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Cholesterol: When to Panic

written by Vin Kutty

comments 107 comments

fish oil cholesterol

This is part 2. See part 1 – Fish Oil & Cholesterol.

Controlling Cholesterol with Diet

Trying to reduce your cholesterol by avoiding eggs and meat alone may not be very effective.

Here’s why:

Most – about 80% – of the cholesterol in your body is produced by your liver and other cells in your body. And for good reason. Every cell in your body has and needs cholesterol. There are hundreds of bodily tasks for cholesterol.

fish oil_egg_cholesterol

Image: Mariola Streim


If you remove all cholesterol from your body, your body will cease to function. Period.

It would be foolish of your body to depend on your diet for all its cholesterol needs because some meals may not contain enough cholesterol to sustain the body. And your body knows this. This is why your liver is in charge.

Your diet contributes to the remaining 20% or so of the cholesterol coursing through your body.

Cutting out meat, or going vegan can modestly reduce your cholesterol. Dramatic drops in cholesterol without a complete rethinking of both diet and lifestyle is likely to be temporarily.*

If your body senses less cholesterol in the diet, it will automatically increase liver’s cholesterol production. And vice versa, if you’re eating a lot of cholesterol, the liver will take it easy on cranking out cholesterol. This is not new science. This knowledge is decades old.

If you quit eating meat and become a vegan, to reduce cholesterol, it may work. Temporarily. After all, cholesterol is only found in animal products.

Vegetables contain no cholesterol. So, if we ate only vegetables, our cholesterol problem would be licked. Right? RIGHT?

But after a couple of months, your cholesterol numbers will start creeping up again even on a vegan diet.

cholesterol and archives of internal medicine

A recent study published by Harvard researchers, followed over 121,000 people over several years. A tiny nugget of data buried in the study showed that:

  • people eating the least amount of red meat had the highest cholesterol
  • and those who ate the most red meat had the lowest cholesterol

That may be an inconvenient fact and should not be ignored.

I am not trying to bash Veganism. I often tell people to make sure that 80% of their plate is vegetables (starchy and not), with only a little bit of meat or seafood.

When to Panic?

What if your total cholesterol is 200? Is it time to panic?

Should you panic at 250? 300?

You should take it seriously. You need a rational and methodical plan that includes:

  1. dietary change
  2. lifestyle change (exercise), and possibly,
  3. medical intervention with  your doctor’s help.

Preemptively asking your doctor for cholesterol-lowering statin medications to pound and pummel your cholesterol number into double digits without getting at the underlying causes is not wise in the long term. Although statins may be what some people eventually need.

It’s easy to following this logic:

a) if cholesterol is dangerous
b) and your cholesterol is going up gradually
c) you should simply nip it in the bud before it gunks up your arteries



A cholesterol number close to ZERO is not good. Or perfect.

Having too little cholesterol may be even more dangerous than having too much.

Panicky patients driven by fear-inducing TV commercials and enabling doctors preemptively popping statin drugs like candy is not wise. There was a doctor in the UK who called for addition of statin drugs into tap water. Never mind that his name is Dr. John Reckless.

For most people, a total cholesterol around 200 is reason for a visit to the doctor for an investigation (rather than panic), especially if you’re female and getting older.

Your total cholesterol number is not very revealing. There are other markers that are far more predictive of your heart health, like ratio of Total-to-HDL cholesterol or non-HDL cholesterol, or LDL particle number or Lipoprotein (a).

Still, I am not suggesting you ignore your Total Cholesterol number. It’s a piece of your health puzzle that you need to solve with your doctor.

If you must panic, I’d rather you focus on the more predictive markers. Or talk to your doctor about yet other highly predictive markers of health (pieces of the puzzle) such as C-reactive Protein, fibrinogen, oxidized-LDL, fasting glucose, insulin, Lp-PLA2, hemoglobin A1C, or even Vitamin D level.

When scientists have tried to model or weight the predictive importance to all of these factors, Total Cholesterol is usually not the top risk factor.

High cholesterol is one of your body’s check engine lights

A cholesterol number of 250 or 300 means it is time to open the hood and give the engine a thorough inspection.

Blindly reducing your cholesterol number with statin drugs is like unplugging that check engine light.

Sure, that annoying red light is no longer there when you start your car in the morning, but the reason why that red light went on still remains.

It’s up to you and your doctor whether you want to ignore the real problem under the hood.

This is why I called hasty, chop-chop statin therapy ‘lazy medicine’ in a recent blog about Fish Oil & Red Yeast Rice.

Before I get drowned in hate mail, let me make the following statements very clear:

  1. If you’re on statin therapy, talk to your doctor. DO NOT self-diagnose and stop taking prescription medications without talking to your doctor – that can be dangerous.
  2. If you have a genetic condition called familial hypercholesterolemia, you probably ought to be on statins.
  3. If you have been diagnosed with heart problems, your doctor may justifiably put you on statins.

What if you don’t fall into the above categories? Well, then, it is time to look under the hood.

If the only solutions your doctor knows for high cholesterol is to:

  1. Immediately put you on statins
  2. Tell you to cut meat and fat from your diet

Ding-ding-ding! It’s time to look for another doctor.

Some doctors – a sad commentary – will prescribe statin drugs even if the patient does not absolutely need it, to reduce the risk of negligent malpractice lawsuit. Sigh.

But the good ones who have the time to practice good medicine, without being harassed by insurance companies, know that high cholesterol is often just a symptom of metabolic or endocrine disorder.

High cholesterol could be caused by:

  1. Thyroid imbalance
  2. Infections
  3. Inflammation
  4. Nutritional imbalance

Most allopathic doctors rarely focus on inflammation or nutritional deficiencies – that’s a whole another rant/blog.

But for many, understanding thyroid imbalances and fixing it through medication or even iodine therapy may fix the problem. DO NOT do this without your doctor’s help! Your thyroid is not a do-it-yourself project! Don’t even think about it.

Speaking of inflammation, what are key causes of inflammation? Too much Omega-6 from vegetable oil consumption. Along with obesity, excess glucose, and gut microbiome imbalance. If your high cholesterol is due to this, then, you’ll need to address all of these root causes as well. Not addressing obesity, excess blood glucose, or gut dysbiosis is akin to unplugging your car’s check engine light.

Statins may reduce your cholesterol number and your overall risk. It might help you sleep easy without worries. But don’t, for a second, think that the root cause issues that produced the problem is gone. The monster is still under the bed if you do not address diet and activity.

The solution to most metabolic disorders:

…is not found in a pill. Wish it was!

The solution is a simple, a whole foods diet that’s mostly non-starchy vegetables, along with some Omega-3 rich seafood, grass-fed meats, fruits, nuts and pastured eggs, all cooked in low-Omega-6 fats like olive oil.

A small portion of the population reacts to dietary saturated fats with dramatic increase in cholesterol levels. If you fall into this group, then, rely exclusively on Omega-9 or oleic-rich fats like olive oil.

Note the absence of sugars, grains and Omega-6-rich seed-based vegetable oils!

Popping a bunch of fish oil supplements will not correct metabolic disorders. Wish it did!

High dose Omega-3 supplementation only gets you partly there…what’s truly required to address metabolic disorder are exercise, reducing Omega-6 rich seed oils, and near-complete elimination of sugar and refined flour, while increasing fiber consumption from vegetables.*

Mainstream medicine is changing…slowly

Dr. Dwight Lundell, cardiologist, explains all this a bit more thoroughly

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of poor heart health is slowly leading to a paradigm shift in how poor heart health and other chronic ailments will be treated.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

– Dr. Dwight Lundell, Cardiologist


BBC Video: Statins – use them or lose them?

So should you ignore your high cholesterol?

No. Don’t ignore it.

High cholesterol just means it’s time for you and your doctor to take a better look under the hood.

If the root cause is metabolic disorder, combine vigorous exercise with the dietary suggestions mentioned above. Statin drugs do not fix metabolic disorders.

If the root cause is thyroid imbalance, work with your doctor or an endocrinologist to address it. Statins don’t fix this.

If the root cause is inflammation, work with an Integrative Medicine MD to address it. Statins don’t fix this either.

If it is an infection, again, work with your doctor to address it.

Panicking about cholesterol won’t get you far. What you need is a methodical plan developed by your doctor, nutritionist, and your gym trainer. You didn’t get here overnight. And the problem won’t be solved overnight. Start addressing root causes of the issue.


*Individual results may vary. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Clinical research suggests the omega-3 dosage needed to help maintain healthy triglycerides is 2000-3000 mg per day when used as part of healthy diet and exercise.


