I have high cholesterol, and I don’t care

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  1. Ellen@BodyEarth’s avatar

    What a fantastic video presentation!  Your information about Lp(a) measurements in the more informative nmol/l is good to know, as are  your recommendations for tests and where to have them done.  I hope to link to this post sometime soon.  Thanks!

  2. Hans Keer’s avatar

    Very nice way of presenting the cholesterol myth. Taking your Vap-test results as the basis was a good idea. It is a shame most doctors do not yet know, what you presented here. I made a video that goes very good with your video. It looks at the matter, more form the standpoint of preventing and curing atherosclerosis and thrombosis. VBR and Thanks for the info.

  3. Matthew’s avatar

    Great videos,very informative.  I’ll definitely share them with my friends and family. I Just had one issue that maybe you could help me clarify. So I understand that there’s no correlation between cholesterol in the diet and heart disease. But there is a correlation between certain types of cholesterol in the blood and heart disease, like high levels of the small, dense LDL are connected to an increased risk of heart attacks.  So then what causes your HDL, and two different types of LDL to increase or decrease? The cholesterol in your diet doesn’t necessarily effect the levels of these different types of cholesterol in your blood right? I believe you addressed this in your cholesterol series, I should probably go back and read it. But is it right to say that cholesterol in the diet doesn’t effect heart disease but certain levels of certain types of cholesterol in the blood can lead to heart disease? Thanks a bunch!

  4. Chris Kresser’s avatar


    Carbohydrates increase small, dense LDL and triglycerides, and decrease HDL – all risk factors for heart disease.

    Saturated fat does the opposite: decreases small, sense LDL and triglycerides, and increases HDL.

    Cholesterol in the diet has no effect on 70% of the population.  On 30% of the population, it raises large, buoyant LDL (which is not associated with heart disease).  The reduction of small, dense LDL via egg consumption may be due to saturated fat rather than cholesterol, particularly in the non-responders.

  5. Bobby D’s avatar

    What a load of crap.  I can’t believe you people buy into this bullshit.  I well-worded article and slick presentation cannot undo decades of well-research facts.  This type of garbage is doing a disservice to everyone who is gullible enough to buy into this stupidity…but I guess that ‘s Darwinism in action.  Keep up the good work.

  6. Chris Kresser’s avatar

    Keep on believing the myth, Bobby. The “well researched” facts you refer to don’t exist.

  7. Sean’s avatar

    I think the author of this article is absolutly wrong.  He/she should read:  The China Study, by Dr. T. Collin Campbell, and Dr. Esselstyn’s:  Reversing Heart Disease, additionally, Dr. McDougle and nutritionist Novack vehemently disagree with the conclusions by this author, whomever it is.

  8. Chris Kresser’s avatar

    I’ve read the China study, and it is horrendously flawed – as many have pointed out. Read this for a start.

    I don’t care who has what opinion. All I care about is what the research says. Good research, not the confounded, sloppy, drug-company sponsored hogwash that paraded as research for decades. Everything I said in the video is backed up by extensive research published in major peer-reviewed journals. You can read all about it in my series. It’s all there. Read it and then tell me that cholesterol and saturated fat cause heart disease. You won’t have much ground to stand on.

    You can mention a few doctors who, not surprisingly, believe in the mainstream hypothesis. I could mention several others who don’t. The fact that a hypothesis is mainstream does not make it correct. As Anatole France said, “even if 50 million people say a foolish thing, it’s still a foolish thing.”

  9. Chris Kresser’s avatar


    You can also read this fantastic article just published:

    Recent Cholesterol Lowering Trials: New Data, New Questions

  10. Jamie Scott’s avatar

    That is an outstanding presentation Chris!  Well done and thank you for taking the time to post such a brilliant resource.

  11. Todd S.’s avatar

    @Bobby D
    No, “Darwinism in action” would be what we (you) have been doing to ourselves for the past half century by listening to the advice that has has us abandon what we’ve been eating for the past thousands.  Is it really coincidence that diabetes and heart disease rates have skyrocketed after embarking on our low fat, high carb craze?

