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Some of you have been posting that LDL skyrockets when doing Paleo. I've beend doing some research why that might be the case. One possible answer is offered by Dr. Joe Goldstrich, (most recently of the Princeton Longevity Center) who used to head the Pritikin Longevity Center in Santa Barbara -- that was back when the Pritikin diet duked out with the Atkins diet: Atkins was high fat, Pritikin was low fat.

This is from the website, Prescription2000 http://www.prescription2000.com/ which features interviews with health practitioners from the low-fat perspective (Cordain was on). Goldstrich is somewhat Paleo-friendly, though he's against saturated fat a la Cordain.

The interview is here: http://www.prescription2000.com/images/stories/audio/2011-03-10-Joe-D-Goldstrich-Integrative-Cardiology.mp3

The transcript is here: http://www.prescription2000.com/images/stories/transcripts/2011-03-10-joe-d-goldstrich-integrative-cardiology-transcript.pdf

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To summarize, what matters is the Apolipoprotein E (ApoE), a lipoprotein that carries cholesterol through the bloodstream. Dr. Goldstrich says you should know your ApoE status before deciding what type of diet to pursue. There are 3 kinds of ApoE: types 2, 3, and 4. And since we have 2 alleles, we can have combinations of 2-3, 3-3, 4-3, 4-4, so on.

For about 65% of the population, the ApoE status is 3-3. If you're 3-3, you can eat fat without unduly raising LDL. That is, those who seem to be thriving on the high-fat Paleo or low carb diets, judged only by their LDL, may have Apo E 3-3 alleles.

For the remaining 35% of the population, about 25% include type 4: e.g., 4-3, 3-4 or 4-4. These people's LDL may skyrocket on a fat-heavy diet, especially saturated fat. And the LDL increase may be in the form of Pattern B (the small, dense ones that are supposed to be dangerous). These people tend to thrive on a low-fat diet, as their LDL would be managed best by keeping saturated fat low. For example, eating coconut oil might increase their LDL significantly, while it would not affect the Apo E 3-3 type. Fish oil could also increase the LDL of these people, while supplement Quercetin could lower their HDL.

What does this sound like? Metabolic typing anyone? I dismissed metabolic typing when Dr. Harris pooh-poohed it. But maybe there is something to it.

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Conclusion: About 65% of all dieters could benefit from a high-fat diet, but 25% may not. We're talking just in terms of their lipid numbers. Whether you believe in the lipid theory is another question altogether, however. So check your ApoE status if Paleoing seems to give you high cholesterol.

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there's some recent, interesting posts about Apo E over at drbganimalpharm.blogspot.com – Andy Jul 11 2011 at 14:58
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 "These people tend to thrive on a low-fat diet, as their LDL would be managed best by keeping saturated fat low." I think low LDL=thriving is misleading. Maybe I'm just bitter about having been strong-armed into having this test, and then being told my only option for living a healthy life was to eat less than 10% fat, and no saturated fat. If they consider being more depressed than I've ever been to be "thriving", I'll take my slow motion suicide by coconut oil, lard, and tallow with a smile. At 65% fat intake, I'm losing weight, and my brain has never been happier. – Happy Now Aug 1 2011 at 7:48
Thriving only in terms of the LDL count. What was your LDL on a low fat diet and what is it now at 65%? – Namby Pamby Aug 1 2011 at 14:07
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 I haven't had it retested yet at the higher fat intake level because I just started that level a few weeks ago. I did go from an ldl of 356 down to 227 by just dropping grain, sugar, and dairy and adding 2-3 servings of fatty red meat/day (40-50% of daily calories being fat). Based on that trending alone, I may or may not get it retested in the future. Also, the more research I do, the less and less convinced I am of the lipid hypothesis, and I feel like every dollar I spend on cholesterol testing somehow reinforces belief in bad science. – Happy Now Aug 1 2011 at 19:47
I suddenly had the mental image of a scientist interrogator grabbing the Apo E test results and shaking it, shouting, "Tell me what role you had in this high-LDL patient!" And it says, sobbing, "I don't know officer! I don't know anything about the matter!" – Kelvin Jul 31 at 20:37

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I did the Apo E tests years ago and found out that I am 4-3. The post test counseling included a prescribed diet of only 10% fat. I did 2 months on the diet, and I can tell you my mental health reached an all time low. I finally came to the conclusion that I'd rather die young happy than live a long "healthy" life of misery. My new rule is that if it isn't good for my brain, it isn't good for my body.

