Cholesterol: When to Panic

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

Controlling Cholesterol with Diet

Trying to reduce your cholesterol by avoiding eggs and meat is useless.

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, you will die.

Period.

So it would be foolish of your body to depend on your diet for all its cholesterol needs. And your body knows it. This is why your liver is in charge.

Your diet only controls the remaining 20% or so of the cholesterol coursing through your body.

All your dieting and cutting out meat or going vegan can at best reduce your cholesterol by about 20%. And that too, only temporarily.

If your body senses that you’re not feeding it enough cholesterol, 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.

So 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. 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’s an important finding!

But not a single TV show talked about this.

Just sayin…

When to Panic?

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

Should you panic at 250? 300?

You should never panic about cholesterol.

What you shouldn’t do is start preemptively taking cholesterol-lowering statin medications to pound and pummel your cholesterol number into double digits.

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

Right?

Wrong.

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 and enabling doctors preemptively popping statin drugs like candy is dangerous. 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 somewhere between 200 and 250 is not reason to panic, especially if you’re female and getting older.

Your total cholesterol number is not very revealing. Still, I am NOT asking you to ignore your cholesterol number!

It’s 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 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. (No, our legal dept. didn’t make me say that. I meant it.)
  2. If you have a genetic condition called familial hypercholesterolemia, you probably ought to be on statins.
  3. If you have heart disease or have had a heart attack, you probably ought to be 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 exercise and cut 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 often is just a symptom of metabolic disorder.

High cholesterol could be caused by:

  1. thyroid imbalance (usual culprit)
  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 supplementation could 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’s a key cause of inflammation? Yup, too much Omega-6 from vegetable oil consumption. I can never beat that dead horse enough.

The solution to most metabolic disorders:

…is not found in a pill. Wish it was!

The solution is a simple, whole foods diet exclusively of non-starchy vegetables, Omega-3 rich seafood, grass-fed meats, fruits, nuts and pastured eggs, all cooked in low-Omega-6 fats – olive oil, coconut oil or pastured butter.

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!

Sure, EPA Omega-3 is one of the most potent anti-inflammatories. But high dose Omega-3 supplementation only gets you half way there…what’s required is cutting out Omega-6, sugar and flour.

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 heart disease is slowly leading to a paradigm shift in how heart disease 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.

Disclaimer

This website is for your education and general health information only. The ideas, opinions and suggestions contained on this website are not to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or problem. Users of this website should not rely on information provided on this website for their own health problems. Any questions regarding your own health should be addressed to your own physician. Please do not start or stop any medications without consulting with your doctor. We neither encourage you to do so, nor can we be held responsible for the fall out of failing to seek the counsel of a medical health practitioner.

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Vin Kutty
Vin Kutty, MS, is co-founder of Innovix Pharma. He is a nutritionist, author, and Omega-3 expert with 20 years of experience.

Comments

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: http://goo.gl/LcTjy and also this one by Robb Wolf here: http://goo.gl/dbYti

      Don’t change a thing about your diet based on this study!
      – Vin

    • 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

  2. Hi Vin

    I really was intrigued with what I’ve read so far. I will be changing Dr.s. My Dr. said that
    my simple carbs was NOT the reason for my ldl being 161, my trigs are very good and
    my hdl’s are 67. I did eat a horrendous diet very high in sugar, BUT, because I’m Polish
    I omitted the red meat eggs, fats. I know poor recipe. I also just turned 50 and am female.

    Can I eat poultry instead of “grass fed meats?” or if you had a gun to your head would you suggest
    grass fed red meats?

    I also have bad genes………….

    Thanx
    Denise

    • 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. Hi Vin,
    Great article. I wanted to ask you a couple of questions.
    I just had surgery for my right hip (labrum replacement) and have been givin naproxen by my dr twice daily to reduce inflamation. I have read that taking fish oil is better than taking the NSAIDs is this accurate? If so how many Fish oil pills should be taken?
    Also, prior to surgery I did full blood work panel and my cholesterol LDL 281 try 15 and HDL 70 I am 38 and have been eating all grass fed organic chicken breast, some beef, almonds, bacon (low sodium), cheddar cheese, pasture raised eggs 2-4 whole a day and veggies. Lots of water an 1 coffee with stevia drops daily prior to blood work for 2 months. I do HIIT 5 days a week and was surprised that my LDL was so high. What do you suggest I do?
    Thank you…

    • 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

  4. Vin thank you for replying so quickly.
    Actually have no pain from the surgery but I am looking into getting omegavia fish oil to try. I am assuming that I should take 3000 mg per day? Also, my diet only had lactose from cheese as my carb intake. I do zero sugar or fruit. Oh and whatever fiborous carbs are in the veggies I consume. I began eating real clean about 3 months ago. Prior to that I was not eating anywhere near as clean and I was having a reasonable amount of carbs from all sources. So I wonder if my blood panel results are from prior eating? Might I have to wait a bit longer to see the benefits of lowering my LDL? Great video that you posted by the professor from USF.
    Thanks again for your help.

