I have high cholesterol, and I don’t care

May 31, 2010 in Heart Disease, Medical Industrial Complex, Myths & Truths | 136 comments

Still think saturated fat is bad for you? Still think eating eggs raises cholesterol? Still think high cholesterol causes heart disease?

If you answered yes to any of those questions, you really need to watch these videos. (But hey, you might learn something even if you answered “no”.)

In this presentation I:

  • debunk the myth that eating saturated fat and cholesterol causes heart disease.
  • explain why LDL and total cholesterol are not useful markers for heart disease.
  • present three markers that are useful markers for heart disease.
  • demonstrate that low-fat, high carb diets promote – rather than protect against – heart disease.
  • show you how eating saturated fat and cholesterol can prevent heart attacks
  • tell you how to order a test that more accurately predicts your risk of heart disease

At the end of these two videos, you’ll be heading to the fridge for some extra butter or cheese on those veggies or a little extra cream in your coffee!

{ 136 comments… read them below or add one }

Ellen@BodyEarth June 1, 2010 at 10:23 am

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!


Hans Keer June 1, 2010 at 11:06 am

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.


Matthew June 1, 2010 at 11:13 am

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!


Chris Kresser June 1, 2010 at 11:21 am


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.


Bobby D June 1, 2010 at 11:45 am

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.


Chris Kresser June 1, 2010 at 11:52 am

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


Sean June 1, 2010 at 2:22 pm

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.


Chris Kresser June 1, 2010 at 2:36 pm

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.”


Chris Kresser June 1, 2010 at 2:45 pm


You can also read this fantastic article just published:

Recent Cholesterol Lowering Trials: New Data, New Questions


Gregory Barton March 26, 2011 at 7:01 am

Could you summarize the article for those of us less conversant with the subject matter.


Jamie Scott June 1, 2010 at 4:10 pm

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


Todd S. June 1, 2010 at 6:44 pm

@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?


Alan June 1, 2010 at 7:44 pm

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.


Chris Kresser June 1, 2010 at 8:01 pm


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.


Brian June 1, 2010 at 8:23 pm

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.


Chris Kresser June 1, 2010 at 8:25 pm

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.


Tyler June 1, 2010 at 10:08 pm

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!


Chris Sturdy June 1, 2010 at 10:08 pm

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.


capmikee June 2, 2010 at 10:43 am

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.


Chris Kresser June 2, 2010 at 11:25 am

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.


Moises June 2, 2010 at 11:09 am

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.


Chris Kresser June 2, 2010 at 11:26 am

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


Baba Ghanoush June 2, 2010 at 2:58 pm

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!


Baldur June 3, 2010 at 6:35 am

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.


Chris Kresser June 3, 2010 at 7:21 am

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.


Jay June 3, 2010 at 6:53 am

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!


Chris Kresser June 3, 2010 at 7:19 am

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.


Chris Kresser June 3, 2010 at 7:30 am


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.


LB June 3, 2010 at 7:39 am

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


Chris Kresser June 3, 2010 at 7:45 am

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.


capmikee June 3, 2010 at 8:06 am

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.


Chris Kresser June 3, 2010 at 8:33 am

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.


Garry June 3, 2010 at 8:24 am

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


Chris Kresser June 3, 2010 at 8:33 am

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


Garry June 3, 2010 at 8:47 am

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?


Chris Kresser June 3, 2010 at 8:59 am

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.


Ellen@BodyEarth June 3, 2010 at 10:45 am

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.


Chris Kresser June 3, 2010 at 10:46 am


Read this.  She covers it very well.


Ellen@BodyEarth June 3, 2010 at 11:03 am

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


PeggySu June 3, 2010 at 1:08 pm

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.


Chris Kresser June 3, 2010 at 2:16 pm

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.


Orson June 3, 2010 at 2:21 pm

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!


Chris Kresser June 3, 2010 at 7:36 pm


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.


Christian W June 3, 2010 at 7:27 pm

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?


Chris Kresser June 3, 2010 at 7:40 pm


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).