I'm leaning towards thinking our current understanding of Apo E is incomplete at best because my lipid panel improved after going paleo. On a vegetarian low fat diet my cholesterol was through the roof (upper 300s for LDL), and the more of my energy I get from saturated fat and meat the less panicked my docs seem to be when they get my labs. My LDL came down over 100 points in one year.

I wonder if what some people are experiencing in their labs is transient hypercholesterolemia, especially if they are adopting a ketogenic diet. I definitely know the urge go get a full physical the moment you start feeling better just to have some sort of confirmation on paper, but I think it is supposed to take at least a couple of months for your lipids to normalize.

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How many pounds did yo lose on a vegetarian diet and on a Paleo diet? Perhaps that has some bearing as well. – Namby Pamby Jul 11 2011 at 16:32
I feel like I should clarify that I grew up vegetarian, eating the low fat foods we were brainwashed into eating in the '80's, I kept that up until my mid 20's, so I was using that as my base for the test that showed LDL in the high 300's. The apo E 10% fat diet for me did include lean meat. I don't think I lost any weight on the really low fat 10% diet, just lost my mind. I did lose about 30 pounds in 6 months when I switched over to a more paleo diet. So maybe that is what changed my numbers. – Happy Now Jul 11 2011 at 18:25
"My new rule is that if it isn't good for my brain, it isn't good for my body." This is really well said. Personally I don't want to have these kinds of tests done, because i've noticed that my metal health has really improved, and my physical health is slowly catching up, so I must be doing alright. Besides, before these tests were doable, people did their best to be active and eat whole foods. I'm glad Paleo has been so good for you, Happy Now. – Caleb the Hobbit Feb 8 2012 at 20:17
I have a feeling that these tests are just another money-making shot in the dark. I wonder if these scientists actually believe their theories anymore. And I don't think paleo will cause you to "die young" (but you were probably being sarcastic). – Kelvin Jul 31 at 20:33
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Dr Goldstrich is going far, far beyond the evidence to untenable conclusions. All you really need to know is the ApoE e4 is the ancestral allele, two copies were the norm in the Paleolithic, and nearly everyone in the Paleolithic ate a high-fat diet, with 20% carb 15-20% protein 60-65% fat being fairly typical. It's most unlikely that pathological levels of LDL were common in the Paleolithic.

The most you can infer is that nutrient deficiencies may have greater effects on LDL levels in people with the ApoE e4 allele. The evidence certainly doesn't tell you that a low-fat diet is optimal.

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 And the new Chris Kresser & Chris Masterjohn podcast/transcript adds it could be temporary increase due to clearing fats from the liver. – Nance Feb 8 2012 at 20:08
I'm no longer convinced that the Paleo diet was only 20% carb. With tubers being so much easier to forage, I see carbs 50%, protein 20% and fat 30% on non-hunting days. Switch fat with carbs on catch-your warthog days, but that would be outnumbered by yuca / yam & taro days. Seriously, for those island tribes like the Kitavans and Okinawans, it's easy to imagine this. For those in Northern Europe, you put your gallbladder to work for a fatty meal. But was hunting really an everyday affair? It was a major enterprise, requiring mobilization and orchestration. – Namby Pamby Mar 20 2012 at 6:17
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Never had that test done, and, yes, my LDL has gone way up - 159 - BUT ...

  1. When we did a more detailed test my particles were almost all "type A"
  2. HDL - 99 - and trigs - 45 - still indicate that this is probably true a year later.

So, I tend to agree with Happy Now that while there is probably something worth exploring further with ApoE, our understanding of how this affects us is still pretty incomplete. I am more inclined to think that increased inflammation from some other health issues is more relevant to the increase in my LDL numbers.

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I don't......one test without context means little. If you have a high LDL and low crp sleep well. Apo e status is correlative with vit d polymorphisms and allowed humans to live in more northern latitudes with less solar radiation. – The Quilt Jul 11 2011 at 14:24
Yes, I also have low CRP, so guess I'm good. ;) And my family background is all northern European/Scandinavian, too, FWIW. – JCB Jul 11 2011 at 14:35
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 It would seem that Apo E4 just tells you how white you are? I feel like I could have figured this out without a blood draw and a copay. I do own several mirrors. – Happy Now Aug 1 2011 at 7:57
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 Update! I just found that Apo E4 is actually most prevalent in moderate to darkly pigmented folks either living near the poles or under jungle canopies. So my assumption about mirrors and my relative paleness being indicative of Apo E4 above can be mostly ignored. Still pretty common in pale folks up north, and apparently not so much around the Mediterranean. – Happy Now Sep 17 2011 at 8:44

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