    • 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

    • 4000 mg of Omega-3 per day is fine. That’s how much I take every day. And it is the FDA dosage for reducing high triglycerides. But more is not necessarily better.
      – Vin

  5. Hi Vin,

    I am taking 4000mg of your Omega-3 per day for high triglycerides (200-400). My total cholesterol is in the 150 to 200 range, and my HDL generally runs low at around 25-30. LDL is surprisingly low in the 50-100 range most of the time. Could my relatively low LDL be deceptive? I have heard that high triglycerides can mask high LDL! I am currently taking two caps in the morning and two in the evening before bed. Sometimes I forget to take my night time dose. Would it be alright to take four pills in the morning, or is it better to divide the dose?

    Thanks in advance,

    Brandon

  6. I just wanted to say “Thank You!”! I was looking for the best Omega3’s because I refuse to pay for Lovaza anymore. And you think glaxosmithkline cares about people who CAN’T afford their omega’s? Of course they don’t, fortunately their patent is up in September. 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. Every blood test since I was 21, my body was in Olympic shape, was getting worse and worse based on the doctor’s recommendation of “stay away from all animal fats and eat only veggies and grains” as my cholesterol and triglyceride’s kept going up and up…a recipe for disaster! Both of my folks died at 55 because of the doctor’s recommendation of eating only grains and veggies. Because you speak the truth and you reveal and expose the others, I thank you a million times over. 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.

    • Rebecca – thank you so much for your feedback. We are truly humbled by your comments. We’re glad that you’re finding value (and truth!) in these blog posts.

      We have decades of ‘brainwashing’ to undo. We were all told to avoid animal fats and eat more ‘healthy whole grains.’ This didn’t help the national waistline. After years of research, I started cutting back on sugars and grains a few years ago. I also started increasing my saturated fat consumption. Yes, the stuff that’s supposed to kill us! Total cholesterol is a poor predictor of future risk. High LDL (bad) cholesterol is somewhat better predictor. Low HDL (good) cholesterol is 4-times better at predicting heart disease risk than LDL. Turns out that saturated fat increases HDL (good) cholesterol and carbohydrates (whole grains and sugars) decrease HDL. We’ve known this for almost 40 years! But it got swept under the rug during the cholesterol-phobic 80s and 90s.

      Here’s another video that you may wish to watch: http://vimeo.com/45485034 It’s by Dr. Peter Attia, lecture at Univ of California San Diego Medical School…and he talks about all these things.
      Thanks again!
      Vin Kutty

  7. just saying thanks , I am looking for info about high ldl 150- low triglycerides – high hdl I cant take cholesterol meds. (do not want to .) Take lots of fish oil . are these numbers dangerous ? Thanks.Shirl.

    • 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

  8. For Vin Kutty – I found your website yesterday after panicking because I have high cholesterol ! I enjoyed your article When to Panic. I summarize that it states not to panic if your cholesterol is over 300 but to “open to hood”. My doctor DID simply prescribe statin! When I heard about the side effects I was horrified. You say that the first step is to look at a possible metabolic disorder, perhaps a thyroid imbalance first. Which I plan to do, but with a different doctor. (That is if insurance will pay for it now that I’ve had my yearly checkup). I thought the end of your article would suggest I buy the product you sell, but it does not. Are you suggesting, in addition to the metabolic search under the hood that I cut back on Omega 6, etc, etc and improve my diet, no need for a fish oil supplement? Again, thank you for your easy to understand articles and you willingness to be honest!

    • 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: http://www.healthyguthealthylife.com/about-2/ (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.

  9. Hi!
    I am worried about having high triglyceride- 345 to 448 (from two differrent labs), Hdl- 44, LDL – 64, vldl- 79. I also have pcos and taking metformin twice for last one year.
    My diet has no animal fat, very little ( not more than one litre per month betwen two of us) ; vegetable refined oil- mostly Kardi, sunflower, soya , groundnut, and mustard by rotation. I eat lots of fruits and vegetables exercise in gym for 45 min per day . My doc says I should start finifibrate and atorvastatin! Should I ?
    I don’t want more medicines ! Please advice

    • 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.