Lena M June 3, 2010 at 9:50 pm

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


Chris Kresser June 3, 2010 at 10:18 pm

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.


LB June 4, 2010 at 8:12 am

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.


SV June 4, 2010 at 8:36 am

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.


LB June 4, 2010 at 8:52 am

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.


Chris Kresser June 4, 2010 at 10:08 am

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.


Mindy June 4, 2010 at 12:33 pm

Thank you for this presentation. My husband told me about it because he has high cholesterol and was put on a statin. He is healthy and only 38, but has had “high cholesterol” since before 30. We thought it a great concern since both of his grandfathers died of heart disease. Yet, when we did his Triglyceride/HDL ratio after reading your presentation we found  it is only 2.36.  However, it was an interesting discovery that for myself, my ratio is 4.77. I have polycystic ovarian syndrome which leads to high triglycerides and low HDL….thus women with PCOS are at a higher risk for heart disease.
Your presentation showed me once again refined carbs are not my friends. I am wondering if you can suggest any guidelines for amounts of carbs to eat? I had a baby 5 weeks ago and need to lose about 30 pounds. I am thinking I will need to go through the fridge and cupboards to get rid of some things. Thanks again!


Chris Kresser June 4, 2010 at 1:05 pm


Unfortunately there’s no single answer to the “how many carbs can I eat” question. It depends from person to person. One way to find out for sure is to test your blood sugar after various meals using a home testing kit (that diabetics use). If your blood sugar is going above 140 after one hour and above 120 after two hours, the meal had too many carbs.

In your case, I’d probably suggest cutting out refined carbs entirely, and limiting carbs to less than 50g per day to bring your blood lipids back into line. Krill oil has been shown to significantly lower TG and increase HDL at 2-3g/d. (Read my series on essential fatty acids and fish oil for more on that). Eat plenty of saturated fats like butter, cream, coconut oil, ghee. Most people find that they lose weight on a low-carb diet, so it’s a double benefit for you.

Re-test in 2-3 months and see where you’re at. You can try gradually increasing carbs if your lipids have come down (but not refined carbs – those are pretty much out forever.)


Mike OD June 4, 2010 at 1:58 pm

Good stuff as I don’t believe in all the cholesterol hype out there in the mainstream. On a related note, I did find this interesting info regarding sat fat and LDL particle size:
“There are two general categories of factors causing small LDL particles: lifestyle (overweight, excess carbohydrates) and genetics (e.g., variants of the gene coding for cholesteryl-ester transfer protein, or CETP).

If small LDL is purely driven by excess carbohydrates, then adding saturated fat will reduce small LDL and increase large LDL.

If, on the other hand, your small LDL is genetically programmed, then saturated fat will increase small LDL. In other words, saturated fat tends to increase the dominant or genetically-determined form of LDL. If your dominant genetically-determined form is small, then saturated fat increases small LDL particles.

So to say that saturated fat increases large LDL is an oversimplification, one that can have dire consequences in the wrong situation.”
from http://heartscanblog.blogspot.com/2010/02/saturated-fat-and-large-ldl.html


Chris Kresser June 4, 2010 at 2:30 pm

In general I like Dr. Davis but he is prone to making unsubstantiated statements like the one you linked to above that many others in the scientific community disagree with. If you read the comments section of that post you’ll see several people asking him for a reference to support his claim. I don’t think he provided any. He has made similar claims about the genetic component of Lp(a), without references. So I’m wary of drawing any conclusions from his statement.


Christian W June 4, 2010 at 2:48 pm

Dr. Davis bases his claim on his vast clinical experience. I therefore don’t think that it should be dismissed out of hand.
Here is what he says in the comments section:
“This is based on having tested lipoproteins in thousands of people over the past 10+ years.

Prototypical “genetic small LDL” person: 5 ft 10 inch, 140 lb male who eats low-carb. In other words this person is at ideal weight and does not eat foods that trigger small LDL–yet has 90% small LDL by NMR (e.g., 1200 nmol/L, LDL particle number 1550 nmol/L). Should this person overindulge in saturated fat, small LDL will go up.”
PS. Thanks for your reply to my previous comment.


