Saturday, February 18, 2012

My "Cholesterol 101" Q&A Podcast on "Ask the Low-Carb Experts" Is Now Available for Listening

by Chris Masterjohn

On Thursday evening I appeared live on Jimmy Moore's new "Ask the Low-Carb Experts" series to talk about "all things lipids" for an edition Jimmy has dubbed "Cholesterol 101."  There isn't much new material here, but there's a lot of application of the theories I've discussed to listeners' questions and anecdotes.  The recording is now available for downloading, and below I briefly discuss what I consider the most interesting case study we talked about and provide a table of contents for easy navigation.

The most enlightening case in my opinion is that of Deanna's step-father, which we begin discussing at the 1:09:30 mark.  He had moderately high total cholesterol (252 mg/dL), but very high triglycerides (534 mg/dL) and a very high total-to-HDL-cholesterol ratio (7.6).  All of this presented with low testosterone.  

The combination of high cholesterol and low testosterone is a strong indicator of suboptimal thyroid status, because thyroid hormone stimulates the conversion of cholesterol to testosterone.  I believe this case supports my contention that moderately elevated cholesterol is of particular concern when the total-to-HDL-cholesterol ratio is very high, because this can be an indicator that LDL is not being cleared from the blood at a robust rate, which is consistent with a failure to clear it from the blood and convert the cholesterol it is carrying to sex hormones.  

The high triglycerides indicate insulin resistance, which is essentially a deficiency of insulin signaling.  Insulin resistance is associated with suboptimal thyroid function.  Since insulin directly promotes the production and activation of thyroid hormone and since it indirectly promotes the binding of thyroid hormone to its receptor by suppressing the release of free fatty acids, the best explanation for this scenario is that a deficiency of insulin signaling is compromising his thyroid function, which in turn is preventing his LDL particles from being cleared, causing them to sit in the blood where they take up more and more cholesterol from his HDL particles rather than being taken into the cells where their cholesterol could be converted to testosterone.  

This scenario is all the more likely if he either 1) is overweight, 2) has fatty liver, and/or 3) is under any type of chronic stress, be it physical, emotional, or psychological.

Unfortunately, he is on a number of drugs and supplemental hormones aimed at treating all of the symptoms instead of a program to normalize his metabolism by supporting insulin and thyroid signaling.

You can listen to the whole show here:

To make it easier to navigate through the show, here is a table of contents:

00:02:08 -- Jimmy introduces me.
00:03:48 -- Cholesterol plays many important roles in the body.
00:05:50 -- Lipids are the victims, not the aggressors, in heart disease.
00:07:28 -- Blood lipids can be used to assess the larger metabolic picture.
00:08:00 -- Dietary cholesterol's effect on blood cholesterol.

00:09:53 -- Darrell's question: Total cholesterol of 295 is concerning, but not a justification for Lipitor.  More information needed, but hypothyroidism or familial hypercholesterolemia are possibilities.

00:15:05 -- Why LDL particle size testing is NOT ready for prime time.
00:16:30 -- Why the total-to-HDL-cholesterol dominates in CVD risk prediction.
00:17:28 -- High triglycerides may indicate insulin resistance, but do not contribute additional information about CHD risk in the general population.

00:20:20 -- Mark's question: lp(a) can indicate a problem, but often just indicates genetics, and is never a justification for statin use.

00:22:45 -- Lynn's question: total cholesterol rising from 160 to 461 in response to increased intake of whole milk, eggs, and meat strongly suggests familial hypercholesterolemia (FH), which should be diagnosed and managed. 

00:28:20 -- Antonio's question: cholesterol increasing in pregnancy -- feeding the baby's big brain?

00:30:10 -- John's question: methylglyoxal modification of LDL may contribute to the cardiovascular complications of diabetes, but is probably not very relevant in normoglycemic people.  There are lots of things that can produce small, dense LDL.

00:33:20 -- Jamie's question: more on the total-to-HDL-C ratio.

00:34:35 -- Sharon's question: high triglycerides in response to carbohydrate suggests insulin resistance resulting from energy overload in adipose and liver tissue.

00:39:57 -- Sam's question: modest elevation of total cholesterol (241 mg/dL) with a total-to-HDL-C ratio of 4.6 may indicate the need for some metabolic improvement but not statins.

00:42:20 -- Paul's question: glycation is a result of poor metabolic functioning and can be result from poor metabolism of carbohydrates, protein, or fat.