  12. Alan’s avatar

    Your video presentations on  the cholesterol myth were great.  I am very interested in having the VAP test done, but the website you mentioned (http://www.privatemdlabs.com) does not do business in three states, (NJ,NY & RI) because of some billing laws. I live in NJ and would like to get the VAP test.  Do you know of any other way for me to get it done without asking a doctor?  I am working with a good doctor now who would probably do it if  I asked, but that means I have to schedule another appointment which is costly. I was hoping to do it online by myself.  Any suggestions would be aprreciated.

  13. Chris Kresser’s avatar


    You can order it from Direct Labs.  They also provide tests without a doctor’s order. It’s a division of Lab Corp, however, which Private MD Labs is also affiliated with – so it may be the same story.

    You can also try Health Check USA.

  14. Brian’s avatar

    Good job with the videos, they are good quality and easy to listen to.   Fat has been given a bad image for quite a while, it’s time to get over that.
    I don’t believe that there is something inherently problematic with carbohydrates, quality (i.e. processed vs. unprocessed) seems to me to be the most important factor.  Cultures have done well on various  macronutrient ratios but those that stay away from refined foods are much better off.  In particular, tubers seem to be well tolerated by many without the issues that some people have with grains.  Fruits are also highly nutritious carbohydrate sources.

  15. Chris Kresser’s avatar

    I agre that whole-food carbs are not necessarily atherogenic.  However, when Americans are told to go on a low-fat diet, they do not replace saturated fat with sweet potatoes and blueberries.  They replace it with bread, crackers, pasta and other highly refined and processed carbs.  This of course is the main problem, as you suggest.

  16. Tyler’s avatar

    Thanks for the well done presentation Chris. I wish more people would take this advice and information seriously. 

    I’ve also been enjoying your podcasts recently. Keep up the good work!

  17. Chris Sturdy’s avatar

    I shared this out on facebook and twitter. We’ll see if any of my friends give it a look. It’s nice to have someone besides me supporting the “fat is not the enemy” anti-conventional wisdom  side of the argument.

  18. capmikee’s avatar

    Hi Chris,
    I’m glad to see you experimenting with different media and overall it’s a great presentation. But I have a problem with your speaking voice – I don’t find it very engaging! I was excited to see your earlier podcast with Stephan, but I couldn’t get through more than a couple minutes of listening to your voices.
    I don’t think it would take much to liven it up – you’re clearly intelligent and well-informed and the only thing lacking is a stronger connection with the listener. I imagine that you’re visualizing an individual listener when you speak, but maybe if you tried addressing an imaginary roomful of people you could put some more life into it. Step back from the microphone a bit and don’t be afraid to speak up.
    It sounds like you’re reading – maybe having some notes more roughly sketched out rather than a fully-written text would help bring some spontaneity. Alternatively, you could rehearse your text a few times so you can speak parts of it from memory.

  19. Moises’s avatar

    Great work, as usual, Chris.
    For those who do not wish to go through the trouble or expense of measuring their LDL subfractions, an alternative is available.
    Take your triglyerides divided by your HDL cholesterol. If this ratio is less than 3.8, you are likely to have the Pattern A, beach balls. Greater than 3.8 is not good, and you need to look carefully at your diet.
    TG/HDL < 3.8 is Pattern A–good!
    TG/HDL > 3.8 is Pattern B–bad!
    see also:
    I tried to explain this to my doctor, when he told me I need to start taking Crestor (a statin). Needless to say, I declined his offer.

  20. Chris Kresser’s avatar

    Thanks for the feedback, Capmike. I appreciate it.

    I’ve struggled with the podcast and screencast format for exactly the reasons you describe. I find speaking to a live audience much easier, because I can connect directly with people and there’s an exchange of energy. Sitting in front of my computer looking at a screen doesn’t do it for me. I use a headset mic, so there’s no stepping back from it at this point, but maybe standing up and moving around the room a bit would help. I use a lot of body language when I speak to live audiences, so perhaps integrating that into my podcasts and screencasts would help animate my voice. (It certainly does when I speak live).