Join the conversation

    • NO, NO, NO! Please DO NOT change your diet based on that study! It is a survey study that – at best – points out associations. There is a HUGE difference between correlation and causation. This study pointed out some correlation. It should be illegal for authors to make conclusive statements based on diet surveys. I made the following comments on our Facebook page:
      “Red Meat & Death by Ignorance!

      Surely you’ve heard about the scary new study. I’ve read the study…and here’s what the authors and media left out:

      People who eat the most processed red meats (hotdogs etc.):
      1. get 37% less exercise
      2. are three times more likely to be smokers
      3. are 26% less likely to take a multivitamin
      4. have higher body mass index (BMI)
      5. drink more
      6. eat 700 more calories/day (!) than those who eat the least red meat.

      Think the above 6 factors had anything to do with the outcome?

      Parting shot: 8% of the red meat eaters had high cholesterol. But 15% of those who avoid red meat had high cholesterol. Sounds right.”

      Nick – I urge you to read Denise Minger’s analysis of this study: and also this one by Robb Wolf here:

      Don’t change a thing about your diet based on just one study! Talk to your doctor and a nutritionst

      *Individual results may vary. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Clinical research suggests the omega-3 dosage needed to help maintain healthy triglycerides is 2000-3000 mg per day when used as part of healthy diet and exercise.

    • Hi Nick – adding more veggie and seafood to your diet is a great idea. But adding more poultry, well, not so much! Poultry is very high in Omega-6, especially dark meat. I still eat poultry, but I stick with the breast meat.

      Yes, I’ve read Gary Taubes’ books. He focuses on sugar/insulin (almost exclusively) as the key cause of obesity and ill health. I mostly agree. I think obesity is , unfortunately, more complicated – you can’t ignore genetics, omega-6, sleep deprivation, inactivity etc. But in Taubes’ defense – and he doesn’t need any, if you’ve ever heard him in public discourse! – most obesity related problems would be solved if people followed his diet advice.

      – Vin

  1. Are there any grains that are acceptable? e.g. quinoa. Or when you say no grains, you mean NO grains! Thanks!

    • Hi Christie – sugar, juice, alcohol, high-fructose corn syrup, grains, flour (even if it is ‘healthy’ whole grain) drive blood sugar levels. This causes the body to produce more insulin. This drives fat storage and weight gain. You end up with high triglycerides and lots of LDL particles. It’s the LDL particles that drive otherwise-harmless cholesterol into the walls of your artery and cause atherosclerosis. This is what eventually causes a ‘cardiac event,’ as cardiologists put it. So to answer your question…how hard and fast you draw the line on grain consumption depends on how worried you and your doctor are about your heart health. Should you eat Quinoa? I am not a believer in ‘everything in moderation.’ That’s a cop out. I have bad genes. Even moderate consumption of grains or alcohol drives up my risk. So I have not eaten any grains in several years. Should you do the same? I don’t know. Only you and your doctor know the facts before you can answer that question. Still, if you put a gun to my head, I’d say: NO GRAINS AT ALL!

      Probably not what you wanted to hear, huh?
      – Vin Kutty

      • Hi Vin,

        I am surprised that you yourself stay away from wholegrains while you are closely monitoring your TGs as studies show that fiber from wholegrains reduces causes of many cause of death.
        Also, are you considering that TG levels are increased by consumption of saturated fatty acids like butter even if it doesn’t affect cholesterol.

        • Hi Joanna – the problem with grains is that the sugar and starch content in them will increase your triglyceride far more the fiber in it will lower it. So the net effect of eating grains is a dramatic increase in triglyceride. Also, there is nothing present in grains that are not in vegetables. As a source of fiber, vegetables are FAR SUPERIOR. So I opt for vegetables instead.

          Butter has a smaller effect on triglyceride. Grains, sugar, starch have a dramatic effect on TG. Generally speaking, fats and proteins don’t spike TG as much as sugar and carbohydrates.

  2. Hi Denise – the connection between simple carbs (sugars) and poor blood fats numbers is very established, proven and no longer in doubt.

    But! Several doctors still believe that dietary cholesterol is the main source of blood cholesterol. Dietary cholesterol has only a very small influence on blood cholesterol. The cholesterol in our diet is mostly the esterified kind, which is not absorbed as is. It is mostly excreted. When you get a blood test, you are measuring endogenous cholesterol that’s mostly UN-esterified, the stuff made by your liver. Most doctors do not know this and end up over-prescribing statin drugs.

    Poultry and seafood are fine in moderation. I am not a fan of moderation. If all you eat is poultry and farm-raised fish, you’ll consume too much Omega-6. If you eat mostly poultry, stick with the white meat – it has less Omega-6 than the dark meat.

    I don’t need a gun to my head to tell people to eat grass fed meats! I avoided red meats for a decade due to moral and ethical reasons. From a health perspective, that was a mistake. Now, I avoid regular beef and pork from mass-market grocery chains. I eat a lot of grass fed beef, pastured eggs, organic local veggies and yes, an occasion chicken or turkey.

    The fact that you have bad genes (so do I) just means that you have to be even more strict about avoiding sugar and grains.

    Hope this helps.

    Vin Kutty

  3. 3000 mg of Omega-3 per day is fine when combined with a healthy diet and exercise plan. That’s how much I take every day. But more is not necessarily better.

  4. Hi Enrique – fish oil will not be as effective as naproxen in relieving discomfort after surgery. Certainly, fish oil is a natural anti-inflammatory. NSAIDs only start causing problems with chronic daily use. Having said that, adding a strong fish oil supplement to your routine will certainly help with controlling inflammation without aggravating the naproxen side effects. Usually, high LDL is seen in people who consume a lot of refined carbohydrates. In your case, your diet appears low to moderate carb and quite healthy. I’d say ask your doctor for another lipid panel (for confirmation) and then as I mentioned in the post, it is time for both of you to ‘look under the hood.’ A basic lipid panel is not very revealing. A good doctor will dig deeper for the root cause of the problem. Ask your doctor about getting an NMR LipoProfile to get a read on your LDL particle number – it is not the same as LDL-Cholesterol number. Hope this helps.
    – Vin Kutty

  5. Hi Enrique – yes, 2000 to 3000 mg Omega-3 per day is good for keeping down inflammation. Definitely get your blood tested again. Wait 2-3 months after any major diet change before you test your blood.
    – Vin

  6. Hi Brandon – yes, absolutely, low LDL can be very deceptive! Especially if you are prone to high triglycerides. Most doctors don’t require you to get an LDL-particle number measurement. It is called an NMR LipoProfile and the sample has to be sent off. Please listen to this when you have a moment: It explains why a low LDL can be so deceptive.

    You can take your pills all at once or split up during the day, as long as you are taking it with food. Omega-3 absorbs best when taken with a meal that contains other fats.

    – Vin

  7. I just wanted to say “Thank You!”! I was looking for the best Omega3’s. Running into your website has changed my life. After watching Big Business and Bad Science, I knew it…I knew all along we had been lied to. I have plastered the youtube video everywhere and sent the link to ALL of my friends. I want to stand on a mountain top and scream the truth. I humbly thank you and will do whatever I can to lead more people to your site. You are a blessing to mankind.

    • Hi Bernadette – this is a question for your doctor. However, I would be shocked if any doctor had an issue with your excellent HDL and Triglycerides! Your total cholesterol number is an aggregate of all types of cholesterol and since your HDL ‘good’ cholesterol is so high, I am not surprised that the total is high too. I’ll say this: I’d love to have your numbers.

  8. Hi Shirl,

    Your numbers are a little unusual. Typically, high LDL will be accompanied by high TG…but not always.

    I would love to have low TG and high HDL. If you divide your TG number by your HDL number, ideally you should be under 3. If you are under 2, that’s great and under 1 is fantastic. This is a very easy way to tell how at risk you are. This ratio is a better indicator of risk than total cholesterol or LDL number.

    Hope this helps.

    – Vin Kutty

  9. What diet do you suggest to a vegetarian, is brisk walking for 45 min and yoga pranayama for 30 min per day good to reduce cholesterol? How much sleep is good enough? Should I eat butter and ghee? How much?

    • Hi Amita – if you chose a vegetarian diet because of its health benefits, well, make sure you eat mostly vegetables, legumes, nuts etc. and go easy on grains and fruits. If you eat eggs, that’s great. If you eat fish, even better. Supplement with Vitamin B12. Exercise is great. Sleep? 7-9 hours. Talk to your doctor.