00:44:45 -- Karen's question: you might want to try testing your cholesterol privately before purchasing life insurance, but that's way out of my realm of expertise.

00:46:05 -- Leo's question: another case of modest elevation calling for statins may indicate the need to find a different doctor.

00:49:14 -- Willy's question: more on lp(a).

00:50:16 -- Valerie's question: total-to-HDL-cholesterol ratio of 4.3-4.6 could indicate suboptimal LDL receptor activity when combined with other symptoms of poor metabolism, but much more information is needed.

00:53:20 -- Kyle's question: Ray Peat's stance on PUFA.

00:56:40 -- Luke's question: Blood vessel function is an important indicator of CVD risk, and it tends to decline after a meal, but there is no basis for specifically blaming fat, and consuming a nutrient- and antioxidant-rich diet is probably the best way to protect against poor blood vessel function.

00:59:34 -- Ellen's question: cholesterol dropping from 205 to 165 with a dietary change could be a good thing or a bad thing depending on the other signs and symptoms.

01:01:54 -- Mackay's question: high cholesterol in celiac disease could be influenced by inflammation, autoimmunity, and nutrient deficiencies secondary to the disease, and the focus should be on healing from celiac.

01:03:56 -- Edward's question: I don't think the LDL-C inaccuracy introduced by the Friedwald equation matters because there is no strong evidence LDL-C is a better indication of anything than non-HDL-C.

01:05:35 -- Everyone should measure their blood lipids because 1) extremes can identify genetic mutations, 2) low cholesterol can either be a problem or indicate a problem, and 3) high cholesterol can indicate a problem.

01:06:56 -- Iron overload with simultaneous anemia caused by low T3, rising LDL-C was the first and most sensitive indicator and could have been used to catch the thyroid problem much earlier.

01:09:30 -- Deanna's question: modest elevation of total cholesterol (252) combined with low testosterone suggests hypothyroidism, especially with a total-to-HDL-C ratio of 7.6.  High triglycerides indicate insulin resistance and insulin resistance may cause hypothyroidism through a deficiency of insulin signaling.  Treat the causes not the symptoms.

1:14:20 -- Wrapping up.


Read more about the author, Chris Masterjohn, PhD, here.


  1. You were amazing Chris! Thank you for sharing your expertise.

  2. Great podcast! Thanks Jimmy and Chris. Was really glad to hear Lynn's question, as I'm in exactly the same boat: TC in the 200 range all my adult life (I'm 53 now) and then suddenly, last year, after 6 months of low-carb eating, TC jumping to 350. The suggestion of FH surprised me, because I assumed, perhaps incorrectly, that FH would cause higher TC numbers earlier in life. You also talked about the need to diagnose and manage FH, but I'm not aware of specific tests to diagnose FH. Is there a test to confirm FH? Thanks again! (btw all my other numbers are good: TG 48, LDL 80, CRP 0.3, NMR & Berkeley say 90+% of LDL is large/buoyant. Also, Berkeley says I'm APOE type 3/3.)

    1. Hi MapleGuitar,

      Your jump is somewhat smaller, and it sounds like it was mostly HDL, which is quite strange, unless your LDL is directly measured and most of it is VLDL and IDL? What is your HDL-C and your total-to-HDL-C ratio?

      Chris Kresser has an FH test he recommends:


  3. Hi Chris, Thank you for replying. My LDL went from 151 to 257 after going low carb. Most recent TC/HDL ratio is 4.4. HDL = 78. The FH screen that Chris(K) referenced only measures TC, HDL, non-HDL, & LDL; so I'm not sure it's of any additional value. But I did just locate some info at the Mayo Clinic web site re genetic testing for FH and will pursue that. I've had lipid panels run 8 times in the past year trying to figure out what's happening (VAP, NMR, & Berkeley). Your podcast comment about FH and "exaggerated response to certain dietary factors" really helps to unlock this puzzle. For example, during a 2 month stretch last year I drank only french press coffee. LDL went up to 345! I stopped the french press completely and 6 weeks later the LDL is back down to 250. The single biggest change to my diet, since starting low carb, is 2 eggs every morning for breakfast. Based on what you said, the bottom line may be an exaggerated response to eggs.

    1. In French press coffee, the coffee oils Cafestol and kahweol raises LDL significantly. ref: No FH do not waste your money to test for it.