Mindy June 4, 2010 at 3:13 pm

Thank you so much Chris. I really appreciate your practical advice. Would you mind giving me your definition of a refined carb? I have thought it is stuff like white bread and pastas. For the last couple years I switched to whole grain bread, pasta, rice and tried to choose low glycemic carbs.  I will print off your response and begin making the changes today!


Chris Kresser June 4, 2010 at 3:37 pm


I’m definitely not dismissing his claim out of hand.  However, it would be nice to see some evidence other than one doctor’s clinical experience.  The main issue, of course, is what will these people eat instead?  If you tell them not to eat saturated fat, they’re going to increase their intake of either n-6 containing seed oils or carbohydrates – both of which either raise small LDL (carbs) or oxidize LDL (vegetable oils).


Chris Kresser June 4, 2010 at 3:38 pm


You might want to pick up a book like Primal Blueprint by Mark Sisson.  He also has a new cookbook out with some good recipes.  You’ll get plenty of good advice about how to eat this way.  I don’t think it’s necessary that you completely eliminate grains, as he advises, although many people do well with that approach and I follow it myself.  Good luck!


Bryan - oz4caster June 4, 2010 at 3:54 pm

Good job Chris!  I like the concise and easy to understand presentations.  I just wish I had know this about 15 years ago when I went for a physical and the doctor told me my cholesterol was too high at around 215 and I should go on a low-fat diet to reduce it.  I tried the low-fat diet for a year and it went up to 220 so he put me on a statin.  I kept up the low-fat diet and gained about 40 pounds over five years and I dutifully took the statin every day thinking it would save me from heart disease.  Then I finally ran into the Dr Mercola and WAPF web sites about four and a half years ago and promptly ditched the statin and changed my diet.  I’ve now managed to lose the 40 pounds eating a fairly low carb diet high in animal fats and very low in fructose, along with some intermittent fasting.  I have to look in the mirror to remind myself that I’m almost 58 and not 20 years younger. :)


Christian W June 4, 2010 at 7:18 pm

I think that a healthy diet that is slightly lower in saturated fat would be something like Arthur DeVany’s take on a paleo diet. (He calls it paleo-Mediterranean). The fat would come from leaner cuts of meats, seafood, olive oil, eggs, avocados, and nuts. This is relatively high in monounsaturates and polyunsaturates to compensate for less saturated fat, but with omega 3/6 balance. Higher in protein too.
Some coconut oil and milk might also fit in here since they are low in palmitic acid and because of other properties.
The reason that I dwell a bit on the issue of an “upper limit” to saturated fats is that I tend to think of macronutrients in terms of appropriate ranges (modern era extremes excluded) wich may vary from person to person . In other words, I think that people should be aware of the nuances that exist and that there are a several possible ancestral diets.
This is where clinical observations (as well as self-observation) are important. Studies tend to look for averages and dismiss marginal phenomena, but where the rubber hits the road is in the realm of individual quirks.
Personally, I’ve had nominally good blood lipid profiles (as defined by trig/HDL ratios) on all diets that I’ve eaten over the past decade (ancestral and not ancestral, though I’ve never tried SAD), however I’m now leaning towards a diet relatively high in eggs, heavy cream, butter (from grass fed sources), and coconut oil/milk since this pattern seems to have produced a healthy high total cholesterol (194) and a good trig/hdl ratio at 0.83. (Strangely my trigs went from  55 in 2008 to 62 in 2010 after switching from my prior eclectic “Mediterranean” diet, which was rather high in carbs, to a paleo diet with less than 50g of carbs per day.)
In any case, these points are minor in the context of the scare around saturated fats which is clearly overblown and to the point of making people much less healthy than they could be, and this take-home message is what most people primarily need  to pay attention to now. Thanks for making this happen.


enliteneer June 4, 2010 at 10:24 pm

I don’t vilify cholesterol and saturated fats, but I also don’t think the importance of  antioxidant-rich fruits and vegetables should be minimized.
Where I’m a bit confused though is with grains and fiber.    One the one hand, whole wheat kernals, for example, is pure carbs…  yet hasn’t there been tons of studies showing the positive effect of insoluble fiber on preventing digestive cancers?
Interestingly, soluble Fiber / Inulin is said to lower cholesterol, of course after watching these videos, the million dollar question would be, does soluble fiber lower the small dense LDL or the balloon LDL / HDL?  Perhaps that will tip the scales!