  10. Hi Shawn – may be there is no need to panic, no way to know based on just a total cholesterol number, but you have to go along with your doctor’s plan. After all, ‘over 300’ is not average. Keeping you on a statin while he/she looks ‘under the hood’ to find the root cause of the high lipids seems reasonable to me. But you DO need to look under the hood. If your current doctor is unwilling or unable, go to an endocrinologist and get your hormones checked out. Metabolic and diet issues are rarely well-handled by primary care docs. You may need an integrative MD who specializes in that. Or you could get your diet straightened out by an RD who specializes in metabolic issues like: (just an example – I do not know her and this is not a recommendation) Going to an RD is like going to Al Anon. You have to go. You have to admit you have a diet and lipid problem. You have to admit that you will make changes and then follow thru. For a lot of people, popping a statin and forgetting about the root cause is much easier. Your choice, but no pill can outrun a bad diet/lifestyle in the long run.

    Yes, I absolutely am suggesting that you cut out sugar, refined grains/flour and Omega-6-rich vegetable seed oils. Just this change alone will drop your risk for a lot of illness…and probably your cholesterol too. High insulin levels goose cholesterol production. Sugar and refined grains will increase insulin levels. Do you need fish oils? May be. But it certainly will not reduce your total cholesterol.

  11. Hi Amita – I can’t give you medical advice. I’m not a doctor and this is the internet – I’m sure you understand.

    The only vegetable oils that I use are: olive oil and coconut oil due to the low Omega-6 levels in both. I avoid all other seed oils.

  12. Hi thanks for your great article. Just want to share my stories. When I was growing up in North Dakota, my mother cooked up bacon for her children’s breakfasts, lifting the sizzling strips out of the grease with a fork and setting them on a paper towel to drain. Then, she carefully poured the hot grease into a jar to save it. She did not put the jar in the refrigerator; it went straight into the kitchen cupboard. She knew that as bacon grease cools, it turns solid and does not require refrigeration. The next day, she spooned the bacon grease back into the fry pan and fried eggs in it. She said that this is helpful in lowering cholesterol.. Do you think this is really helpful? Thanks in advance.

    • Hi Leona – for most people, dietary cholesterol (from bacon fat in your case) does not affect blood cholesterol. By ‘most people,’ I mean about 75%. In the other 25%, eating more cholesterol from animal fats will increase blood level of cholesterol. For the most part, if you eat high-cholesterol foods, your liver will simply down-regulate its internal cholesterol production. And if you stop eating all animal fats (like vegans), your liver will up-regulate cholesterol production. So for most people, eating bacon fat and eggs will not change blood cholesterol. The other 25%, well, we still don’t know for sure if there is a net increase/decrease in risk. If you fall into the 25%, then it may be safer to cook with olive oil instead of bacon fat. The ‘saturated fat is bad for you’ ideology has been pretty much dismantled and proven wrong. The latest evidence shows that saturated fats are neutral at worst. Then again, bacon fat is mostly monounsaturated fats – the kind in olive oil.

      For what it’s worth – bacon fat is NEVER wasted in our kitchen either.

      • I thought that cooking with Olive Oil was now considered to change it negatively and turn it from healthy oil into molecularly altered losing health benefits?

        • Hi Devon – if you use extremely high heat and prolonged duration, some of the healthy polyphenols in extra vigin olive oil may get damaged. Otherwise, most of olive oil is Omega-9 or oleic acid, which can handle quite a bit of heat. I regularly use ‘Extra Light’ Bertolli oil for high heat cooking and switch to extra virgin olive oil for salads and low heat cooking.

  13. Hi, thank you very much for the information that you provided. My wife and I recently knew that she is pregnant. She is dealing with obesity (1.65 meters, 85 kg), and the gynecologist was very worried about her cholesterol levels, which were 325, and that number comes from a test a week before she got pregnant (she is constantly monitoring her cycles so she knows she wasn’t pregnant at the time of the bleed test).
    I’d like to know about the risks that she (and our baby) face into the future. I’ve heard that cholesterol increases the risk of abortions, but I don’t know if that is true. I will really appreciate your answer. Thank you very much in advance.

    • Hi Andrew – first, congratulations. You need to work with a doctor to understand the full risk of the situation. My suggestion would be to quit all sodas, juices, processed foods, fast foods, refined grains, and anything that increases her blood sugar levels above 120 – get a blood sugar kit from the drug store. Increase vegetable, eggs, meats, olive oil and yes, seafood consumption. This is NOT the time to cut calories or watch your calories – it is the time to eat HEALTHY. Time is ticking. Look into Chris Kresser’s Healthy Baby Code. Good luck.

  14. Hi Shadab – I’m not a doctor and this sounds serious, so you need to go with that your doctors says. I can only give you nutritional advice. This could be genetic – I have no way of knowing…talk to your doctor about genetic testing.

    I suggest you change to diet to include less fruits, less grains and more protein and healthy fats like olive oil and coconut oil. LDL is mostly driven by sugar, grain and starch consumption. Yes, your fruit consumption is probably behind your glucose numbers.

    On the plus side, your TG/HDL ratio dropped from 2.4 to 1.5 – that’s great. But the total cholesterol number is useless because it is a combination of numbers that you want higher and lower.

  15. Hi Deevesh – fish oil/cod liver oil will not help you lower total cholesterol. Walnut and almonds will not help either. Yes, switching to olive/coconut/butter is a good idea. Watch your sugar/starch intake – that’s likely a cause in the spike but I suspect something else is up – you may want to talk to an endocrinologist to make sure your thyroid and other hormone numbers are fine.

    Focusing on total cholesterol is pointless because it is a combination of numbers that are supposed to be both high and low. Focus on triglycerides, HDL, LDL particle size/density, CRP, blood glucose and A1C. A regular doctor will probably throw some statin drugs at you and sure, they will lower your total cholesterol, which will give you a false sense of comfort without truly reducing your risk. Is that what you want? A 45% spike in cholesterol in 1 year is not normal. Get to the root cause with the help of a specialist. I suspect statin deficiency is not the root cause.

  16. Hi Francisco – this is a good question for your doctor. It is normal for total cholesterol number to vary 25-30% in either direction. Total cholesterol is a useless number anyway since it is a mix of numbers that are supposed to be high and low. Focus on triglycerides and LDL – these two are much more predictive of future heart issues. Both your TG and HDL are numbers that I wish I had.

  17. Hi Dave – I have no doubt that your LDL dropped 55% on the vegan, no-oil diet. Removing oils and fat from your diet is very effective in dropping total chol and LDL in some people. I am actually one of those people. If changing your diet alters your LDL and Tot chol more than 20 or 25%, then the fats you consume should be mostly monounsaturated and little bit of Omega 3 and 6. Unless you know the LDL particle number and size, you don’t know if that 50% drop translates to a 50% reduction in risk. There are better markers of heart health risk than calculated LDL-C. I suggest you work with a lipidologist in your area.

    As for the Esselstyn diet (or the Furman diet), they are very effective for people transitioning from the standard american diet which is high in refined grains, processed seed oils etc. I know a lot of people who’ve improved their health on these diets. Part of the reason they work so well is that they are free of sugar, sweets, refined grains and processed vegetable seed oils. Dropping these items from your diet will improve your health, reduce inflammation and reduce your risk for disease. But swearing off an entire class of nutrients (fats) is not based on solid science and carries a lot of long-term risk. We have a few years worth of DHA and Omega-6 fats stored in the body. You are reaching the point where you will begin going deficient in some of these nutrients unless you supplement. And any diet that absolutely requires you to supplement with DHA and B12 is simply not sustainable. I’d say the same thing to folks on very-low-carb atkins diet – it may drastically drop their triglycerides and A1c in the short run, but they are also starving their probiotic flora, which is undesirable in many ways.

    But people tend to become religious about these things. In my opinion, there is nothing wrong with the Esselstyn or Furman diet that a little wild salmon can’t fix.

  18. Hi Dave – looks like you’re monitoring your health pretty closely. Flax is OK but it has ALA Omega-3 and ALA requires a dozen other things to be in perfect alignment to convert about 5% to EPA and virtually none of it converts to DHA. I suggest you get an algae-DHA supplement. It’s perfect for Vegans. Good quality extra virgin olive oils is something to consider on your salads as well. Perhaps consider macadamias instead of peanuts. Macs are high in Omega-9 and low in Omega-6.

    I’ve read the Esselstyn study – it’s compelling but has several method weaknesses. Same for Ornish. My interpretation of the study was that the reversal in atherosclerosis could be a result of several dietary factors others than meat or fat avoidance. Regardless, what these studies show is that you have a tremendous amount of control over your health and the combination of diet/lifestyle far better than relying on pharma drugs alone without a lifestyle change.