  4. Hi MapleGuitar,

    Above you wrote that your LDL was 80. Now this makes more sense. The TC/HDL-C is somewhat elevated, but the very high TC makes it more of a concern. It's a very large jump. I would get the FH genetic test. I assumed that's what Chris had recommended, so sorry for the mistake. If you do not have FH I would thoroughly investigate thyroid health. Carbohydrate restriction can lower thyroid status in many people. But if this is an exaggerated response to eggs (or french press coffee), it would certainly suggest FH.


    1. I also would like to get the genetic testing for FH. From my readings, there are several different genes that could be responsible. Does anyone have more information about this? Apparently even Dr. Davis just uses NMR, which just gives lipid measurements.

    2. Hi Susan,

      I think the appropriate diagnosis is actually made by molecular functional analysis rather than genetics itself, though genetics could be part of it. For example they may take some of your cells and assess their ability to take up your LDL particles or standardized LDL particles. This could also allow further assessment of where the uptake is failing if indeed it is failing. I'm not sure how to order this test. Someone else said they were looking at some information from the Mayo Clinic so you may want to take a look at their web site to try to track down the test. NMR cannot diagnose FH.


    3. Thanks, Chris,
      I'll check into that. I also found information about the genetic testing. Apparently, it is a genetic sequencing test on the LDLR and APOB genes. This is supposed to discover 95% of the gene mutations responsible for FH. I have not yet found out where to get this or the cost.

    4. I have more information about the testing. "Prevention Genetics" in Wisconsin will do DNA sequencing for the LDLR and APOB genes. This is not up on their website yet, but I talked with a very helpful man (Mike) who is going to e-mail me the price. They also do testing to determine if pieces of the gene are missing or rearranged for LDLR, which he said was fairly common. It is not yet done by this lab for APOB, but that would be rare in that gene. Another gene that could be involved is PCSK9. This lab does not yet sequence that gene, but probably will in the near future. From what I have read the other two genes account for most of the FH. The testing would start with one sequencing and only move on to the others if the defect is not found. Also, once one person in the family is tested with the sequencing and something is found, then the other people who could have inherited the FH can have targeted testing on only the specific mutation found, and it is much cheaper.

    5. Thanks Susan. That makes a lot of sense. For the mutations already identified, sequencing should be sufficient. There is frequent discovery of new mutations however, and much of what you discuss has been discovered only in recent years, so this emphasizes the need to do functional analysis as I mentioned before for cases where the mutation may not be one whose functional effects have already been characterized, but as you said the most common ones will be caught by the sequence analysis and that is the best and I imagine most cost-efficient way to start. Thanks for passing this along!


  5. I'm sorry -- I did goof on my first post. I began eating low-carb as a result of an A1C test of 6.0 early in 2011. Little did I know what it would lead to :-) In mid September 2011 I had a thyroid panel performed at LabCorp. Just one of the numbers (T3) measured a teeny bit low on the reference intervals (Free T4 1.27, TSH 2.16, T4 7.3, T3 uptake 32, Free Thyroxine Index 2.3, and T3 69). At the beginning of this journey I weighed about 180 and now weigh 160 (I'm 75 inches tall) so I think being slender for all my life, and especially now, perplexes my physician; i.e., I don't "look" like a typical diabetic or hypothyroid person. Chris, thanks again for all you do. It's invaluable to folks like me on the n=1 highway.

    1. You're welcome, MapleGuitar. It would be interesting to see reverse T3. If inclusion of carbohydrate despite eggs and other such foods in the diet lowers the cholesterol, I think there could be a thyroid issue despite the decent numbers, in particular if there are other symptoms of hypothyroidism. However, if this is mostly a response to inclusion of eggs and such foods rather than carbohydrate restriction, FH seems more likely. I'd be interested to hear how your test comes back.

      Take care,

  6. Hi Chris!

    Excelent, as usual! Two questions:

    1. As with CVD risk, ratios are not best predictors of insulin resistance? Does triglycerides/HDL ration is not a better predictor of IR than TG alone?

    2. What's your take of "Triglyceride Paradox" (example:, where people of african descentent usually TG nor TG/HDL is not a predictor of IR nor CVD.