Chris Kresser June 5, 2010 at 7:09 am


I’m all for fruits and veggies as well.  However, I will say that several large studies have shown that the “5 servings a day” suggestion provides no benefit over eating a moderate amount of fruits and veggies.  Foods like organ meat and even muscle meat are often much more nutrient dense than fruits and vegetables.

My problem is that people (especially parents with their kids) are often bending over backwards to get enough fruits and veggies while neglecting the importance of seafood, organ meats and animal fats – all of which will have a much greater impact on nutrient status and health than going from 2-3 servings of fruit & veggies a day to 5. Keep in mind that there are some traditional cultures that were very healthy who ate only animal products and no fruit and vegetables, but there are no traditional cultures that ate only fruit and vegetables and no animal products.

Regarding fiber, I think it’s important to some degree (mostly because it stimulates butyrate production), but I also think it’s over-rated.  A primal/paleo type diet of meat, low-sugar fruits and low-starch vegetables will provide plenty of fiber.  Grains are not necessary for that.

Thanks again for your comments.


PeggySu June 5, 2010 at 7:17 am

Just to add to what you wrote about constipation.  Does the questioner know that a low carb/low fiber diet greatly reduces the volume of excreta? If this is what he means by “slow down”, that’s expected.


ben June 5, 2010 at 9:36 am

Given the cholesterol numbers to look out for…

HDL >> 40
TG   << 150
TG / HDL < 3.8  (i.e.  Pattern A )
LPA Lipo Protein  < 75 nmol/l  (or < 30 mg/dl)

I’d definitely want to do the NMR test (although I’ll only ever seen VAP and GGE)..

I’ve sent blood drops for Vitamin D testing (CanaryClub.org, a place similar to  PrivateMDLabs), but I’ve always wondered if, in general, it’s a bad method.

When you go to the doctor,  they immediately refrigerate it.. . yet when you send it by mail, the time and temperature changes it goes through, not to mention the contamination with the paper, seems it would skew the results significantly, no?

Also,  is ox-LDL, and very low density lipoprotein (VLDL)  in the same category as  the beach ball (not dangerous) LDL?   If not, what numbers would you look out for there?

Speaking of more numbers, some of these places can also test for Omega-3/6/9?   Any ballpark numbers what would be considered healthy?



Chris Kresser June 5, 2010 at 9:41 am

Apparently those D tests have been validated and are accurate.  But I haven’t looked into this extensively so I can’t say for sure.

ox-LDL = very bad.  One study I read suggested it’s 8x greater a risk factor than normal LDL (though as we know, normal LDL is only weakly correlated).  VLDL is a proxy for TG.  In fact, VLDL can’t be measured directly and is calculated by taking a percentage of TG.  Not a very useful marker IMO.

Check out my series on fish oil.  I talk about the new omega-3:omega-6 index in there and summarize what the studies have shown about that.


enliteneer June 5, 2010 at 12:01 pm

Thanks, I did some searching and at least according to this study, soluble fiber lowers pattern b (dense ldl), without adversely tinkering with hdl or triglycerides:
Also, don’t statins come from plant sterol/stanol compounds and other natural food sources? (pig’s hearts, red yeast rice, whole grains, legumes, etc)
I avoid taking prescription drugs indiscriminately, but curius, is there something about the statins themselves that should be avoided?