  10. 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. I eat generous amounts of butter and ghee – dietary cholesterol consumption only increases blood cholesterol in 1 out of 4 people. Talk to your doctor about seeing where you fall.

  11. 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.

  12. 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 – pregnancy in itself is risky, but in your wife’s case, I would think the obesity has more consequences than the high cholesterol, although they probably are related, in that if you fix the obesity, the cholesterol will probably take care of itself. The issue I see is that your child will have much higher chances of becoming obese and/or diabetic even if he/she eats a perfect diet and exercises a lot. What your wife eats now will affect not only your children’s genes but your grandchildren’s genes. 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.

  13. I am 29. About 3 months ago, My cholesterol levels were:
    Total : 341
    LDL : 257
    HDL: 57
    TGL : 137
    My doctor scared me and asked me to go on Statins immediately. I bought the statins, but decided not to take them. Made some changes in my lifestyle. Not too dramatic. Just a slightly better diet. More fruits and Fibre. And moderate exercise. 1 mile running, and basic strength training, around 3 days a week. Yesterday’s test results were :
    Total : 303
    LDL : 217
    HDL: 65
    TGL : 103
    I know, this is still not good, but in 3 month my LDL has come down 40 points. Which is great, and guess I am on the right track. What worries me though is that my blood glucose levels are slightly higher from 91 to 97. Within range, but still. Is it the result of having more fruits? do you think I am on the right track, or with my numbers do you think it may be a genetic disorder?

    P.S. My father had a moderate heart attack at 43. Although he has been healthy since.

    • 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.

  14. Hello Vin,

    Thanks for this article, very informative and i appreciate your guiding people like me looking around this topic.
    I did however want to clear, as i’m little confused and first timer in this cholesterol scenario.
    I’m 40 yrs male and usually had around 200 cholesterol (as i check every year) but this year (a few days back) it was approx 290. I have a basic life style with less intake of fats, calculated intake of polutry meat ( half kilos a week but not any fish) , i take salads, black tea, and 2 serves of alcohol per day. I brisk walk for 1 hour daily.

    I wanted to ask if:
    1. Taking cod liver oil capsules / fish help me reduce the same
    2. Will Wallnut / almonds help
    3. Should i go for Olive oils while cooking

    I do not want to take medications at this stage / age. Let me know how you see my situation, please.

    Thank you

    • 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.

  15. My total cholesterol is 250 and my hdl 59,triglycerides 59 ,LDL 159.my question is,is there any reason why is high when last month was 160,60’and LDL 84?

    • 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.

  16. “All your dieting and cutting out meat or going vegan can at best reduce your cholesterol by about 20%. And that too, only temporarily.”

    Hogwash! What do you guys do, copy from each other’s websites?

    Three years ago I went on Dr. Esselstyn’s no-oil vegan diet and cut my LDL-C from 134 to about 60–a reduction of 55%. Today, it’s still 67 or 50%.

    I don’t know where you guys come up with this stuff.

    • 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.

  17. I appreciate your comments, Vin. However, the Esselstyn diet is not a zero fat diet–it runs around 10%. I use a tablespoon of ground flax seed once or twice a day over a giant salad along with nutritional yeast and a B-12 supplement. Another 2 spoonsful of powdered cocoa I use for vasodilation effects has 50% fat. And don’t tell Dr. Esselstyn, but I do occasionally eat some peanuts, which have thousands of times more omega-6 than I ought to be eating!

    I also now know my particle size, which is alarming. So, I asked Dr. Esselsytn what his patients’ typically are. His response was that he never had them checked. As long as what passes between your lips (no oils or animal products) don’t damage the endothelium, it doesn’t matter. He has a study to prove it. So, now my “alarm” is a mere curiosity. “How do vegans like me compare with the norms established for non-vegans vis-a-vis particle size?” And “How does our ‘no-oil or animal products’ diet compare to the reversal of atherosclerosis in others?” I know of no studies that show reversal other than Esselstyn’s and Ornish’s.

    • 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.

    • 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.

  18. Vin, I’ve observed that Dr. Esselstyn’s diet evolved with the times in light of newer knowledge. His first study was not as restrictive with regard to caffeine, yogurt, sugar and fructose, yet reversed CAD anyway, so I don’t think those are the major reasons for its success. You just know that blood sugars ran too high for many of these folks while they were eating whole grains like brown rice and oatmeal, but checking post prandial effects is never mentioned in his book. He often cites the Vogel studies on lingering brachial artery impairment after a fatty meal as the reason the endothelium becomes vulnerable to plaque formation. Now there’s evidence carbs impair it too. Apparently, to me at least, the oil and fat in the diet is the major player here in view of the carbs allowed on Dr. Esselstyn’s diet.