    1. Hi Mario,

      Thanks for sending along the paper. I thought it was interesting until it got to the "mechanisms" section, at which point it became more or less incoherent. They claim that blacks are "more insulin resistant" than whites, but that this does not lead to high triglycerides because insulin is more effective at suppressing free fatty acids and the "resistance" to it doesn't "inhibit" lipoprotein lipase like it does in whites! In other words, despite being more insulin resistant, they are more sensitive to insulin, and thus the insulin resistance doesn't promote the typical symptoms of insulin resistance because the greater resistance coexists with greater sensitivity. In all honest, I do not understand that at all.

      I didn't mean to suggest that, statistically, there is a better linear prediction of IR with TG than with TG/HDL-C. I meant, mechanistically, elevated TG >150 mg/dL is, in my view, very likely to indicate insulin resistance, and if these elevations occur in response to dietary carbohydrate this is especially true. From a mechanistic standpoint, I would think that the plasma TG to dietary carbohydrate ratio would provide a better diagnosis, because removing carbohydrate can lower TG without resolving the underlying problem and simply "mask" the energy overload that is lying behind the insulin resistance.

      They seem to believe that low HDL-C occurs in insulin resistance solely or primarily as a result of increased heaptic TG export into plasma, which then provides more substrate for CETP to trade TG for cholesterol with HDL particles. I disagree. This may be part of it, but I believe a large part of it is that insulin signaling is an important governor of thyroid status, and that when insulin resistance exists, thyroid status declines, and as a result the activity of the LDL receptor declines. This lengthens LDL residence time, providing more time for cholesterol/TG transfer with HDL particles. I also suspect that fatty liver independently decreases LDL-R activity, but have no direct evidence of this, and there is some indication that insulin itself might promote LDL-R activity, but I need to look into that further.


  7. It was pleasure to read an expert like you. Amazing stuff

  8. Hi Chris! I got your reply over at Special K's recent interview. Thank you so much. I really really appreciate your thoughtful reply and advice. You guys are really helping me gain invaluable, practical knowledge about health markers, and how to gauge when and if problems might be lurky on the horizon. A simple thank you seems like so small a show appreciation, but alas it is all I have to offer! Keep up the good work Master J! Sincerely, Valerie

    1. You're welcome. A simple thank you is plenty! Thanks for your appreciation!


  9. Dear Chris:

    Thanks for the Podcast. My particular problem is way too many small-particle LDL. Is there anything I can do to specifically target this and bring it down to normal levels?

  10. Hi Chris:
    How would you best determine if thyroid intervention would help in upregulating LDL receptors with a thyroid profile where TSH is 1.6/1.7 and T3/T4, both total and Free within normal ranges? My guess is that they thyroid is normally functioning and that thyroid intervention would be unnecessary and do little to increase functioning of the LDL receptors. Your thoughts?

    1. Steve,

      Actually thyroid hormone will increase LDL receptor activity regardless of whether someone is hypothyroid, as long as they have at least one correctly functioning gene for the LDL receptor. In other words, even in euthyroid heterozygous familial hypercholesterolemia, thyroid hormone will still increase LDL-receptor activity. However, research suggests this approach is only safe under the guidance of an expert physician and by titrating the dose very slowly by a quarter grain of thyroid extract every six months working up to a maximum of 2 grains. In the old days, there were some irresponsible physicians who killed a handful of people giving them >8 grains or even much more than this.

      I do not think you can diagnose thyroid issues on the basis of blood tests alone. You need to look at other signs and symptoms. You should be able to find a list of these symptoms by searching pretty easily, but they include cold hands and feet, low sex hormones, fatigue or mental exhaustion, weight gain, hair falling out, thinning of outer eyebrows, puffiness, etc, and they do not always occur in the same combination in everyone. Diagnosing thyroid issues is complicated and needs a big picture approach.


  11. You are really an expert, it helps me a lot, thanks.

  12. Hi Chris,
    Always learning incredible information from your work. Really great stuff!!
    Something you said in this interview has absolutely rung a bell for me. I'm hoping you can shed a bit more light on it. At about 1:13:24 you mentioned that High Cholesterol and Low Testosterone is a combination that suggests a metabolic backup from either a Thyroid issue or "another issue". I just got my Thyroid panel and hormone panel back and I seem to have just that magic combination but my thyroid panel was all in normal ranges. Total Cholesterol was 271, TG 51, HDL 73 and LDL 188. Total testosterone was 277!! Free Testosterone (Direct) was 5.9. These seem very low for a 44YOM. Some of the other numbers seem to be on the lower side of the normal ranges.
    Can you please tell me what was the other issue associated with this combination if it doesn't appear to be Thyroid.