Chris Kresser June 5, 2010 at 12:49 pm

Yes, they’re in those compounds.  But as usual with pharmaceutical medicine, they’ve isolated a particular molecule and amplify it to a level not found in natural compounds.

The question is why use statins (whether natural or synthetic) anyways?  They provide no benefit for 95% of people, and even the benefit for the remaining 5% is highly controversial – as I will explain in an upcoming presentation.


Chuck Perez June 6, 2010 at 7:42 pm

there’s a cool documentary-like movie called fat head.   The guy eats nothing but McDonalds for a month (similar to Super Size Me), except he limits his carbs to 100g and actually loses 10 lbs!!  (100g of carbs is only .05% on a 2000 calorie diet)
For me, that’s unachievable, but isn’t there such thing as good and bad carbs?  Shouldn’t the yardstick actually be Glycemic Index (or Glycemic Load)?  If a carb has a low Glycemic index (< 65), then it doesn’t cause the insulin reaction that is attributed with inflammation / fat gain / heart-disease.


Chris Kresser June 7, 2010 at 8:11 am

There’s certainly a difference between refined and unrefined carbs. But in the US, when people replace saturated fat with carbs they always replace them with refined carbs.


Marek London June 8, 2010 at 8:16 am

The glycaemic index/load of carbohydrates has a basis in logic, but unfortunately does not stack up in the real world because it only relates to carbohydrates being eaten in isolation (people eat their jacket potatoes with tuna and butter, for example, not on their own). Also cooking and heating the food can change it’s GI/GL.
Protein, fat and fibre slow down the release of carbohydrates. A relatively low carbohydrate diet that features good proteins, oils and fibre will ensure a balanced blood sugar response. Whatever source of natural carbohydrates you include will make very little difference within this format.


Mindy June 8, 2010 at 10:06 am

Dear Chris, I would appreciate your thoughts on something. I picked up the book Primal Blueprint on Friday and read it through the weekend. My husband, children and I are ready to go primal and have begun. I was actually planning to make it a bit of a science experiment for my son. (we’re homeschooling.) Last year I had my cholesterol tested and my tri/hdl ratio was 4.77. This was the main motivation for going primal….that and losing weight. Well, I got another cholesterol test yesterday to have some current numbers. I totally expected them to be similar, if not a bit worse since I’ve gained weight with having a baby 5 weeks ago. Much to my surprise my ratio is now 1.92. Here is a comparison from the last test:
                          March 2009                           June 2010
Weight                145                                            166
Total Chol        165                                               222
Trigly                 210                                               127
HDL                    44                                                  66
LDL                      79                                               131
                         Taking Metformin                    off Metformin
                           for PCOS                                       pregnancy, birth, breastfeeding
                        Eating whole grains                   eating whole grains, plus plenty of
                         lots of sugar                                  sugar
                                                                                   added Flaxseed Oil as
                                                                                   recommended to lower trygl and
                                                                                     raise HDL a year ago
                                                                                    Eating Primal for two days

The only thing I can see that would have made the big difference is adding the Flaxseed oil. I was unable to exercise a lot during the pregnancy. Metformin is supposed to lower triglycerides and I am no longer on that drug. The results just took me completely by surprise.
I am still planning on going Primal for at least two months and retesting. i have to admit that now I feel a bit more nervous about adding the saturated fat and saying good-bye to grains. The thing that makes me want to still give it a try is the weight loss. I have tried low glycemic diets, whole grain, low fat and still no significant weight loss. The big difference with Primal Blueprint will be no grains, more fat (lots more!) and no sugar.

You don’t think eating primal those two days prior to my cholesterol test could have effected the test too much?? I know Mark mentioned in his book that following the diet for 30 days would change things…but two days? What do you think?


Chris Kresser June 8, 2010 at 10:15 am

Two days couldn’t make much of a difference.  It’s possible that the flax oil brought it down significantly.  It’s also possible that there was some other underlying process driving up your triglycerides that is no longer present.  Pregnancy cause several powerful hormonal and biochemical changes in the body, so it could have been the pregnancy that caused the shift.