    As to “markers” in the blood, what good is a high HDL if it’s only in response to the liver’s attempt to mop up the excess LDL caused by bad eating? What about the efficiency of said HDL? The vegans on Esselstyn’s diet had low HDL on average, I’m sure but very efficient ones.

    Particle size is an interesting marker to me because I can’t find a study where the sizes are compared between the different types of diets: 10% vegetarian low fat, and standard (or non-standard) American omnivore diets. If you can point me to one, I’d appreciate it.

    • 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.

    • http://jn.nutrition.org/content/134/10/2517.long

      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.

  19. Thank you, Vin. Now I have a lot of new terms I have to look up!

    One thing that stands out to me is that this is a study of high-fat diets with respect to Dr. Esselstyn’s diet–an order of magnitude three to four times as much actually. His point is that eating that much fat causes the endothelium to be perpetually vulnerable, since additional plaque-causing agents from the next meal or snack enter the blood stream before the endothelium can regain its protective shielding capacity.

    So, if I were eating such a diet, it would help to know how to minimize the damage as shown by this study. On the other hand, Esselstyn’s diet is only 10% fat and has been shown to arrest and sometimes reverse heart disease. I’d be more interested in a similar study that compares Esselstyn’s diet to these and the clinical results of the same regarding atherosclerotic events.

    • 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.

  20. I believe the Vogel study referred to by Dr. Esselstyn to was done in 1997–long after Dr. Esselstyn’s initial study of five years was complete. It apparently compared a meal of “plain cornflakes”at McDonalds with a “high fat” meal of the same calories from their menu. So, the Esselstyn diet in no way was “based on” Vogel’s work. It’s based on eating the same things that are known not to result in heart disease in other cultures.

    • Thanks, Dave. I look forward to reading this. I’ve only scanned the abstract so far. The opening sentence about plant-based traditional cultures caught my eye. I’ve been traveling through Asia and Middle East for the last several weeks, talking to both cardiologists and regular people about their current diets and their ancestral diets (what their grandparents ate.) I’m very disturbed by the trends in most of the countries – sugar and processed grain consumption is through the roof. Lots of obese kids. Many of these people are finally no longer poor and can now afford junk/fast foods. General Mills, M&M Mars, Pepsico etc. are marketing aggressively to them. The ex-poor people want to be seen eating junk food and driving cars because there is a social status message being conveyed to others. Parents (even doctors!) are encouraging their kids to eat Kit Kat and drink Pepsi. Having said that, most of these people ate a very balanced and healthy diet as recently as 30-50 years ago. There are quite a few vegetarian cultures, but most of them considered fish to be a ‘vegetable of the sea’ – a concept that I find amusing yet brilliant. Their traditional diets are low in meat, but all coastal cultures ate a lot of fish and coconut oil or palm oil. Quite a few plant-based diet cultures, but none in Asia are exclusively plant based. I’ve done the same thing in Africa and South America as well and there are none there either. While an exclusively-plant based diet may be superior to all of these, we cannot point to any traditional cultures as examples. Veganism is without a doubt a modern concept, not a traditional diet. The most strict vegetarian culture I’ve met are the Jains of northwest India but even they rely heavily on full-fat dairy. A few coastal cultures give fried fish heads to pregnant women and children. Even more brilliant! Fish heads are full of DHA. The cardiologists I spoke to felt such practices were ‘backward’ while giving his kid two KitKat bars at dinner time. He also felt everyone ought to be on statins. I am shocked by the amount of sugary beverage consumption in the Middle east. They seem completely unaware of their impending diabetes and heart disease explosion. When the doctors are clueless, it is time to worry.

  21. Hi there, I am 32, 6 months pregnant with normal weight
    I just had a blood test an cholesterol came back very high. LDL 180, HDL 91, with Triglycerides at 130.

    Everything else was in the normal range, but should this be a cause for alarm?

    • 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.

  22. 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.

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

  24. I am 36, Male and Vegetarian
    My CH values are : Aug 2014/ May2014
    TC = 284 / 275
    LDL = 204 / 184
    HDL = 49 /43
    TG = 210 / 251
    For the last two months I have been eating mainly Aloeveera Juice, Amla Juice , Flex seeds, Wallnuts , Fruits , Daliya and very light dinner in olive oil but still not much change. I am worried. what I should I do.