  13. Chris: Would be interested in your thoughts and strategies for reversing CAD, if such a thing is possible vs. limiting or stopping its progression. Also, what anti-inflammatory strategies would you suggest instead of statins?
    Thanks; Your thoughts will be helpful for those of older folks who for one reason or another have CAD.

  14. Hi Master J,

    I tried posting over at Special K's site too but there was an issue with the comments not appearing completely.

    I had high cholesterol (TC: 376, TC/HDL: 4.64) last year after being on a low carb diet with weekly carb refeeds in conjunction with weight training. I lost quite a bit of bodyfat; went from around 188lbs->160lbs. After following Paul Jaminet's recommendations of eating at least 100g carbs everyday, I got the numbers down to somewhat normal ranges (TC: 280, TC/HDL: 3.46). Keep in mind that fat consumption was still high (eggs, dairy, coconut oil, beef, etc.)

    Late last year, I went on a carb cycling diet where I would eat around 50g carb on Rest days (high fat, high protein) and 400g+ on Workout days (high protein, low-ish fat). I workout 3 non-consecutive days a week so basically 4 days were low carb.

    Got my lipids tested after about 12 weeks on this program and got back horrid numbers (TC: 396, TC/HDL: 5.42). I consulted Paul again and he recommended I check micronutrient status and also consume no less than 100g carbs even on rest days.

    After a couple of weeks of eating more carbs on rest days, I got back these numbers (TC: 360, TC/HDL: 5.45). I was having less coconut oil at this time which reduced my HDL by a bit. I was concerned about Iodine because I only got 150mcg from my multi and do consume a decent amount of crucifers. So now I am supplementing with a total of 600mcg Iodine while eating at least 100g carbs on rest days. Also got free T3 and free Testosterone tested with the last round of lipids (free T3: 1.96 pg/ml, free Testosterone: 16.5 pg/ml).

    I want your opinion on whether I am more likely to be suffering from a thyroid issue given these results or FH? Keep in mind I got pretty decent if not great numbers last year while still eating a ton of fat. The only thing I've played around with since is the carb consumption.


    1. Jarri,

      Looks like we had/have very similar issues. You can see my story on Paul's website:

      I've had good results following Paul's 100g carbs per day suggestion. My last results, 6 weeks after weaning T3 supplement, were TC 236, HDL 73, TG 56 LDL calculated (Iranian) around 123.

      I am also eating, as you put it, 'a ton of fat'. I would suggest that, since you had good results following Paul's advice, carry on with the 100g per day, or more, if you can tolerate it without putting on weight or spiking your blood glucose. You should see results within a few weeks. If not, consult with the good ladies at the rT3 yahoo group:

      and check out my latest report in the files section while you're there.


  15. Thank you guys, for posting some wonderful information on cholesterol. My latest visit to the doctor had me worried, when he told me that I should watch my cholesterol and sugar level, as I was a borderline case. I have started taking all the precautions. I also came across this post, which I think is informative.

  16. Thank you, Chris,
    This is probably one of the most valuable podcasts of the past months for me, answered some of blood sugar related questions I was uncertain about.

  17. I listen to Jimmy Moore's podcast religiously and found this cholesterol based episode refreshing! Chris sounds very bright and look forward to checking out more of this site.

    It does seem to me though, that if rabbits develop something similar to arterial plaques when fed an animal diet, then this is pretty damning evidence regardless of the reason... i.e. a low ldl receptor uptake leading to degraded cholesterol in the blood.

    But Jimmy should have at least asked one or two questions on Taubes' low-carb/paleo diet theory, even if it might be slightly out of scope. Since he didn't, I'll ask here:

    Assuming one is not diabetic and has normal insulin sensitivity, does high amounts of insulin in the blood, caused by consuming calories in the form of carbs, lead to increase fat storage? Or is fat/weight gain strictly a function of calories in vs calories out, regardless of fats or carbs?

  18. Hey this was a great podcast about a really important issue. I have been looking into clinical studies on high cholesterol and related health complications. This LDL - cholesterol issue is pretty interesting, and I think it has been a recent focus of medical researchers.

  19. Hi Chris, thanks.

    I'm a 41 year old male who has gone from being a vegetarian for a few years to eating a WAP style high fat diet, and have significantly healed my gut and cured myself of long term anxiety and depression issues.