    I would also look into Vitamin K2 supplementation or eating Natto or sauerkraut. Natto and sauerkraut are very rarely included in vegan diets but really ought to be. K2 controls the enzymes that controls arterial calcification – even omnivores are deficient in it because it’s found mostly in liver, grass-fed butter, hard cheeses etc and these are all things that even omnivores avoid.

  19. This is great stuff, Dave.

    I’m not too surprised at the high adherence rate given the ‘intensive counseling.’ I’m also not too surprised at the low rate of cardiac events in these people given so many positive changes – highly motivated, non-smoking volunteers who got intensive counseling and training seminars, exercised and ate a lot of veggies that support endothelial health, eliminated processed foods, sugar, sugary drinks, juices, fructose, caffeine, excess salt in addition to support from spouse, continued use of cardiac medications.

    The above lifestyle ‘package’, it turns out, is very effective. There are about a dozen variables. Calling it a ‘plant-based diet’ is under-selling the package. This generates a lot of great hypotheses but offers nothing concrete establishing causality between meat and oil avoidance and disease.

    Michael Pollan’s quote, ‘Eat food, not too much, mostly plants,’ still holds true.

    Example of a highly biased (schizophrenic?) paragraph from the study follows:

    “CAD (Coronary Artery Disease) begins with progressive endothelial injury, inflammatory oxidative stress, diminution of nitric oxide production, foam cell formation, and development of plaques that may rupture to cause a myocardial infarction (MI) or stroke.”

    “This cascade is set in motion in part by, and is exacerbated by, the western diet of added oils, dairy, meat, fowl, fish, sugary foods (sucrose, fructose, and drinks containing those, refined carbohydrates, fruit juices, syrups, and molasses) that injures or impairs endothelial function after each ingestion, making food choices a major, if not the major, cause of CAD.”

    The first sentence shows that the authors are focused on the right stuff, but the second sentence reveals the bias. You cannot eliminate sugar, refined carbs and high-omega-6 fats from your diet and then credit improvements to elimination of just the meat and the other fats.

    I’ve shared my opinion before and I’ll say it again: there is nothing wrong with Esselstyn’s diet that a little extra virgin olive oil and wild salmon can’t fix. And may be a little egg yolk and grass-fed liver on the weekends. That’s the diet I shoot for. My Triglycerides have dropped from 700 to about 100. HDL is up 25%, CRP is down from 4 to under 0.5, LDL particle size have ballooned, my AA/EPA ratio is close to 1…virtually every marker has improved despite an increase in fat consumption. Was is the ounce of heavy cream that I pour in my coffee every morning or the grass-fed butter that I scramble my eggs in or the coconut milk smoothies? But I also eat a lot of veggies, dark colored berries, fermented veggies, lots of soluble fiber for my probiotics…I walk 4 or 5 miles a day, I get lots of sunshine, I lift weights and am in bed for almost 9 hours a day and manage my stress with meditation and playing with kids and pets. That’s a couple of dozen variables. Which one’s doing the trick? No clue. Is my butter + eggs routine hurting me? May be. But it’s a calculated move to get a whole bunch of nutrients I need and prefer to get from foods as opposed to supplements.

    What works for me does not work for my wife. And may not work for others. But I love to read anything published on the matter, so thanks for sharing the link.

    • Mr. Vin,

      I am needing some guidance. I took my 12 yr old daughter for routine bloodwork and her total cholesterol was 285 . LDL 209 and trig 108. We were referred to a pediatric cardiologist and he wants her to change her diet and increase exercise and wants to see her back in 6 months. After reading your article, I’m really wondering if I should take her to an endocrinologist? I know something has to be up because since she was born she has always been severely constipated and I know that has to be lack of fiber but could that have been her body’s ” red flag” that maybe we should have checked this out a long time ago??? I appreciate your time. I’m worried sick.

      • Hi Yucimid – I cannot give you medical guidance. Diet and exercise sounds like the right thing to do. But it depends on what type of diet your kids is on. Most cardiologists I know, know very little about nutrition, yet they are expected to give dietary advice. So the decision to address the problem with ‘diet and exercise’ is correct, the details of the dietary intervention may be off target.

        The constipation is a red flag – it indicates poor diet/lifestyle. Worrying does not help. It is time for your daughter to start eating a lot of vegetables, non-sugary-fruits, nuts, beans, lentils, etc. Talk to a nutritionist in your area.

      • My whole life I was constipated . IBDC tbeybwould force fiber and fluids . It just made me sicker and sicker. Turns out I have gastroparisis . Also SIBO methane/ something else.. all the finer just made things worse. As an adult I started using laxatives for relief.. my stomach muscles failed. The only thing that has brought relief is no fruits and veggies no grains no nuts no seeds. I absolutely love all of the above so if I know I can be sick for 2day to 3 weeks I’ll enjoy a ice cold Cesar salad or some mango.. all the supposed bad stuff white bread white rice white potato I can easily handle but try not to eat to much of. I sick to meat eggs and string cheese it’s much easier on my tummy. Boring but if I want to feel good I have to steer clear of All fiber and sugars from fruits and veggies ..fiber is my systems killer .. hope that helps

  20. I can understand restriction on sugar and fructose. Caffeine is a mixed bag. Commercial yogurt is dangerous crap – junk food masquerading as health food. Most commercial yogurts have a lot of added sugar or fructose and are grossly underfermented to improve production efficiency and cost. However, if you are not dairy-sensitive (many are) then home-made, full fat yogurt can be a good thing. Given all that, I can understand the restriction on yogurt too. It’s a good sign that his diets are evolving – I take it as a sign of reducing (but not absent) dogma. There is enough at stake here to fund teasing out some of the confounders and gets more conclusive answers. If I followed the Esselstyn or Atkins diets exactly as prescribed, I’d be replacing one problem with another. I know this from extensive self-experimentation and testing. I’ve arrived at something best described as high-veggie, moderate-carb relaxed-paleo.

    Still, I really like the increasing focus on endothelial health in the Esselstyn approach.

    If I come across a diet/particle size reference, I’ll post it here.


    Not surprisingly, genetics plays a big part – this paper focuses on Apo E. Wish services like 23andme were more widely available. This, once again, reinforces my belief that there is no one perfect diet for everyone. The recent TIME magazine cover urging everyone to ‘Eat Butter’ may be fine for some and is a step in the right direction for erasing blind fat-phobia, but may make things worse for about 25% of the population. I worry about the knee-jerk bacon worship I’m starting to see in the ‘paleo’ community. Unlimited butter may not be a good thing for those with 3/4 or 4/4 genotypes.

  22. Hi Dave – I don’t know if the kind of study that you’re looking for has been conducted. It would certainly address some unanswered questions. I’d rather we focus on the endothelium and what causes issues with it.

    As much as I agree that the endothelium is very critical, we need something other than Vogel’s research to make dietary decisions. Vogel himself admits that the assumption that progression/regression of atherosclerosis is predicted by endothelial function is based on preliminary data. I’ve read a lot of Vogel’s work and find it to contain poor assumptions and poorer designs. A classic is considering salmon and canola oils to be equivalent because the portion size used in a study contained the same amount of Omega-3. If one is not outraged by that, I’d say they don’t know enough about either salmon or canola oil. Another classic is giving a third of a pound (YIKES!!) of whole wheat bread and some olive oil to patients and then blaming the olive oil for the subsequent endothelial dysfunction. It’s often one face-palm moment after another with his recent paper. Basing any diet on Vogel’s work is like a financial TV reporter trying to put a positive spin on bad news by using second order derivative language like ‘the rate of decline is improving,’ or ‘the growth rate is slowing.’ Most people take such TV reporters and, for that matter, Vogel’s work at face value. The message that the media spread: if olive oil is bad and canola equals salmon, then canola must be good. Again, yikes! This is not how science is supposed to work.

    Despite all that, I still think foods/lifestyles that drive endothelial issues and inflammation are what we need to focus on. And then overlay data from individual genetic testing and results from doctor-guided-experimentation to find your own secret sauce.

  23. I’m 6 months pregnant and just had a blood test with high cholesterol. 297. I’m normal weight, but I’m very concerned since I don’t believe cholesterol has ever been an issue. I understand it is higher during gestation, however, this seems unusual.