    Apart from this there is unbalance in Liver profile
    GGT – 98
    SGPT – 57
    ( I used to consume alcohol 2 years back but not now )

    • 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.

  25. Hi Vin, I am concerned because my doctor told me my Glycemic number was “prediabetic” at 106. I am a 53 year old male, 6’2″ and 177 pounds. Her label scared the living hell out of me. Eating a NO sugar/No flour diet is so hard, you cannot believe it. My cholesterol was also high: Total-234. The year before it was 189. Triglyerides were 106, HDL was 56, and LDL 157. Cholesterol/HDL Ratio was 4.2 and non-HDL cholesterol was 178. Please help me understand how much trouble I am in? Do I have to completely give up dessert? Pleasse advise and thank you. Best, Zandy Campbell

    • 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.

  26. Hi vin I have been really scared that I am gonna die from high cholesterol…..6 years ago my cholesterol was 285 in 6 months of diet and exercises I got it to on 220 and the dr wasnt worried anymore and my trglicerides were 200 from 380,..and I was sober from alcahol about 2 years when this was all happening….I am 38 and my diet fell apart 3 years ago and its up to total 256 and trigliceridesare 239 but I ate alot of ice cream all l week before test,, now I am having a baby with my fiance and I just keep thinking am I gonna have a big heart attack or something..its hard now wn to eat right and it has been 2 months since test and the nurse said that triglicerides wont change that easy and come back in 2 months if still high medicine is an option….I really think I had high cholesterol in the first place from being a serious alcaholic and now sober along time please shed some light on me

    • 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 4000 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.

  27. 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.

  28. Hello Vin,

    in my last check up, I have found out these results:

    T.cholesterol 321
    LDL 208
    HDL 43
    Triglycerides 367
    BMI 26.6
    GGT 57
    ALP 97
    ALT 48
    AST 32
    I am 29 years old. My diet before the test was 85% fast foods. now after the test I stopped the fast foods and started being almost vegi. I stopped red meats and any fried foods and i am concentrating more on fruits and vegetables and wholegrain and started walking 30 mins a day.
    I have not visited a doctor to discuss it yet.
    am I doing the right thing?

    looking at the numbers, what do you suggest?

    Thank you.

    • 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.

  29. My dad got
    t.cholesterol 324.9
    hdl cholesterol 55.6
    ldl cholesterol 192.3
    Vldl cholesterol 77
    s.tryglycerid 384.8
    ratio 5.84
    he is smoking and drinking alcohol as well. I am do afraid of him now. Can you please tell me is this levels should be highly concerned or not?

    • 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.

  30. 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.)

  31. 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.

  32. Thank you so much for your respond!
    I’m 50 and new to high cholesterol, 270, and looking for alternatives to just prescibed medicine. I’m from Southern Europe and still following Mediteranean diet here in the States. For example, no juices or soda, of course, only water or mineral water. Back home people are big on buckwheat and hulled barley theese days, so I’m thinking of replacing wheat with them. Hope that’s ok. Would you include blond psyllium in you diet to lower your cholesterol?Thanks again for keeping up with your web site, truly great info….

    • Hi Sanja – if buckwheat or barley helps you with transitioning away from wheat, you can try it. I certainly won’t be trying it. I am not focused on or worried about cholesterol. I focus more on inflammation, blood glucose levels, and gut health (permeability, microbiome, etc.). So, no, I don’t recommend psyllium for reducing cholesterol. However, psyllium has some soluble fiber that could help support gut bacteria populations.

  33. Vin,
    I just wanted your opinion on some extreme changes in my cholesterol levels and what tests/levels I should also want to request from my doctor. I have had three cholesterol tests in the last ten years. The results are:
    June 2006 June 2010 June 2015
    HDL 33 49 43
    LDL 187 151 336
    TRI 131 133 96
    Total 246 224 398

    Obviously I am extremely alarmed by this number. in 2007 did a stool test with enterolab that supposedly showed very high levels of gluten and dairy antibodies as well as soy. Would not adhering to a strict diet cause enough inflammation to warrant these LDL numbers? I must admit I have dietary lapses where I eat both gluten and dairy, the last 4 years more than previously. My most recent cholesterol test was taken after I had not eaten hardly anything for five days due to stomache problems. Would eliminating dietary cholesterol effect LDL production in the liver at such an accelerated rate? I also had my triacylglycerol lipase checked in 2006 with a level of 110 (my understanding being low levels could indicate hypercholesterolemia). My PA wanted to start statins ASAP of course but should I get another lipid test done first? Would a machine or human error result in my ldL being wrong? When I asked my PA about these things as well as my LDL particle number and LP(a) level he looked at me with a combination of surprise and disgust, then told me he would refer me to his supervisor who is an actual doctor, he refused a referral to see an endocrinologist. Any thoughts would be appreciated.
    alex

    • 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.