    My question relates to the significant change in my blood results from about 3 years ago to now. I didn't understand this at the time but I had what appears to be very low cholesterol in 2009 with TC of 131, LDL of 77 and HDL of 48 and Trigs of 35. I believe these markers may have been directly related to my anxiety etc. My recent tests showed TC of 239, LDL of 166 HDL of 63 and trigs of 53. Although my TC/HDL ratio is a little outside of the normal range at 3.8 I am not so concerned about it as I believe my health is significantly better than it has ever been.
    I was wondering what your thoughts on this were, and whether you thought a TSH of 1.06 is low and may indicate some kind of thyroid issue which may potentially be impacting on my LDL in some way. My Testo is 23.3 nmol/L, free testo of 491 pmol/L, SHBG of 35 pmol/L and DHEAS of 4 umol/L, which seems to be in the normal range to me. All my other results seemed to be in the normal ranges, except for a UREA of 8.1 nmol which apparently is a little high, and a low ALP of 31 U/L.

    Thanks for any further insight you might be able to give me in relation to the theoretic possibilities.

  20. Chris: Could you comment on my Cholesterol? My total has gone from about 300 pre-weight loss to 210 post 40 pound weight loss on high carb low calorie regime.
    between 9/15/11 and 12/30/11 I lost 40 pounds eating a lot of fruit and carrots and counting calories. I dropped wine consumption from 2-3 glasses per day to 1-2 per month. was 209 pounds at 5'9" (BMI 31) to 169 (BMI 25). On 1/15/12 i started a very low carb diet. Essentially shooting for less than 20 carbs per day. In the next 90 days I lost and other 20 pounds to about 150, with a BMI of about 22. Body fat is 11.5%. I am 60. I have been exercising through walking at leaste 10,000 steps er day. On 3/15 I had my fasting lipids checks and my total cholesterol was 416. Triglycerides unchanged from 12/15 at 84 and HDL up from 58 to 90 . LDL went from 136 to 317. My doctor had kittens. I repeated the test on 4/13 and got essentially the same results. Total, 436, Tri 90, HDL 90, LDL 338. I feel great. Much better energy. Taking up road biking. Life is good. But over 400 cholesterol seems a bummer. Also, big huge diet changes. from no eggs and veg to high eggs and green veg after 1/5/12. also supplementing with krill oil, Carnatine, glutamine, etc. Any thoughts? Thanks

  21. Hi Chris,

    For the last 5-6 months, I switched over to a low carb (~50-75g/day) diet, mostly making up the calories with whey protein and lots of fats (olive oil, avocado, grass fed butter).

    While a lot of clear markers improved, my total cholesterol and LDL jumped quite a bit, to levels that I believe you've mentioned you feel are high. (I'm male and I think you mentioned 220 as a reasonable limit)

    What next tests or changes would you make if you were me?

    Total cholesterol: 204 --> 238 * scares me a bit. most say this should be below 220, 240 for females
    HDL: 60 --> 70 * very nice improvement
    Triglyceride: 104 --> 84 * very nice improvement
    LDL: 123 --> 151 * big jump here. most docs hate to see this, but from what i'm reading LDL doesn't mean very much - only particle size.
    Triglyceride/HDL ratio: 1.73 --> 1.2 * this is considered the best predictor of cardiovascular disease. Very nice change here

  22. It seems like Chris must be very busy at the moment, but from what I understand, based on the details you have given, your test results represent a marked improvement in your metabolic condition.

    As you have correctly observed, your HDL has improved and your HDL to trig ratio has improved and your trig levels have improved.

    With my understanding of Chris's work, the increase in your LDL could represent many different things and is not really at a level where it would be of great concern, depending on your particular circumstances. For example, if you have begun to lose weight, or improve a preexisting fatty liver condition as a result of your dietary changes then the improvement process, releasing stored lipids, etc could in and of itself result in higher LDL levels in your blood at any given time.
    Alternatively, your results could simply represent a normal day to day fluctuation in blood lipid levels.
    All in all however the overall results appear to represent a significant metabolic improvement, and you may need to look for a doctor who is open to the latest research in relation to these matters, if the one you are currently seeing is unable to move forward.
    I would recommend continuing on with what you have been doing and get the same tests quite a few more times in order to show a realistic pattern so you can see the direction your lipids are going in, and keep in mind that if you are repairing a significantly damaged metabolism it might be better to wait for the changes to stabilize so that you can get a more accurate view of where you are in reality.
    Dan M

  23. To William Rush,

    You might want to rule out Familial hypercholesterolaemia, as this might be a possibility in your case, and it is important to know if you have this.