  24. Hi Amanda – this is a question best answered by your OB. Normally, I would tell you that I’d jealous of your numbers and that I wish my HDL was that high or triglycerides so low – both are great numbers. But talk to your OB and find out what he/she thinks. Even if your doctor thinks your cholesterol is too high, doing something about it (pharmaceutically) while you’re pregnant seems like a bad idea. This is also not a good time to go on a low-fat diet – your baby’s brains and eyes need a lot of fat to grow. Especially a lot of DHA. I assume you’re getting about 900 mg of DHA per day, not that you’re getting into the third trimester.

  25. Thank you. I thought my numbers were high but Ifeel a bit better now. I will speak to my doctor as soon as I can. Thanks for the speedy response!

  26. Hi RKV – have you talked to your doctor about this? That’s the first place to start. My only suggestion to you is to eat mostly vegetables, legumes and nuts. Avoid grains, sugars, juices and sweets. If you’re low in protein, get a protein supplement to go along with your veggies.

  27. Hi Zandy – if you live in America and eat a standard american diet, you will become prediabetic. Some of those prediabetics will become full-blown diabetics. This transition from prediabetes to diabetes is starting to happen at younger ages, even kids! This is mostly because of high sugar, refined flour and refined grain-based processed foods. If you don’t want to become a full blown diabetic, I suggest you start taking baby steps. First cut out sodas. Then juices. Then breakfast cereals and processed foods. Then REDUCE the amount of foods made with flour. This process might take a few months. During this time, get to know real, home-made foods – veggies, tubers, fruits, meats, eggs, seafood, nuts etc. Once your menu starts to look different, you will realize that there is a WHOLE WORLD of delicious foods to eat. It’s sorta like going to a foreign country. At first you stick to eating the most comfortable stuff that reminds you of home…after a while, you will see things differently. Hope this helps.

  28. Hi Brian – I understand you are scared…you’re going to be a parent soon and you need to be around long enough to raise your child. I can relate to that! SO…instead of being scared, use this as a motivator to make some big changes in your diet and lifestyle. High blood lipids is something you and your doctor can get under control with diet, exercise, supplements and drugs. You have these four highly effective options in front of you. You should start with diet and exercise – follow a high-veggie paleo type diet or Zone or South Beach type diet. All of these diets restrict sugar, processed grains and other key things that affect blood lipids. I disagree with your nurse – triglycerides are very easy to reduce. You can do it in a month or two with a sugar-free, flour-free, grain-free diet. If you add aerobic exercise and 3000 mg of Omega-3 per day on top of the diet I just described, I’d be shocked if you couldn’t get your triglycerides down to about 100. But you can only get it down to 100 if you are strict and dedicated.

  29. Ok I am gonna try..I played alot of sports when I was younger so I am not that big , but I am pretty big I’m 5’6″ and weigh 170 I saw on a video about cholesterol and they said that they never proved that high cholesterol caused heart attacks but they did prove statins lower it and people should take them haha,, my dr is about 24 and graduated last year and I just keep thinking everything I put in my mouth that its rising and rising… So can raw sushi be good and whole grain breads..or just veggies, chicken, nuts, fruits, and sweet potatoes?

    • Hi Brian – if you like sushi, by all means, partake! Pass on all breads – whole grain or otherwise. Stick to seafoods, meats, eggs, green leafy veggies, some root vegetables, some fruits and some nuts. Sweet potatoes are great too.

  30. Hi Aziz – your numbers are scary. This is classic metabolic syndrome and possibly insulin resistance. Quitting fast food is probably the best thing you could have done but what you’re doing beside that is going to keep your numbers in the danger zone. Whole grain is not healthy – that’s a myth. It will increase your blood sugar and that in turn will increase your triglycerides and cholesterol. Fruits can increase your blood sugar and in turn TG and Chol. So go easy on fruits. Meats and fats are not harmful, contrary to popular belief. But the TYPE of fat used to fry foods is critical. You can and should eat foods cooked in butter, coconut oil and olive oil. For now, avoid sugar and anything sweet and also avoid or drastically reduce grains. Increase vegetables, proteins and healthy fats.

  31. Hi Sajani – yes.

    You already know what to do with smoking and alcohol. I’d eliminate sweets and any sweetened beverages. Replace grains with vegetables and protein.

  32. I had blood work done for life insurance, and they denied me because my total was 80!! I have been panicking ever since. I have not gotten the breakdown yet, but how do I raise mine!!?

    • Hi Stephanie – just trying to under the situation…are you telling me that your total cholesterol is 80? And that your policy denial was based on total cholesterol being too low?

      My suggestion is to not panic. Get all the facts and talk to your doctor about this. If you want more control over this, find a lipidologist and a dietitian to help you fix your diet. (Although only about 30% of people can change their blood cholesterol level up or down with diet changes. For most people, eating cholesterol will not affect blood cholesterol.)

  33. Hi,
    I have found conversation on your web site very helpful so I thank you for that.
    You recommend eating grain free diet. Could you please be more specific? Thank you,

    • Hi Sanja – by ‘grain free,’ I mean no wheat, wheat flour, rice for the most part. If you eliminate these along with soft drinks and juices, you will eliminate most of the blood glucose increasing foods and beverages. We’re after the reduction of high blood glucose. Of course, a lot of people have sensitivities to wheat proteins like gluten.

  34. Hi Alex – I cannot answer a lot of these questions because they step into medical diagnosis, for which I am neither authorized nor qualified. Having said that, I know that cholesterol numbers vary a little – normal variability. If you are doubting your numbers, talk to another doctor, or better yet, a lipidologist in your area. They can specifically answer all the medical questions you’ve posed without just throwing statins at you. You may need statins, after all. Getting a second opinion is always a good idea, especially if the second doctor is a lipidologist or an integrative MD. They’ll help you more than an endocrinologist. They’re less likely to look at you with ‘surprise/disgust.’

    It does seem like there are some eating related red flags that you will need to address with a licensed dietitian. You’ve done a lot of tests, so you have information to work with. My advice is not to panic. Work methodically with professionals and get to the root cause of high LDL. Once you know what the problem is, then the cure will require focus and discipline.

  35. Hi Connie – sounds like you’ve been reading a lot. So you must get a sense that you DO have quite a bit of control over your health with just food and lifestyle changes. Your doctor will have to tell you which drugs you can come..if and when. But you have 100% control over what you eat. I see lots of little red flags in your question, but nothing that can’t be corrected with some professional dietary advice. You should work with a licensed dietitian, preferably who is partial to a whole foods, ancestral approach. Call it Paleo if you want to feel hip. If I were you, I’d go with a high-veggie, high-seafood, moderate-carb approach. Start with ditching all your cereals. There is no such thing as ‘healthy whole grains.’ Get rid of the junky snack foods and replace them with fruits and nuts. Obviously get rid of all juices and sodas. Then work on getting rid of the pastas and grains. Get rid of anything with flour. Eat stuff that was alive last week. That’s the best advice I can give you: EAT STUFF THAT WAS ALIVE LAST WEEK. Lifestyle…well, start with a 5-mile walk a few times a week, preferably in the middle of the day, without sunscreen or shades. Both your skin and eyes need bright light for different reasons.

  36. Hi Kathy – read the ‘Perfect Health’ diet by the Jaminets.

    Whole grains (or grains of any kind) as a basis of a diet is a phenomenally bad idea. Replace grains with vegetables.

  37. Hi Gib – it is important to eat nutrient dense foods during pregnancy – vegetables, seafood, eggs, liver, nuts. Reduce high-calorie + low-nutrient foods like grains and desserts. Talk to a dietitian if you are concerned. But what ever you do, do not reduce fat from your diet. Low-fat diets can cause developmental issues for the baby.

  38. Hi Leda – should you be freaked? Well, does your doctor want you to be? That’s the question that affects you.

    I’d love to have your numbers, but that’s just my opinion. 🙂

    Looks like you’re making some important changes in your diet. Make sure you do not go too low with starch and vegetables – you need them for your gut microflora. Going low with carbs can certainly lower your blood lipids but can also raise other issues.

  39. Hi Kelly – I would LOVE to have your numbers! Jealous. Yes, Omega-3s will help, not necessarily with these numbers, but with so many other health issues.

  40. Hi Missy – we’re glad to add to your confusion. 🙂 Whether you take statin drugs to lower a total cholesterol of 229 is between you and your doctor. (Nuts, if you ask me, but I’m not a doctor.) But make sure you are not planning on being pregnant while on the drug.

    If you eat a low-fat, low-cholesterol diet, I can promise you that your cholesterol will go up. Why? Because low-fat diets are high in starch/carbs and that will jack up your cholesterol. Your HDL is low because of inactivity and possibly eating a low-fat diet. Eating cereals, grains, oats, and sugar will also increase your cholesterol. My suggestion: eat mostly veggies and roots/tubers, with lots of olive oil and some seafood, eggs, and a little meat. Basically fresh stuff that was alive and growing last week.