  34. I have been reading your post and I just got my blood tests back… My cholesterol went up over 10 months from 203 to 250. I am 49 yrs old and have been on medicine for it for 10 yrs now.. My doctor says its hereditary because my father died with a heart attack when he was 44 and they assume that he had a lot of these issues.. He didn’t go to the dr , it has been 46 yrs since his death and as you know people didn’t just go get checkups back then. So I am also on medicine because I have an irregular heartbeat,Pvc’s… And I am on medicine for osteoarthritis… I have inflammation..i have stomach issues.. on nexium for that.. I would love to come off of some of these medicines, just don’t know where to start.. My diet is ok.. I know you say stay away from wheat, so you mean cereal also.. I thought switching from just say a sweet cereal to a healthy one, like Wheaties, would help my cholesterol.. but it seems no matter what I do, I feel like I’m having more problems, more inflammation, and joint pain and more stomach issues.. I eat like a wheat toast and 2 slices of bacon for breakfast or cereal. Sometimes a fried egg with wheat toast. For dinner I eat like a baked chicken or pork chops, a starch and vegetable. the way I was taught for a balanced diet.. we do have hamburger meat sometimes, tacos, hamburgers, spaghetti. And I do eat a snack a day with coffee. Not 3 or 4 snacks.. I was using artificial sweetner, but I stopped that.. I’m not sure what I’m doing wrong, but I would love to come off some of these medicines.. But my thinking about eating a balanced diet is not working.. so when u say no grains, u mean no rice, no potatoes, no starchy foods.. I’m just alittle confused.. I thought about talking to my rheumatologist about coming off my meds and trying something all natural. I see where you posted that omega-3 oil may help with inflammation.. I think I read that, I have read so many post of yours, lol.. but can you give me some advice. I know you are not a doctor but any input would be great.. thanks

    • 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.

  35. hii. i got my lipid profile back(it was just a general checkup). my cholesterol is at 300. triglycerides level at 673 and HDL at 39. my age is 21. Any good advice?

  36. Hi Vin,
    My husband just got his numbers and he is at total 250 and bad 160, our doctor has not prescribed any statins. I too thought that whole grans, less red meat, chicken breast only (no skin, he hates that) no soda, was the way to go, but after reading I don’t feel I have a handle on what we need to do for our future health. It makes me feel a little hopeless. Do you have a book or can you recommend a book with recipes and such so that I can help him and my own cholesterol? Thanks so much!

    • 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 Vin,

    I am 30 years old pregnant woman. 160 cm/ 45 kg before I’m pregnant and always healthy lifestyle for my entire life. Now I am 6 months pregnant (second pregnancy), my weight now 52kg and for the first time i checked my cholesterol total is 342!!! I was shocked. This week constantly i feel more tiredness and some heartburn feeling annoyed me, so i do a lot of bedrest. I might think this is the effect of pregnancy (some references saying pregnancy can cause higher cholesterol). I admit it since this pregnancy i eat everything, craving for some unhealthy food stuff. This is my first cholesterol check ever in my life, Should I worry or should i not?

    • 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. Recent labs;
    Chol 251, Trig 97, Hdl 74, LDL 158, AIC 5.2, FBS 98. Should I be freaked out? about LDL & Chol,& FBS? I have been minimizing most grains since July 2014, also eliminated sugar, honey,maple syrup. I do use some Just like Sugar (zero carbs)& erythitol. I had already decided to eliminate all grains 1/1/2016 since I still was dabbling in corn & rice. I still allow portion control potato. I use olive oil, coconut oil & ghee only. If you have any guidance I would appreciate it. For me statin drugs are not an option.

    • 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. My Triglyceride is 68, HDL 90 and LDL 196. I don’t want to go on statins advised by my doctor…I am post menopausal and starting on bioidentical cream. My diet is average. Do you think my numbers are of concern…and would omega 3’s help?