    Dan M

  24. Hi Guys,
    Could someone please help me understand my numbers? Do I need further blood work due to my present numbers, and if so what am I looking out for? I’m a 37 yr old male, 5.8, 7.5% BF, 160lbs, 29-30 waist size, exercise regularly. Been on a paleo type diet for about a year now. Very low carb, less than 100g per day. I’m gonna give you all my numbers from before I switched from a high grain high protein low fat diet to the paleo type diet with around 9-12 ounces of animal protein per day, I switch my fats through the day, roughly one TBsp of olive oil, 1 tbsp of walnut oil for lunch, I cook all my proteins in either raw butter or coconut oil, I may have one ounce of raw almonds or 1 tbsp of almond butter raw or 1 scoop of coconut butter for a snack each day. 2 whole organic eggs per day. Lots of salads and 3 servings of steamed or sauteed greens per day. All I drink is mineral water. Please help me understand my numbers!

    High Grain High Pro/low fat diet #’s

    Trig’s ?

    6 months into paleo diet


    12 months on Paleo diet


    Thanks for your time!

  25. Hi, I'll give you my interpretation based predominantly on my understanding of Chris's work although I am not a doctor and you should take everything I say with a grain of salt:)

    Generally speaking your numbers appear to be a vast improvement on your high grain diet numbers. For instance your HDL has continued to go up and your Trigs appear to be going down although there is no number available in your initial blood work.

    It does not say whether or not you have lost much weight in the year since you have changed diets however your increased LDL could possibly reflect some weight loss or the clearing out of fat and cholesterol from a improving fatty liver. There is not enough info given to say whether or not this has been a factor or not.

    As you have only taken 3 tests it is impossible to exclude the fact that the high LDL in your last test could easily reflect a natural fluctuation in your levels. I would suggest that you get more tests in the next few months to try and get a more accurate picture of your situation, as these numbers, although slightly outside the norm, most likely just reflect a need for some metabolic improvements. Your Total to HDL ratio is 3.4 which is still roughly within acceptable numbers.

    It would probably be worth your while testing for FH if your LDL continues to go up, and you may want to look into getting a full thyroid panel including TSH, T3, T4, reverse T3 and an antibody test for Hashimotos at some stage if your LDL doesn't come into range or continues to go up.

    In any case, from my untrained perspective and with the limited info given, it appears that you have greatly improved you metabolic risk factors, however some more tweaking in regards to diet and lifestyle may be necessary in the future if reflected in future test results.

    Cheers Dan M

  26. FACTS:
    Male, white, 52
    approx. 130lbs fat-free mass
    Bodyfat: approx. 19%

    GOAL: <10% bf using a LC PaIeo diet combined with Intermittent Fasting which means I must lose at least 17lbs of bf, both subcutaneous and visceral.

    Resistance train 4xs/week
    Cardio interval train 2-3xs/week

    I was dx'd via ultrasound with non-alcoholic fatty liver disease (NAFLD) two years ago. It is indeterminate how long I've had it. Liver enzymes continue to remain within normal range and I notice no symptoms

    I am hypothyroid and have been taking 75mcg of sustained-release T3. My latest thyroid numbers are posted in the link below [p2, 3, 10].

    TSH has improvement over last labs. Both T4 and T3 show depressed, however, I was fasting for nearly 20 hours on the first day. rT3 is less this time, which is a good thing.

    Have been on LC Paleo diet for last three months and doing between a Lean Gains [ ] 16/8 IF protocol to as much as 20/4 IF protocol. I do mini-carb refeeds (about 50-60g) on my workout days only. If I increase carbs more than this, my post-prandial BG will exceed 125.

    What's freaking me out are my latest lipid tests. I had the top three done in a matter of two consecutive days [p2, 5, 11-14].


    If we’re clearing lipids from the liver, then this is a good thing, but HOW CAN I DETERMINE THAT IT'S THIS AND NOT FROM THE DIET ITSELF?

    In other words, is the increase due to CREATION or CLEARANCE (resolution of NAFLD)?

    I have not changed any macros in my diet, maybe slightly more lean grass-fed animal protein, but saturated fat intake has remained constant throughout. And most of the saturated fat is drained because I steam all my meats, so how can it be CREATION?

    The only other fats I eat with frequency are O3s (2-4g), coconut, flax, macadamia and olive oil.

