with high cholesterol than low. If cholesterol is so bad for you, why does it suddenly become good for you when you are old? And why is it not bad for women? The science does not add up for cholesterol being causal. That is why I don't stress over cholesterol. I think it is a weak marker at best and not causal at all. The goal would be to find out what is causal, and ironically, inflammation is already well known to be causal. Of course, then the question becomes what causes inflammation?

To keep things in perspective, for a while, everyone worried about butter intake and margarine was considered healthy. Now suddenly margarine is bad again and butter is good. Fad science flip flops all around. You have to look at the real research behind each fad. This is true in the mainstream as well as the paleo community. The research does not support blood cholesterol as a causal problem, but big pharma is making millions on those cholesterol pills so don't expect them to tell you to stop taking them on their own. They will continue to ride that cash cow till exhaustion just as they did with the whole thing about how all postmenopausal women should be taking hormones, until that blew up in their faces and the hormones were finally shown to cause more harm on average than good. And once the cash cow begins to stall, they will already be ready with a new pill for a new problem thaty you all should take forever and they will say the same thing which is to not be cavalier with your health and don't question the big pharma salaried 'professionals' because they know more than you.

When in reality they are being paid to repeat what they are told and few of them have ever even looked at the research. I dare any one of you to research the hell out of cholesterol drug trials and then try to have a conversation with your doctor on the subject. HOw many of them will even know even the basics of the biggest drug trials? I'd bet very few. Most only know what they have been told by big pharma at those continue education seminars that are all put on and run by big pharma. And each of those doctors get thousands of dollars annually as kickback from big pharma each time they prescribe you another pill. This is good to keep in mind, ie that almost all doctors are actually paid extra to tell you to take a pill or three.

So no, I am not being cavalier. Concern for myself and my health is why I spent many long hours educating myself on the subject. I am not being cavalier, I am being educated.

Dr. Uffe Ravnskov's, book, The Cholesterol Myths might give you peace of mind.

http://www.ravnskov.nu/cholesterol.htm

Here is an excerpt from his site. You can read the explanations at the aforementioned site. This list has linking explanations on that page. One must scroll down very far to find it.

Here are the facts!

...

1. Cholesterol is not a deadly poison, but a substance vital to the cells of all mammals. There are no such things as good or bad cholesterol, but mental stress, physical activity and change of body weight may influence the level of blood cholesterol. A high cholesterol is not dangerous by itself, but may reflect an unhealthy condition, or it may be totally innocent.

2. A high blood cholesterol is said to promote atherosclerosis and thus also coronary heart disease. But many studies have shown that people whose blood cholesterol is low become just as atherosclerotic as people whose cholesterol is high.

3. Your body produces three to four times more cholesterol than you eat. The production of cholesterol increases when you eat little cholesterol and decreases when you eat much. This explains why the ”prudent” diet cannot lower cholesterol more than on average a few per cent.

4. There is no evidence that too much animal fat and cholesterol in the diet promotes atherosclerosis or heart attacks. For instance, more than twenty studies have shown that people who have had a heart attack haven't eaten more fat of any kind than other people, and degree of atherosclerosis at autopsy is unrelated with the diet.

5. The only effective way to lower cholesterol is with drugs, but neither heart mortality or total mortality have been improved with drugs the effect of which is cholesterol-lowering only. On the contrary, these drugs are dangerous to your health and may shorten your life.

6. The new cholesterol-lowering drugs, the statins, do prevent cardio-vascular disease, but this is due to other mechanisms than cholesterol-lowering. Unfortunately, they also stimulate cancer in rodents, disturb the functions of the muscles, the heart and the brain and pregnant women taking statins may give birth to children with malformations more severe than those seen after thalidomide.

7. Many of these facts have been presented in scientific journals and books for decades but are rarely told to the public by the proponents of the diet-heart idea.

8. The reason why laymen, doctors and most scientists have been misled is because opposing and disagreeing results are systematically ignored or misquoted in the scientific press.

...

And from Dr. Kurt Harris, in this post:

http://www.paleonu.com/panu-weblog/2010/7/21/statins-and-the-cholesterol-hypothesis-part-i.html

I do not believe in any of the versions of the lipid hypothesis, ranging from Ancel Keys' original idea that cholesterol or dietary fat clogs the arteries, to the currently fashionable one that “small, dense” LDL particles are like microscopic rodents that are designed to burrow under the intima of your blood vessels and kill you.

Neither cholesterol nor any of the lipoproteins nor LP(a) is a "cause" of CAD (coronary artery disease). There is no evidence that “fixing” these numbers is of benefit other than by accident and there is plenty of evidence that you can kill people by trying to do so.

HDL, particle numbers, particle sizes, LP(a) are all parameters that are more or less associated with CAD. If they respond positively to changes in diet, then they are just covariant with decreased risk of CAD or MI due to the changes you made in your diet. They are not necessarily, and not usually the direct mediators of the decreased risk.

It is possible that each of those doctors would answer individual queries.

I hope this helps a bit.