    • 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, I’m 29 and was told recently by my dr my cholesterol was a little high at 229 and my hdl was 34 so low.. my trigs are 144 normal range I was told. my dr put me on simvastatin 10mg last week. I have not been able to take them because honestly the side effects and stories I heard freak me out. I was told to go on a low fat/low cholesterol diet. No one will tell me anything other then I need to get those numbers down work out more and get away from red meat. my dr said eat more fish fruit and veggies no diary and to eat multi grain breads and cereals if I need to an oatmeal okra spinach (I don’t like any of this besides cereal)..I am honestly lost in what to eat or avoid. This probably isn’t the right place to get advice for my comment but any would be helpful i’m scared out of my witts and been scared with every single thing I put in my mouth. Am I suppose to never eat dairy and beef ever again???..I ride a exercise bike 30mins a day plus alot of core exercises for a back problem daily. last month I was out of commission for a month. So I didn’t do that at all could that raise your cholesterol not working out for a month when i’ve done it 6 days a week for the last 3 years? I know I need to cut out sugar an stuff. but one site tells you eat multi grains and one site tells you not to??

    • 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. I have RA and so already inflamitory issues, in addition to that they put me on RX Xeljanz which increases Choles #’s. My tital chol was 284 my hdl 34 my trig 185 and my LDL was 194 (thats the one that scared me) they put me on Lipitor, but I would rather go off that. I have added more fish and almonds to my meals, I have cut back on Red meat and i try to limit all my carbs.. anything else I can do? I love this article.

    • 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: https://www.amazon.com/Autoimmune-Solution-Spectrum-Inflammatory-Symptoms/dp/0062347470/

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

  42. I’m a 54 year old female and just had my cholesterol checked .
    Cholesterol -314
    Triglycerides -154
    HDL-47
    LDL-236
    My dr told me to start taking lipitor, I don’t want to do this with medicine. With my numbers is there any chance I can change them with diet and exercise? I’m 5’4″ and weigh 145, a year ago I weighed 130 , started eating junk food again and gained 15#. My cholesterol numbers last year were
    Cholesterol -265
    Triglycerides -93
    HDL-49
    LDL-197
    I’m so scared that I’m going to have a stroke or heart attack, and feel like my life is out of control. Please tell me what I should do.

    • 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. I’ve just received results that concern me … I am 57 exercise nearly every day…. my hdl 107, my ldl 167 and my triglyceride 86. I’m in panic mode … thoughts?

    • 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.

    • HI Carol – there are a couple of studies that suggest krill oil can reduce triglycerides. Results of cholesterol reduction has been positive but less 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.

  44. Hi I am 54, post menopausal, with total cholesterol 285, hdl 92, ldl 174, and triglycerides 95. The ldl level is down 20 points from one year ago due I hope to weight loss. I know my doctor will probably want me to take medication, it’s just what they do here. Is it necessary? I take omega 3 when I think of it, which is not often.

    • 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.

  45. Dear Vin, I hope you are still looking at these post.

    I’m a fairly healthy 55 yr. old woman and have never known of a problem with my cholesterol. I just had a blood test which resulted in the doctor calling to tell me that I need to be on Statins. Without understanding anything that I just read in your post or by the comments you’ve made to others, I told him, “No, thank you” knowing there must be a better way. I have been eating mostly organic veggies, mostly organic meats, hardly ever any processed food (occasionally mayo or mustard, or if I eat out – who knows?) and lots of good fats (coconut, olive, rather than the bad oils. I know I deal with a lot of stress and have a lot of inflammation in my body. Becuase of this I did try the ketogenic diet for about a month, which did help me feel much better, I had more mental clarity, and it did away with the arthritic pain I was beginning to feel in my hand, and much of the back muscle pain that I’ve had for so long. But because of the extremely low carbs, I felt like I was drying up and couldn’t get enough water, and because many on this diet have documented that they often have low potassium and magnesium on this diet, I didn’t think it was a good thing to continue as a lifestyle. I was off the diet for about 6 weeks before taking the blood test, although I have continued using sugar alcohols (Xylitol and Erythritol) in place of honey or raw sugar in my coffee and for a sweet substitute. I am very concerned that my cholesterol is so high, Yesterday’s results were:
    Total: 278
    HDL: 91
    LDL:176
    TRIG: 53
    NON HDL: 187 Whatever that is?
    I would appreciate any thoughts or any advice you can offer. I found your article very helpful and I appreciate the time you’ve taken to help others. You’ve been very professional when answering difficult questions. Thank you.

    • 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: http://omegavia.com/omega-3-blood-test/ I’ll say this: I’d love to have your HDL and Triglyceride numbers!

  46. Hi I recently got a blood test and the results came out
    LDL: 108
    HDL: 180
    I’m really scared I’m 20 I’m afraid of what to put in my mouth now I’m a skinny person I don’t know what route to go

    • 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.