    What evidence supports this unconventional theory?

    I understand that one of the key problems with fatty liver disease is that the lipids get stuck in the liver and they’re not being released into the bloodstream.

    How could this be the case when taking liver support supplements like milk thistle, dessicated liver, choline, lecithin, etc.? Why wouldn't such intervention spur on the purge also?

    Why wouldn't free fatty acids (FFAs) from stored subcutaneous fat be released into the bloodstream as well?

    Could this explanation be the mechanism behind the clearance of FFAs: During fasting or starvation, free-fatty-acids are released during lipolysis into the liver and muscles to be burned as energy, this is called fat-oxidation. During the fed-state and especially while eating a starch-based-diet, fat-oxidation is inhibited and replaced with carbohydrate-oxidation, insulin is what mediates this shift. When carbohydrate-oxidation is taking place, fatty-acids are shuttled back and "locked away" in adipose-tissue... where they belong.

    In addition to LC Paleo/IF, I also began taking 1g of choline nearly a month before the labs + 3mg methylfolate/day to help with a genetic methylation defect.

    Could the above combination have created a mega-purge?

    Could the answer be that the best predictor of fatty liver is obesity and insulin resistance?

    Anomalies to purge theory:

    Why the decreased HDL when I was making nice progress before?

    Lastly, I had been fasting for 18-20 hrs prior to my blood being drawn. My fasting insulin was only 5.2. Then why an elevation in HbA1c (5.8) and FBG (95)? Should've been in the low 80s, especially when fasting for LONGER periods AND on LC Paleo.

    So, why is my insulin sensitivity is taking a nosedive during this so-called healing crisis as well [see Insulin Resistance Score - p12, 14]?

    Can someone please interpret my lipid profiles, especially the NMR LipoProfile and tell me what is going on?

  27. Hi Chris,

    Thanks for this - awesome read, full of useful info. I wanted to ask your opinion on something - i am 27, thought i was pretty healthy (slim, fit, ate well) but had quite high LDL. Then I found out i had thyroid cancer...wondering now if that had something to do with my high LDL? Had my thyroid removed now and am on a drug to get my thyroxine into me....interested in your thoughts on where i should be trying to keep my t4 levels? The Docs currently have me on slightly too much for some reason...I live in New Zealand and it took 18months of me telling the Docs about the lump i had in my throat for them to finally tell me it was cancer...thanks to that i not only lost my thyroid but most my lymph nodes in my have subsequently lost faith in the doctors here. Your thoughts would be much appreciated.

  28. Hello, so I recently wrote up an article on a probiotic formulation that can reduce bad cholesterol levels. I think the results of this study are really intriguing, especially since this is a method of reducing your cholesterol which can be easily implemented. Just like taking your daily vitamins, you could be taking a probiotic supplement that would be doing a lot of good for your long-term heart health. What's more, the effective dosage for this probiotic is way less than plenty of other cholesterol-lowering supplements that researchers have experimented with.

  29. Hey, thanks for the really great post. I think it is really interesting to think about the difference in cholesterol between genders. For men, we need to be wary about elevating cholesterol levels until we hit 50. While women tend to keep relatively stable levels of cholesterol until they hit menopause. Still, I was really surprised when I read about a recent study on high cholesterol levels. Apparently, American adults have better cholesterol levels now than they did 20 years ago! It just seems shocking that our overall cholesterol levels could be better when our waistlines have gotten bigger.

  30. Hi Chris,
    I have been on simvastatin 40mg for one month following a TIA. My TC has gone down from 6.9 on arrival at hospital to 4.2. I have looked at the research and it seems that the likelihood of further problems is not that different whether or not I continue on statins. A proportional risk reduction figure looks high at around 25% but in real terms it's not much less than the full risk, maybe 6% at most. I want to come off the statins but am now worried about vessel wall and clotting problems being exacerbated at discontinuation. How can I effectively manage this? I am also on 75mg aspirin which I don't mind continuing.

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  32. It’s really a great and helpful piece of info. I’m satisfied that you simply shared this useful information with us. Please stay us up to date like this. Thank you for sharing.

  33. Good explanation of thyroid problems connected to cholesterol levels

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  35. Thank you for all your great work! My wife has thyrioid problems, but does not blog, I work for a Jupiter Florida cosmetic dentist and came across this and shared this with her. She was most appreciative as diabetes also runs in her family.

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