  41. Hi Vicke – the current preventive or functional medicine thinking on RA and other auto-immune disorders is that it is a ‘three-legged stool’ of genetics (cant do anything about that), diet (you can do lots about that) and stress or other environmental trigger (you can do lots about that too). So if you remove one or two of the triggers, you symptoms will reduce significantly. As far as diet, you need an anti-inflammatory and gut-friendly diet. You may have a lot of stress or other environmental triggers. Find a functional medicine doctor near you.

    To go about doing this, get a copy of this book and read it cover to cover a few times:

    Replacing all grains, especially wheat, with lots of fresh, non-starchy vegetables should be step 1.

  42. Hi Jodie – sorry to hear that you’re feeling out of control and scared. I cannot give medical advice. However, the combination of medication + diet & lifestyle changes can be more powerful than just either option. The decision to take (or not) medications is yours. However, if you avoid all sugar, grains (refined or whole) and replace that with vegetables, seafood, and all other healthy foods I talk about on this blog, you will be better off. As for exercise, aim for 10,000 steps per day along with some weight bearing exercises a couple of times a week. Real changes in diet and lifestyle is hard. But worth it.

  43. D – I, along with millions of others, would love to have your lipid numbers. I suspect you are in panic mode because you do not understand the numbers. It is time to go back to your doctor and ask him/her to explain.

  44. HI Carol – there are a couple of studies that suggest krill oil can help manage triglycerides if taken with a healthy diet and daily exercise. Results of krill oil and cholesterol is not conclusive. The issue with krill has always been cost. To get an effective dose, you will have to spend a few dollars per day. It is a poor source of Omega-3 and a good source of phospholipids.

  45. Hi Cat – I cannot give you medical advice. But I can tell you what I focus on: HDL, Triglyceirde, and non-HDL cholesterol. Two of those three markers are in excellent shape for you. You may get a bit concerned about your high TOTAL cholesterol, but keep in mind that it may be high due to your high HDL, which is the good cholesterol. I feel comfortable saying that you need to watch your sugar/refined starch/flour intake. Increase exercise and decrease inflammation through diet, supplements, and lifestyle. Many books have been written about my previous two sentences, so you have quite a bit of self-support about inflammation, exercise, and watching sugar/carb intake. Hope my wishy-washy answer nudges you in the right direction.

  46. Hi Kathy – a few points:

    1. The decision to take/not take medications should come from your doctor, not based on something you read on the internet. It doesn’t matter whether my writings are based on facts or ‘full of it’!
    2. Ketogenic diets can be effective in the short term for many metabolic disorders. But I dont recommend staying on it for more than a month. After that, you’re better off with slightly higher whole food carbs from veggies.
    3. Read this: I’ll say this: I’d love to have your HDL and Triglyceride numbers!

  47. Hi Jaimes – fear of food is the wrong path. I strongly suggest that you sit down with a licensed practitioner and have him/her explain your blood test results to you. But somehow the HDL number does not look right to me. Check the numbers again. HDL is considered ‘good’ cholesterol, so a number higher than 60 is considered very desirable.

  48. Hi Belal – cheese and oily foods do not typically increase triglycerides or lower HDL. That comes from high sugar/grain diets combined with genetic predisposition and inactivity. I agree with plant-based diet, but not if you interpret it as grain-based. If you continue to eat grains and flour, all of these numbers are likely to worsen. Eat more plants and less grains.

  49. Hi Steve – there is not much you can do about genetics. So focus on the other two levers: diet and lifestyle. You may think that being vegan takes care of the diet part, but you’d be very wrong. Most vegans I know eat a lot of grains. Stop that if that’s you. Eat mostly vegetables, legumes, seeds, and some fruits and roots. Avoid all grains. Roots can get you in trouble too. Increase your healthy fat (olive, coconut, avocado, flax) consumption – seed oils (corn, canola, soybean, peanut) should be avoided. Find vegetable sources of EPA and DHA Omega-3. Then the only thing left to do is exercise.

  50. Hi Mollie – is your doctor as panicked as you? If so, think about getting another doctor. Your numbers, while not ideal, should not warrant the reaction you are having. Yes, a little high, but not shockingly high – that’s my opinion and not a diagnosis. Back off on the fruits, grains, and tubers. Increase vegetables, protein, healthy fats like olive and Omega-3. Increase exercise.

  51. Hi Gina – what I’m about to say is going to frustrate and confuse you. Red meat is not the problem. Even a little bacon or lard is just fine. There are several non-dietary reasons why your cholesterol may be high (see article above) but foodwise, you need to back off from sugar, grains, and flour – these are the dietary culprits. And increase your exercise and activity. Lack of exercise is one of the biggest reasons why HDL falls. High triglycerides is almost all from high sugar, grain, and flour consumption.

  52. Bravo, Filomena! I love it! Thank you for sharing.

    Most chronic diseases are strongly influenced these 4 things: diet, exercise/lifestyle, genetics, and environment. Not much you can do about genetics and the environment in the short term. But there is a LOT you can do about diet and lifestyle. Good for you!

  53. Hi Sally – two things: 1) there is quite a bit of test-to-test variability in cholesterol tests. It is possible that your 305 could have been a little lower. And 2) 5 weeks of fun eating and lower exercise can easily spike lipid markers. I suspect if you go back to eating and exercising the way you always have, you’ll go back to your original numbers. If you don’t, then it is time to sit down with your doctor.

  54. Hi Richard – these are questions that you should be asking your doctor. I am neither qualified not authorized to give you this advice over the internet. But I’ll say this: I wish I had your triglyceride and HDL numbers!

  55. Hi Barb – yes, let’s leave town! You, me and the two other people who love bison fajitas! The problem is, if you leave town, there is probably another doctor in your new town who’ll put you on statins! 🙂 I don’t see a problem with your diet, given your love for veggies. If you are not overdoing sugar and grains, you’re better off than most people. Like I said in the article, there are several reasons why your cholesterol is borderline. Your have an amazingly good HDL at 101. Your triglycerides are decent. Your non-HDL cholesterol is sort of high. Find out what your genetics test tell you. Hopefully you have an Integrative Medicine MD in your area who can give your genetics results a once over. If you dont have one of those types of doctors, please look into it. It is possible that you are in the group of people who do not do well with saturated fats. Most people are OK with saturated fats, but some people (may be 1 in 4 or 1 in 5) respond to a high saturated fat diet with higher LDL levels. This has to do with ApoE4 genes – talk to your doctor about it. If you fall into this group, switch from coconut oil, butter, ghee etc. to mostly olive oil. I like Bertolli Extra Light olive oil.

  56. Hi Dan – your HDL seems OK. But the other numbers are a tad high. Wouldn’t hit the panic button, but check with your doctor on how to proceed. Looks like a nutritionist ought to be able to help you dial it in a little better. And, of course, exercise helps.

    • Should’ve mentioned I do exercise intensely 3-4 times a week…do you think cutting out grains, flour, sugar would bring them down?

      Doc keeps asking me to get on statins…


      • Hi Dan – of course, cutting out grains, flour, and sugar ought to be dietary priority #1. Get your starch from veggies and fruits. Consume olive oil generously.

  57. Hi Zainab – when you refuse medication from your doctor (whether your doctor is right or wrong), you are taking matters into your own hands. It is fine if a car mechanic wants to charge your $1000 for a repair and choose to fix it yourself but it will take 2 days if you repaired it yourself. This is not the same. Most people don’t know how to interpret blood lipid results and how to influence blood lipids with diet and exercise. Garlic and Omega-3 are great, but it may not be enough if your diet is high in sugar, grains, and flour. Or if you do nor exercise. I cannot tell you how much risk you are in. But if you are not going to listen to your doctor, you better know exactly what you are doing, with both diet and exercise. I’d recommend hiring a licensed nutritionist and an exercise coach right away.

  58. Hi Chichi – your doctor is the only qualified person to answer this question. But, if you are concerned about high triglycerides, know that sugar and grains are the primary source.

  59. My mom’s triglycerides level is touching the boundary of 900 this month and just before a month it is 500.Although from the last month she is taking prescribed medicines and controlling her diet(she is pure vegetarian also) but these levels are not getting lower.

    • Hi Pradyumna – please work with a certified dietitian and your doctor to address this issue. These levels are not to be ignored. Ideally, at these levels, you need to be on a sugar-free diet, along with walking several miles daily and whatever medications you are given by your doctor. Relying on medications alone without changing diet and activity levels is not a good idea.