  47. I tested my blood cholesterol (Age: 33 years)

    LDL : 330 mg/dl
    HDL: 38 mg/dl
    Triglycerides: 200 mg/dl

    I was eating too much cheese and oily foods and I have heart disease common in my family. Dr. suggested to take 40-80mg of statins and aspirin and change Diet to Plant based.
    What do you suggest?

    • 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.

  48. Hello Vin,

    Here is my status from Lipid Profile
    Total Cholesterol : 321 mg/dl
    LDL : 245 mg/dl
    HDL: 38 mg/dl
    Triglycerides: 191 mg/dl

    I am a Vegan and have a Family history of of Heart disease, Diabetics and Hyper tension.
    I am now 31 and and am worried by looking at these numbers. How do I determine if the issue is due Genetics and what are the precautions to be taken in future.

    • 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.

  49. Hello Vin,
    I am a 60 year old female, 5’9, 125 pounds. Active.
    I have been a non meat eater for 43 years, I do still consume fish occasionally.
    My diet is mostly vegetables with fruit, dairy and whole grains in moderation.
    I have always had perfect blood studies, text book but not today….
    My blood work came back today with cholesterol @222, ldl @ 140 and gloucose @ 103. My hdl is 63 and my non hdl is 159 .
    Cholesterol/ hdl = 3.5.
    I’m in shock and really confused. Why are these all elevated?
    I also suffer from panic disorder very badly and have been having a real,problem with it the past month, could my stress be pushing my reading?
    I’m so upset about these labs , I cannot even begin to tell you, I have always worked very hard to maintain a healthy life style. No smoking, very little alcohol, never any drugs ( no fun at all) so these studies have me not only upset and concerned but actually a little mad, I mean why I said this happening?
    Thank you so much for any light you could shed, I’m sure my Dr. will recommend drugs, she tends to do that for everything, which I refuse.
    The only medications I take imitex for migraines and Xanax for my panic disorder , both only as needed.
    Thank you again.

    • 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.

  50. Hi just happened to find this web site. I am a wreck. I am 58 years old and had complete blood work done. She took 6 viles of blood. All come back great. But HDL is 40, Cholesterol 270, Triglycerides 290, LDL 172, Cardiac Risk Ratio 6.8 and non HDL Cholesterol 230.

    I just can’t believe it. I eat red meat maybe once a month. I do not eat fast foods at all.
    I do have 3 cups of coffee a day with 3 sugars in it. I do walk and I weigh 125 lbs
    So doctor called in a prescription for Atorvastatin. The day I went to see her I had no idea she was going to do this blood work. I went to see her because I was very tired and thought my Vitamin D was low like last year. So that morning I ate eggs, had coffee with sugar, went to lunch and had Chicken & Broccoli in a cream sauce and had icecream ect ect. then had all this blood work. I really don’t want to take this pill but I feel like my numbers are a death sentence.

    • 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.

  51. I would just like to comment that about 3 yrs. ago I had gone to see my doctor i wasn’t feeling very well in addition i’ve added about 30 pounds and at that time weighed 160 pounds & 5 1′ in height …I had blood work done and came back with high cholesterol 599, (I was a walking heart attack)…he wanted to medication (simvastatin) first thing I asked was “how long do I have to take these meds?” he said for life and there isn’t anything you can do…well I told him to keep the meds. I’m not taking them! The very next day I had gone to see a nutritionist put myself on a diet and started exercising my butt off mostly walking walking & walking nothing insane…I lost the 30 extra pounds and my cholesterol! I truly believe it’s all about how and what you eat and exercising even if it’s just walking. I never thought it was going to work out the way it did and not saying it’s for everyone but I wasn’t going to have a doctor tell me there was nothing else I could do but take meds for the rest of my life and be done with. I’m 53yrs. old and not as active as I once was so yes I still watch what I eat and try to walk as much as I can everyday.

    • 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!

  52. my cholesterol has always been a bit high around 250 and my HDL is good and ratios good and low triglycerides so I was not concerned…went on a vacation…cruise and visiting family for 5 weeks…came home with an ear infection…had some blood work done about 5 days after I complete my antibiotics (which I never usually take) my cholesterol came back at 305! HDL was 75 triglycerides 119 LDL 206 OMG can it really go up that fast?? I did not do much exercise on my trip…I Plan on bringing it down naturally….how can it have gone up so much in 5 weeks??? any suggestions?? i am in my 60’s do have a bit of low thyroid, take thyroid…..in good health I thought….. thank you

    • 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.

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