I didn't read the analysis that carefully, so apologies if I missed something.... I do have a couple of questions. How did they come up with these results? I have never seen this data before, so I am a bit skeptical. Do they provide references to peer-reviewed studies? Did they cherry-pick the data? For example, the Kitavans (not included in their analysis) have horrible cholesterol values but no heart disease and would be a relevant population to include in this analysis. Lastly, in modern population total cholesterol of 150 or less is actually pretty significantly associated with greater mortality...

Folks, we DON'T know enough to be cavalier about this. Thread starter makes a great point. It's fine and dandy to point out 1 to 1 flaws with the lipid hypothesis, and I'm sure everyone wants to tell themselves that they are not screwing up by disregarding lipids, but the truth is WE DON'T KNOW!

There are equally brilliant researchers and scientists who feel that you BETTER watch your cholesterol. Just because their viewpoint is not in line with yours and just because they are as imperfect as the guy's cited here is no reason to disregard them.

DO NOT DISREGARD TOTAL CHOLESTEROL AS A POSSIBLE REASON YOU'RE GOING TO END UP SOME DAY WITH HEART DISEASE

Here is a link to a study showing that CRP c-reactive protein and the ratio of total cholesterol to HDL are the two best predictors of cardiovascular disease in women. http://www.ncbi.nlm.nih.gov/pubmed/10733371?dopt=Abstract I agree with you that a naive kind of attitude towards cholesterol is risky, and personally I take very seriously my TC/HDL ratio. I know that several proponents of "high fat" paleo think that cholesterol levels and even lipids in general are irrelevant. I humbly disagree with that particular view, and plan to disagree until shown that controlled studies of people following a high fat paleo diet show statistically significants improvements in cardiovascular health when compared with a healthy moderate fat paleo diet.

Paul Jaminet wrote an excellent series of articles on his site about this. In the articles he questions the values in the table above, discusses the role of cholesterol in immunity, and points out that 6-month-old infants have cholesterol values around 200mg/dL. Definitely worth reading.

I think this is a GREAT question.

OK, everybody (or almost everybody) here disagrees with the lipid hypothesis.

Even if we do not believe that high cholesterol leads to CVDs, the point travis makes is:

Why are our TC and LDL values HIGHER than HG populations? Let's try to stick to this point instead of keeping on derailing on the anti-lipid hypothesis front.

Something must be happening if our LDL raises (like it has happened for me), when going paleo.

Anyone has ANY idea why that could be? Travis said he initially pin-pointed saturated fats, but then changed his mind (correct me if I'm wrong). Eva says there is no strong correlation between saturated fats and TC. I disagree: Robb Wolf on one of his podcasts does say that if you want to lower your LDL dropping your saturated fats will help. He does not say it is necessary but that is also the same recommendation that 90% of MDs would give you. There is a link there in my opinion. At the same time being paleo I believe that we should be able to ingest saturated fats.... so maybe our high TC - even if correlated with saturated fats - is caused by something else and that's why HG populations do not have high TC. Maybe something that goes with the saturated fats. Some kind of condition that added to the saturated fats will increase your LDL cholesterol.

What could that be?

Inflammation? Over-training? n6 / n3 imbalance? Stress? Eating too much? Eating too little? Losing weight?

My LDL is quite high (TC is 250, Tri 62, HDL 54, LDL 186 with the "bad" formula), I am 28 years old, and this was 8 weeks into paleo. I am quite sure it was lower before but I will get retested in February.

It would be interesting to make this a survey for the "high LDL" crowd and see if there is any commonality.

For myself I'd say I may train too much (4-6 week quite heavy Jiu Jitsu sessions), I was a bit over-stressed when I did the exam, and my n3 n6 balance is probably messed up as I tend to eat too many nuts (which I am tryin to cut down a bit), and I do not take fish oil supplements (but I have been eating more fish although probably not enough).

It's an interesting question (definite upvote), but there's no reason other than inertia to think sat fats have anything to do with it. There could be many different reasons for the gap -- and the gap may not be a bad thing anyway. After all, if you graph total cholesterol versus total mortality instead of just CHD, the sweet spot for modern humans seems to be about 190. Above 210 or so, the curve starts to climb from CHD, but below 160 it climbs pretty fast from causes like stroke and suicide. So 110 may not be a good goal for us anyway; for whatever reasons, when we're in the least danger of death, our cholesterol happens to average about 190.

If you see cholesterol not as a poison, but as the building block and repair substance it is, this becomes a very different question. Then it's not, "Uh oh, maybe our cholesterol should be lower"; but instead, "What is all this cholesterol doing for us?" It's like seeing a car with Bondo all over it. The Bondo is a good thing. It didn't cause the car to rust; it's holding the car together. But you have to wonder what caused the car to need so much of it in the first place.

Musing about some other possible causes:

Sunlight. Sunlight turns cholesterol into D, and HGs probably spend more time in the sun than we do, and they don't use sunblock (except the natural sunblock of a tan, which doesn't stop D production). Maybe they keep more of their cholesterol converted. I noticed that the Inuit and night monkeys have the highest levels of their respective groups, and they probably get the least sunlight (if "night monkey" means what I guess it means). That's one data point of correlation, for what that's worth.