  60. I eat a whole food plant based diet and have a total cholesterol of about 75-80. Been a lot longer than a few months. No meat, No dairy and no processed food. I have NO issues whatsoever. I was diagnosed with Crohn’s about 17 years ago and since changing my diet, my health has been amazing. Just sayin’

  61. Hi Christine – your TOTAL cholesterol number is an aggregate. Part of the reason it is high is that your HDL ‘good’ cholesterol is high. I’d kill (so to speak) for your HDL and Triglyceride numbers. Your LDL is a calculated number, not a measured number. To truly understand the risk posed by ‘high’ LDL, you’ll need to have your doctor measure your LDL particle size and number. Insurance blood work does not go that deep. If your insurance company deemed you ‘high risk’ solely on your total cholesterol, my apologies. Cholesterol is one of dozens of risk factors. Yet, we are very hung up on it. Having said that, gauging risk by reading this post is not recommended. You still need a doctor for that.

    • Vin,
      Thank you so much for your reply. No word yet on whether or not the insurance company deems me a high risk. I will ask my doctor to measure LDL particle size and number as my next step.
      Thanks again.

  62. Hi Cheryl – with familial hypercholesterolemia (FH), it is challenging and you need to be very diligent with treatments that your doctors prescribe. I’d say you’re a perfect candidate for working with both a cardiologist and an Integrative Medicine MD to address this. General practitioners may not get you tested for LDL particle number or Lipoprotein(a) etc.

    You may be one of those people who hyper-responds to saturated fats – hard to say if you are/not – but better to be conservative and reduce saturated fats and replace with olive oil. You may also benefit from anti-inflammatory nutrients like EPA or Curcumin and Vitamin K2 to reduce calcium deposits in arteries. More on Vitamin K2 here: . Cholesterol ALONE may not clog up arteries – there is always some plaque from calcification. Vitamin K2 can help with the calcification and virtually everyone eating modern diets is somewhat deficient in K2.

    FH is a classic scenario where you have to meet it with medical/pharmaceutical/nutritional/lifestyle interventions. You really need all of it.

  63. Hi Jonsselys – yes, you should get a full evaluation from a cardiologist, as there maybe a genetic condition involved and it’s best to know the risks early.

  64. Hi Shawn – I am not a doctor. Even if I were, couldn’t gauge your health with just 2 numbers. Instead of questioning your doctor, it’d be more productive if we talked about diet and lifestyle changes.

    While you may truly need the statin that your doctor prescribed, you need a healthy diet and daily exercise even more. That sweet tooth you mentioned is not going to help you. You’re only 38, so it’s still early to turn things around. My general suggestions are to eat mostly non-starchy vegetables with some tubers, seafood, meats, eggs, and some fruits in moderation. Be generous with olive oil and seafood. Do not drink anything with calories. Eat only foods that were alive last week. Get 8-9 hours of sleep in a cool and very dark room. Avoid messing up your circadian rhythm by exposing your eyes to screen after sunset. Walk several miles a day in the sun. Do resistance exercise 2-3 times a week. While this is not meant to fix your cholesterol issue, it is meant to generally make you healthier.

  65. I just recently made the comment about my cholesteral being in the 700s, I forgot to mention my thyroid is out of whack, I suffer from hypothyroidism and hashimoto’s disease, hoping when I get that straitened out it will help too and my liver and kidney enzymes are up as well..I have not had a drop of alcohol in over a year and a half. .just thought I’d mention this as well. Thank you Candy Gates

    • Hi Candice – re-posting my response to your question on another blog here as well, since half your question is here:

      This is clearly a medical situation that requires close supervision by your doctor. In addition to your existing doctor, I strongly suggest that you find a local Integrative Medicine MD. They are more likely to get to the root cause of the issue.

      Your fear of fried foods and craving steak (with a touch of guilt, perhaps?) suggests you may harbor old dietary biases. While many fried foods are unhealthy, fats are a diverse group of foods. Many fats are healthy and some are not. You cannot throw the baby out with the bathwater!

      You should INCREASE fats from things like avocado, grass-fed butter, and certainly olive oil. You should decrease sugar, sweets, flour of all kinds, and grains. Dramatically increase vegetables and seafood.

      Consider a high-veggie Paleo-type diet. Eat only things that were alive last week.

      Walk 10,000 steps a day.

      Don’t chase this with pills first. Start in the kitchen.

  66. Hello to you 🙂
    I’m very worried about my total cholesterol levels.
    Six months ago it was 140mg (i was vegan) and from then i passed to a low carb diet with good quality food, red and white meat, high quality dairy, 2-3 boiled eggs a day (raw since the last few days), some veg and fruit, little quantity of quinoa bread and basmati rice (not every day), some 85% of dark choccolate.
    I measured now the tot cholesterol and it was 402mg (hdl 68, ldl 377) and i’m very worried, eventhough my triglicerides levels are 61, pcr < 0.5, fibrinogen 211 which show a low level of inflamation.
    I have read that the low carbers say from one side that the high cholesterol is not the monster that we think, in the countrary it is very important for a lot of functions of our body so we should not worry about the total one, and from the other side they say that the high cholesterol is not the culprit of heart problems but the spy that something bad is happening in our body. This is a little contradictory.
    So, knowing that 80% of cholesterol in the blood is produced by the liver and only the remaining 20% depends from the food, how is possible that leaving grains and going towards a low carb diet with high quality animal food, the cholesterol (depends by the liver yes?) is increasing so much?

    • Hi Aldos – I can understand your concern and why you find nutrition information contradictory. There is a segment of the population that responds to increase in saturated fats in the diet with an increase in cholesterol. Not everyone responds this way, but if you’re one of them, I suggest you focus on sources of monounsaturated fats like that found in olive, macadamias, and avaocados. Meats, butter, and coconut oil may not be for you. Work with a licensed dietitian in your area to refine your diet to suit your body. f

      • Perhaps I should ask for my tg levels, but I’m a thin 6’ 1” 175 lb male that has an active job and is active with projects at home. I’m starting to run a bit but used to run many years ago. I’m 35 and I only eat olive oil, coconut, or butter. I usually eat only whole grain bread but am cutting them out. We eat grass fed meat and a lot of chicken. We are going to up the veggies, but really I eat decently. I have had a thyroid test and it was normal I guess. My glucose levels are normal. My hdl is 59 and total is 277. I have sharp pains in my heart throughout the day and an odd feeling almost constantly. I do not sleep at all well and have had vitiligo for 10 years. I would not describe myself as a happy person and sometimes very dark. I’m making a lot of life changes to try to look forward to things in life and go on short runs. No idea how it will pan out, but is there a specific thyroid test I should ask my doctor about or something I’m missing?

        • Hi Johnmark – the ‘sharp pains in my heart’ comment above concerns us. Please have that thoroughly checked out by a doctor as soon as possible. You can work on tweaking diet and lifestyle after you’ve had that checked out. As for thyroid tests, most doctors start with a TSH test. Integrative medicine MDs run a few more tests because TSH does not give you a full picture. Some doctors like to run a T4 test (this is the hormone produced by the thyroid gland). T3 is a more metabolically active form of the hormone, so some doctors like to know what that is too. In some cases even that is not revealing. If you want to go deeper into the weeds, Free T3 and Free T4. And finally, you may want to rule out Hashimotos by checking for thyroid antibodies. So, there are several layers of thyroid investigation. Talk to your doctor about this.

  67. You are forgetting about the PCS9 protein. Too much results on the blockage of liver sensors and the liver produces cholesterol non stop!

  68. Thank you for the explanation. My blood test result today showed a cholesterol of 250; HDL at 51; LDL at 188; triglycerides at 99 and VLDL at 11. Could it be due to cheese, or cocunut milk and bread and eggs? please advise

    • Hi Samina – I suggest working with an Integrative Medicine MD to get to the bottom of the numbers. Some people (may be 1 in 5) respond to foods with saturated fats with higher blood cholesterol. Most people dont respond to dietary cholesterol. My advise is to work with a doctor. We are neither qualified nor authorized to go any deeper into diagnosis and treatment.

  69. Hello!
    Thank you for all the good information
    I was wondering if you have any thoughts about my blood test results. I am a 57 year old female.
    Cholesterol 246
    HDL 93
    Triglycerides 72
    LDL 137
    Thank you for your time,

    • Hi Peggy – I am not permitted to interpret lab results, as that would be practicing medicine. I can tell you this: I wish I had your HDL and Triglyceride numbers! As the article above says, total cholesterol is a mishmosh of both ‘good’ and ‘bad’ cholesterol, so it is a poor predictor of health outcome. HDL and triglyceride are both great predictor of health. LDL is a pretty good indicator even though it is calculated as opposed to measured, but it is also a complicated one – there are several types of LDLs (small dense versus large fluffy) and the LDL particle number (which you probably did not measure) is an far better indicator than just the calculated LDL.