    I did have the major points of the talk memorized, and I wasn’t reading, so I think it’s mainly just the lack of engagement that’s the problem. Thanks again for your suggestions. I’d like to make this format work because I’m going to have less time for writing long articles very soon.

  21. Chris Kresser’s avatar

    Great suggestion, Moises. This is indeed a good option for those who don’t need or want another test.

  22. Baba Ghanoush’s avatar

    Thanks for the very informative videos! I have not made up my mind on the issues addressed, but appreciate your well-reasoned viewpoint.
    Btw, I have no problem with your voice, but the captions on the first video are a riot!

  23. Baldur’s avatar

    Great videos!
    In my experience, 95% of those who post negative comments on these statements are vegetarians or statin pushers who are scared sh**less by the prospect of the truth coming out to the general public.
    However I wouldn’t advocate eating lots of bacon too fast. A recent meta-analysis by Harvard scientists (http://www.hsph.harvard.edu/news/press-releases/2010-releases/processed-meats-unprocessed-heart-disease-diabetes.html) indicates that eating too much processed meats (sausages, bacon, deli meats) can raise the risk of heart disease and diabetes.
    On the bright side, there was no association of unprocessed meat consumption with chronic disease. It’s not about the fat or red meat people, and hopefully scientists will not make the mistake of lumping processed and natural foods together in future studies.

  24. Jay’s avatar

    Chris…i watched this as i ate my two fresh pastured eggs and drank a full glass of raw unpasteurized milk with 4.3% butterfat cream (YUM!)…and laughed the entire time.  My wife who works at a local hospital as an occupational therapist was listening in…she says, “So everything the heart Doc’s have been telling us for years is a load of ….”  My reply, “Yeah, pretty much.”  Her reply, “Well, it is just one test and one opinion.”  My thought, kinda hard to argue with the inverse proportions of entire populations and heart disease vs. cholesterol levels.
    Well done sir!
    My encouragement to the masses of Healthy Skeptic readers…if you haven’t done so already, run out and buy the nearest copy of Julia Child’s ‘Mastering the Art of French Cooking”…life is so much the better with butter, cream, and cheese!

  25. Chris Kresser’s avatar

    You might mention to your wife that what I shared is far from “one opinion”, and my rest results are not at all uncommon. There’s a very large number of people eating a high-fat, low carb diet these days (a la Atkins, primal/paleo, South Beach, etc.) and these diets consistently improve people’s blood lipids. The scientific literature is full of studies that show this. Likewise, there is an already significant and rapidly growing community of “cholesterol skeptics” (comprised of doctors, researchers and public health officials) that challenge the mainstream dogma that cholesterol causes heart disease. See here for more info on this.

  26. Chris Kresser’s avatar

    You’re right, and I shouldn’t even bother replying. 99% of the time these folks are doing “hit and run” jobs, and have no intention in engaging in a dialogue – because they have no facts backing up their faith. But as the saying goes, “you can’t fight faith with facts.”

    I’ll have to take a look at that study. Most of the studies I’ve seen linking processed meat consumption to heart disease have been confounded by other factors.

  27. Chris Kresser’s avatar


    After reading the description of the study, I’m skeptical for several reasons:

    1) It was observational.  Observational studies are only valuable for developing hypotheses that may be worth testing.  They don’t show cause and effect.  For example, the whole cholesterol myth began when early researchers noticed an association between cholesterol and heart disease in some populations.  We have to be very careful about drawing conclusions from observational studies.

    2) The authors claim the mechanism for cured meats contributing to heart disease is the sodium and nitrates.  Yet the research clearly shows that salt does not raise blood pressure in most people, and that nitrates are not a cancer risk.  These are two more myths I hope to take on at some point.

    3) This was a meta-analysis.  Meta-analyses are fraught with problems, and authors of these types of studies get into all kinds of statistical mischief to try to prove their point.

  28. LB’s avatar

    So what are the Aborigines doing or eating that’s giving them heart disease?

  29. Chris Kresser’s avatar

    I’m not sure, but I suspect it’s because they have rapidly incorporated processed western foods like white flour and sugar into their diet. We see this time and time again with indigenous populations around the world. The Aboriginal Australians did not have such a high rate of heart disease before eating Western foods.