Sleep. HGs probably sleep on a more natural rhythm, waking up with the sun and going down with it, and almost never staying up all night drinking coffee and cramming for an exam. Lack of quality sleep is a major:

Stress, especially constant, chronic stress. Sometimes I'll stop in the middle of the day and realize my entire body is clenched, especially my face, and I'll take a few minutes to just relax -- stop squinting, roll my shoulders back, etc. I don't have a high-stress job or anything; I'm just a normal guy trying to keep up with ordinary modern life, paying the bills, getting places on time, and keeping track of who needs what from me. But it adds up, and it's always there wearing at a person, especially mentally, which brings up:

Brains. The brain uses a lot of cholesterol. I wonder if anyone's done a study comparing brain size to cholesterol levels. I don't know how much modern man's brain size and structure differs from the average HGs, but aside from that, we use our brains differently to handle all those modern mental stresses. Maybe that has caused our brains to ask that we have a higher reservoir of cholesterol to draw on. (Although horses, if their actions are any indication, have brains the size of a walnut, so this may be contraindicated.)

Pollution, from unfamiliar chemicals in our food -- even good food -- to stuff in our air, homes, and vehicles that HGs don't have to deal with. Since cholesterol is used to repair some kinds of tissue, maybe we need more of it to repair damage caused by substances in our environment that are unique (or unique in their quantities) to modern man.

Diet. For all that we avoid the "neolithic agents of disease," most of us probably don't eat a lot of bugs or drink our water straight out of streams. We can mimic a HG diet to some extent, but it'd be pretty hard to duplicate it without actually becoming a HG.

I could probably come up with more, but I'm running out of time (see, more stress). I think the take-away from all this is that we're different from HGs -- not so much biologically (though that's true in some ways) -- but our lives are very different in a variety of ways. That higher cholesterol may be helping us deal with those differences. As you suggest, if we went back fully to a HG lifestyle and environment, maybe after some generations our cholesterol would sink back down to 100 or so. That probably doesn't have much application to reality, though.

Cholesterol is a zero predictor of impending cardiac death. I'm just guessing but i could imagine that HG societies maintain a higher serum vit C than the SAD or modern Paleo diet. Vit C had a direct effect on cholesterol levels. in low grade scurvey cholesterol is protective. in low grade scurvey arterial plaque saves your life. exposed collagen in an artery immediately forms a blood clot. with plaque sitting like a scab on top of free radical damaged collagen clots dont form there, clots form else where. its interesting to note that vitamin C reduces cholesterol levels.is a high cholesterol level Good? no, it means your body is reacting to a negative condition. that condition might be low grade scurvey. its also interesting that 30 percent of modern Americans suffer from gingivitis and gingivitis is a predictor of atherosclerosis related heart disease. Gingivitis treated with Vitamin C. atherosclerosis is treated with lipitor?LOL

Hell of a bump, but I missed this the first time around and it's also something I wonder about. Here's a counter-point from modern human data: http://renegadewellness.files.wordpress.com/2011/02/cholesterol-mortality-chart.pdf

I've seen various flavors of that chart from various bloggers. Not sure who did the original analysis or even if it's true. If it is accurate, though, then modern all cause mortality is lowest at ~220 mg/dl.

So what's going on here? Primitive cultures at ~120mg/dl presumably having great health, modern humans dying the least at ~220mg/dl?

I haven't the foggiest. :/

As the cholesterol hypothesis is not proven, neither is anything disproven. If anybody wants to be a fan of a diet, that has nothing to do with what is true or not. Neither does voting make something true or not. It's especially not proof to point out that "Kurt Harris says so...".

I'm interested in this. I began my paleo journey a year and half ago or so and had a total cholesterol of around 170 with an LDL of about 100. Last time I checked my total cholesterol was 312 with an LDL of over 200. So I'm interested in this topic.

Quixote was a cavalier. Just believing that high serum cholesterol is OK because it's an artifact of the Atkins/LC/paleo spectra does not make high serum cholesterol good except in a quixotic romance.

My romantic notion is that the American problem is too much food of all kinds coupled with too little manual hunting-and-gathering. But I have some N=1 numeric evidence that it is true - lower BP, higher HDL and smaller waistline - all of which are valid predictors of lower mortality.

The question this brings to mind, that I don't know the answer to. How has cholestorol testing changed over the years? Can we compare cholesterol tests from 1988 to today? How accurate were/are they? I've seen articles saying today's tests are +-15% in terms of accuracy for example.

I have been paleo for 1 year.

2 years ago, my readings were: TC - 179

LDL - 121

HDL - 29

Trigs - 142 (while taking trig lowering Gemfibrozil 6+ years)

6 months into paleo: TC - 171

LDL - 124

HDL - 36

Trigs - 32 (quit taking Gemfibrozil 4 mo earlier)

12 mo into paleo:

TC - 239

LDL - 174

HDL - 49

Trigs - 54