      Estimating your health risk by focusing ONLY on cholesterol is like ranking a car based on its top speed or how comfy its seats are. There are lots of other things to look at – fasting glucose, A1c, hsCRP, homocysteine, Omega-3 index, thyroid levels, hormone levels, liver markers, and on and on. You can go pretty far down the lab test rabbit hole. A good doctor ought to be able to tell if you need additional tests to tease out the risk.

      In the meantime, eat lots of veggies, seafood, and olive oil – basically stuff that was alive last week. Walk a LOT. Sleep a LOT. Spend time outside. Hang out with friends and family. And do whatever makes you laugh.

      Good luck and keep us posted.

      • How important is fasting prior to a Lipid Panel being preformed? In January of 2020, I had my regular yearly check-up (I was 36 at the time) and my doctor surprised me with my first Lipid Panel test. She had asked me if I had fasted and of course I replied “No” because no one had told me to. It was a morning appointment and I had not had anything other than my usual morning coffee (more than modest amount of creamer) so she figured I would be ok to have the testing done.

        Here’s my issue. Although at the time I was slightly overweight, 182lbs and 5’6, my numbers came back pretty high. Total 300. HDL 54 (good, my one win!), LDL 204 (bad, might as well schedule the bypass surgery), and TGL 203 (terrible, I pretty thought I was going to die right there). I admit, I was not in the best of physical shape, however, I was still surprised at the high levels. Another factor that I considered is that we had just celebrated the holidays with my very German in-laws, and, as tradition, consumed a higher than normal amount of German sausages even taking some home with us, which I am sure I ate within a day or two of my panel.

        How much could the recent diet of German sausages and lack of fasting before my panel have affected my results?

        Fortunately, I jumped right on a diet and today I am 163ish lbs (still working on that). I haven’t been retested yet as we recently moved to a new state.

        • Hi Jen – I’d like to gently take your hand and walk you away from the cliff. 🙂

          Yes, your numbers are on the high side, but not high enough to think stuff like ‘might as well schedule a bypass surgery’ or ‘I thought I was going to die right there.’ That’s fear. I’m not telling you to dismiss your weight or lipid panel. I’m also not telling you to not to be concerned or do something. My point is that you may be more fearful than needed.

          Having said that, yes, you need to fast for at least 12 hours before a blood draw for a lipid panel. It’s OK to have black coffee before that, but you need to drink a lot of water about an hour before the blood draw. I drink about 20-24 ounces of water an hour before the blood draw. You might find that your numbers will be lower.

          As for German sausages (yum! cant say no to that.) a few days prior will not have affected your numbers much.

          Think big picture. And think long-term.

          Think of dietary changes as 3 different approaches – what, when, and how much. Most people tend to obsess over the WHAT.

          The ‘WHAT’ – Here are my suggestions for dietary changes:
          1) Cut out all forms of sugar – especially beverages with calories. Fat is not your enemy, so coffee with some cream is fine.
          2) Cut out processed foods and processed flour. Yes, this means no donuts, pizza, and any packaged foods that contain flour.
          3) Limit ‘healthy’ whole grains. You need to get your carbs from vegetables and fruits.
          4) Eat stuff that was alive last week – veggies mostly with generous amounts of olive oil, some eggs, seafood, poultry and red meat. But mostly leafy green veggies and some root veggies for carbs. Fruits, nuts, and dark chocolate are fine. Eat lots of avocados! Remind yourself that when nutritionists say ‘eat more fruits and veggies,’ that what most people hear is ‘eat more fruits.’ People tend to conveniently forget the veggies part.

          The ‘WHEN’ – this is a newer concept. Eat all your meals and calories during daylight hours, preferably within an 8-10 hour window. DO NOT eat late at night after sunset or after you’ve turned the lights on in the house. The reasoning behind this has to do with your circadian rhythm. The next step here would be to reduce that feeding window to 6-8 hours and fast for the rest of the 24 hours. And then if you’re OK with that, look into intermittent fasting.

          The HOW MUCH – well, that’s part of intermittent fasting. This isn’t just the old ‘portion control’ that we’ve been hearing about. This has more to do with eating fewer calories as a part of fasting than it does with eating smaller amounts at each mealtime.

          And there’s the thing about physical activity. Lots to say about that but this is not the forum for that.

          Hope all this helps. Come back and share with us how your numbers turn out.

  70. This is all good information! This is shedding new light & I do need to look under the hood carefully. I’m concerned about being on my statin drug at 58 yrs of age , female 123 lbs for the past 9 yrs. My stomach gained a lot of weight and I’m in pre-menopause. My current blood tests: Tri 82 mg, HDL 86, LDL 137 total Cholesterol 239. I don’t smoke, I drink red wine, I do eat red meat, fish, dark chicken. My other blood tests were good. I admit I have less energy & not working out regularly. My diet is good but could be better. Would love to get off the statins knowing risk factors they play. I would appreciate your good advice.

    • Hi Melinda – first things first: I am not a doctor, but a nutritionist and a chemist. So I cannot tell you which drugs to take or stop. That would be illegal. 🙂

      So, the question of statins is one you need to address with your doctor.

      Having said that, your HDL and triglyceride number (and their ratio) are enviable! Statins cannot improve HDL, so your HDL number was likely this before you began taking statins.

      If you’ve gained weight around the middle, then you need to get a much better understanding of your blood glucose (fasting, post-prandial, insulin levels, A1c etc.) to get a clear idea of how your body is handling sugar, juices, carbs, flour, and other white foods. I suspect you are already insulin resistant or inching towards it.

      Lack of energy could be related to a dozen things – deficiencies of some sort…could be B complex, D3 or a host of other things. It could be thyroid issues. Could be hormonal transition associated with menopause.

      Consuming meat is fine. Occasional red wine is fine. What I’d suggest (given scant info and insight into your diet) is to focus on sugar and flour elimination while increasing vegetable and fiber intake. Do this with a lot of discipline. Focus on whole foods (carrots, beets, plantains, sweet potatoes, and other roots and tubers for your carbs) instead of grains and flour.

      Eat stuff that was alive last week.

      Aim for 25 different veggies every week – this will be tough for most, but make it a goal. Focus on eating within an 8-10 hour window during sunlight hours and not eating outside that window. Exercise, well, you know what you have to do. Focus a LOT of sleep and stress management – these two lifestyle changes (sleep and stress) will help your immune system for pandemics present and coming.

      Focus on whole foods and don’t get caught up on vegan, keto and other distracting arguments.

      Food offers you 3 levers of control: what, when, and how much. I suggest you pull all three levers. Most get hung up on ‘what.’ But ‘when’ is a powerful tool for people with insulin resistance, especially if you graduate from time-restricted feeding to occasional/intermittent fasting.

      Good luck and keep us posted on how you do.

  71. I’m completely confused. I have never been overweight. Regular exercise. My BP is low. Heart rate, low. I don’t eat junk. I don’t eat meat. My blood test shows, good glucose level, High HDL, low trg. and high LDL 101, 57, 165 = 277. Not great. But, the family factor is weak, my father, maybe grandma. They were both overweight, never exercised. Immediately my doc. wanted to put my on Lipitor without even a discussion. Now, I’m seeing a card. because I want another opinion. I’m sensitive to meds. So side effects are a real issue. I’ve heard everything from muscle pain, liver damage and weight gain on Lipitor. Now what do I do? I’m frustrated by the instance meds and I’m scared too.

    • Hi Wendy – your numbers are not frightening. Not perfect, but nothing to be upset about.

      I suspect your doctor wanted you on Lipitor because of the family history. Statin drugs like Lipitor can wipe out CoQ10 from your body (part of the reason why some people experience muscle pain with statins) as well as block your body’s innate ability to convert Vitamin K1 to bone-protective K2. So if you decide to go on Lipitor, supplement with CoQ10 and Vitamin K2.

      Unlike your doctor, I am neither authorized nor qualified to give you medical advice. But you ought to look into CoQ10 and K2. Discuss those and other side effects concerns with your doctor. If your doctor is dismissive of the CoQ10 issue (most don’t know that statins interfere with K2 production, so they get a pass on K2), that is inexcusable as we’ve known about it for well over a decade.

      To a smaller degree, statins can reduce Vitamin A, D, E too. Again, discuss your concerns with your doctor.

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