  30. capmikee’s avatar

    We discussed that processed meats study on lowcarber.org: http://forum.lowcarber.org/showthread.php?t=412279
    We thought up  a couple of possible reasons for the result:
    1. The problem is with all processed foods, including grains and vegetables – but the study didn’t count other processed food.
    2. Processed foods like sausage, lunchmeat and hot dogs are more likely to be eaten with bread than fresh meats are. It’s possible that people filling out the food frequency questionnaires didn’t mention the bun when they said they ate a hamburger or a hot dog.

  31. Garry’s avatar

    Are saturated fats inherently unharmful/beneficial, or are they unharmful/beneficial only in the presence of a low-carb diet?

  32. Chris Kresser’s avatar

    I would say they are beneficial in the context of a diet without refined carbs and sugar. Doesn’t have to be low-carb.

  33. Chris Kresser’s avatar

    Exactly the type of problems I alluded to in my comment below with observational studies. Mozaffarian has done some good work but I’ve seen several of these types of studies from him.

  34. Garry’s avatar

    What I meant was, can saturated fats be harmful (i.e., the mainstream view) in the presence of refined carbs and sugars, or are they simply unharmful or even beneficial no matter what?

  35. Chris Kresser’s avatar

    I’ve seen some limited evidence that saturated fat can be problematic along with a diet high in refined carbs, possibly via promoting insulin resistance.  However, I’m not certain about this at all.

    It’s kind of a moot point for me, because there’s absolutely no reason to eat processed and refined carbs.

  36. Ellen@BodyEarth’s avatar

    Off topic:  I very much look forward to reading what you have to say about nitrates not being a risk for cancer.  I also wonder whether you’ll address this Japanese prospective cohort study looking at CVD, cancer and salt intake among the Japanese, who consume large amounts of salt in pickled and cured foods. It suggests that nitrates may play a role in cancer.  I haven’t read the whole study, so don’t know about confounders, but thought I’d point it out in case you hadn’t seen it!
    Also, I think you voice was just fine in your presentations.

  37. Chris Kresser’s avatar


    Read this.  She covers it very well.

  38. Ellen@BodyEarth’s avatar

    Wow.  I had no idea. Thanks so much for the link.

  39. PeggySu’s avatar

    Both videos were excellent.  Thank you. 

    I just had a standard lipid panel with results similar to yours: triglycerides 57, HDL 71, and total cholesterol 217. (My PCP, who happens to be a cardiologist, offered me a statin prescription but I said no thanks.)

    Could you explain the VLDL Calculation they do on a standard panel?  Is it useful?  Mine was 11.

  40. Chris Kresser’s avatar

    You’re in good shape. Your TG/HDL ratio is 1.24 and that is a proxy for LDL particle size. Anything less than 3.8 suggests large, buoyant LDL.

    VLDL is “very low density lipoprotein”. It carries more triglycerides than other lipoproteins. There’s no way to measure it directly, so they usually take a percentage of triglycerides to determine it. It’s not a very useful marker. HDL, TG and lipoprotein particle size are much more significant.

  41. Orson’s avatar

    Have you read Gary Taubes’ excellent book, “Good Calories, Bad Calories”?  Your videos were like a cliffs notes version; great work!
    I have been tinkering with the diet you lay out in the second video for a couple of years.  One thing I’ve noticed is that my digestive system seems to… “slow down” quite a bit when I’m ingesting primarily fats and proteins.  Consequently, I’ve tried to eat a ton of fibrous greens alongside my fats.
    Do you know of any research that’s looked at the (what I would assume are deleterious) effects of “irregularity” due to insufficient fiber, stemming from a fat/protein based diet?  This topic is obviously not as fun to think/talk about as the causes of CHD, but seems to me to be hugely important.  Sorry if this is off topic and/or TMI!

  42. Christian W’s avatar

    Awesome presentation Chris. I’m going to forward to people I know. (And congratulations on your high total cholesterol!)
    One technical question: The presentation implies (probably for the sake of simplicity) that LDL isn’t supposed to enter the intima of the blood vessels, and that mostly the small dense LDL do so. Though, isn’t the situation rather like a “flux” of cholesterol being delivered (by LDL) and removed (by HDL) in and out of the intima as appropriate to maintain the blood vessel wall? If so, then one may wonder why LDL particles and especially small dense LDL get stuck in the intima (evolutionary design flaw? a result of oxidation?) so that the atherosclerotic process can get started. Do you have any thoughts (or good sources) on this?

  43. Chris Kresser’s avatar


    I’m not a big believer in fiber. There are many traditional cultures around the world who eat diets high in fat and protein and very low in fiber and have no problems with constipation. My belief is that constipation is almost always a result of dysregulated gut flora. This can be caused by poor diet, antibiotics and other medications (including PPIs), stress. It can be remedied by consuming fermented foods like yogurt and kefir and perhaps taking a probiotic and/or prebiotic supplement.

    I have read Taubes’ book – he’s made a great contribution with that piece of work.

  44. Chris Kresser’s avatar


    What I didn’t have time to get into in the presentation is that oxidized LDL (ox-LDL) is probably the most significant risk factor of all when it comes to lipoproteins.  Ox-LDL damage the intima in a way that normal LDL particles do not.

    However, guess what lipoproteins are most likely to oxidize?  Small, dense LDL.  So we need to do what we can to prevent small, dense LDL (eat saturated fat, minimize carbs) and reduce oxidation (eliminate vegetable oils, reduce stress, exercise).

  45. Lena M’s avatar

    Very nice videos, excellent ‘Beyond Bullet Points’ http://www.beyondbulletpoints.com/ use of visuals.
    One way to make it more engaging would be if you had another person to dialog with – ask questions back and forth. Won’t save you much time though!
    GGE = GRADIENT Gel Electrophoresis, http://www.ivdtechnology.com/article/gradient-gel-electrophoresis-clinical-evaluation-heart-disease-risk

  46. Chris Kresser’s avatar

    I’d love to find someone to dialogue with. It’s pretty clear to me what that adds, and it would be a lot more fun.

  47. LB’s avatar

    Western processed foods may have influenced the rate of  heart disease  in Aborigines to a degree; however, as the rate of heart disease is approximately double that of the rest of Western civilization, there’s obviously something else WAY out of whack there.   Not fully exploring that data point is bothering me.. Otherwise, I liked the presentation.

  48. SV’s avatar

    Just to play devil’s advocate: if traditional food sources were replaced entirely by cheap and accessible western staples (read: highly refined carbohydrates), wouldn’t a 2x (or more) increase in CHD be in line with expectations?  I know a lot of work has been done on the Pima Indians over the last several decades; they might be an example of this.

  49. LB’s avatar

    SV, I’d expect heart disease rates to come into line with the rates of Western culture, not go so far beyond it.  And why did I say 2x?  It looks more like 5x or 6x.

  50. Chris Kresser’s avatar

    Some believe that the disproportionate increase in CHD seen in Aboriginal Australians is in part due to a genetic predisposition that makes them especially vulnerable to the modern diet. From this article:

    Research suggests that the metabolism of Aboriginal Australians has been geared towards making them efficient hunter-gatherers, which was vital for a successful traditional lifestyle.

    Aboriginal Australians have a lighter build than European Australians, with relatively long legs, short bodies, narrow chests and narrow hips and shoulders.

    When Aboriginal people lived a traditional lifestyle, they generally had a low body mass index (BMI, which is determined by your weight in kg divided by your height in metres squared), compared with what’s considered normal for European Australians, and their weight did not tend to increase with age.

    This naturally light body type and low BMI of Aboriginal Australians indicates that their bodies may need less energy (food) to sustain them than European Australians.

    It’s also thought that Aboriginal people had a highly efficient metabolism which helped them survive while living a traditional lifestyle. For example, some Aboriginal and Torres Strait Islander populations have mild glucose intolerance and relatively high cholesterol, characteristics that would help them gain weight to keep them alive when necessary.

    While they lived traditionally and were fit and active, and ate high-fibre, low-fat meals such as wild animals, vegetables and fish, they were protected from becoming obese or developing diabetes.

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