Low-fat, low glycemic and “whole grain” diets don’t help with weight loss much.  I imagine you’ll lose some weight on Primal, but there are many other benefits as well.  Don’t worry about saturated fat, as I’ve explained in the videos.  Remember that these are the fats our ancestors ate for hundreds of thousands of years.


Mindy June 8, 2010 at 10:23 am

Thanks, Chris. I think the hormone part probably played a key role as you suggested. The deal with PCOS is that is throws off hormones and it seems to be tied to insulin. Pregnancy definitely helps in my other symptoms…I could definitely see it helping in ways I couldn’t see. It’s all about the insulin. ;) I think I am beginning to see it now. The benefit for me to go primal is the insulin. Wouldn’t it be wonderful to go primal and see my hormones regulate and see my cholesterol and other symptoms come into line. What a wonderful thought! My husband and I…and kids are thoroughly enjoying the primal diet….it really makes a difference being able to add the fat back into things. Wow! Thank you again for this original post. I have a feeling my life will be changing for the better!


Chris Kresser June 8, 2010 at 10:46 am

Mindy, I wouldn’t be surprised at all if your PCOS symptoms diminish on the primal diet as your insulin/blood sugar system comes back into balance.  Good luck.


LastDawnOfMan June 9, 2010 at 7:24 am

Okay, good job on pointing out that the evidence against dietary cholesterol is still a little weak. And also for pointing out that any doctors out there just relying on serum cholesterol as a predictor of anything, instead of the HDL/LDL/triglyceride levels, is either incompetent or badly out of touch … no, just plain incompetent.
BAD JOB on telling everyone they can choke down as much eggs and bacon as they care to. Eggs still contain saturated fat, bacon definitely contains saturated fat. I can understand letting people know that AS FAR AS WE KNOW it’s okay to eat a small amount of eggs with the other benefits they have, given that they don’t frickin drown them in lard and salt (which, by the way, the majority of people seem prone to do).
But why for the love of god did you start touting bacon as good food? Bacon doesn’t have those other benefits. Unless you are having a very third-world-type, protein-deficient diet, you should be eating bacon like you eat donuts and other crap food, which is, very sparingly and knowing that is not for nutritional reasons.
Given that first-worlders are hitting the hospitals hard and dying in droves from heart disease aggravated by being big fat chubby gluttons, it’s irresponsible to be enabling the addicts by telling them how all the stuff about bacon being bad is just so much stuff.
All in all, the rant against cholesterol is a big straw man mixed with a beaten dead horse. Don’t make it sound like you’re on the cutting edge by debunking what the medical community already abandoned at least a decade ago.


Chris Kresser June 9, 2010 at 7:35 am

There is no evidence that saturated fat causes heart disease. None at all. As the presentation clearly outlined, saturated fat raises HDL and decreases small LDL and triglycerides. The idea that salt raises blood pressure is not well supported in the scientific literature either. That may be true for a select group of “salt sensitive” people, but it’s not true for most people. You can read Gary Taubes’ award-winning article called The Political Science of Salt for more on this. Nitrates do not cause cancer as is commonly thought. Read this article to learn why. So there’s no need to avoid bacon because it has saturated fat, sodium or nitrates. What is making people “fat, chubby gluttons” as you call it is processed and refined carbohydrates – not saturated fat. Sounds like you’ve got some reading to do.


ben June 9, 2010 at 9:31 am

A recent study finds nitrates, when combined  with proteins and a lack of Vitamin C, are pretty bad for you:


Chris Kresser June 9, 2010 at 9:36 am

That’s right, because vitamin C plays an important role in preventing the potentially cancer causing effect of nitrate.  But without vitamin C deficiency, there isn’t a problem.


Alisa June 15, 2010 at 11:28 pm

Wow, thanks for these awesome videos. I am officially a new loyal follower of your blog. I can’t have the butter and cheese for my own health reasons … but, I am certainly up for enjoying some more fats!

I have been intrigued by the Paleo diet concepts as of late, and your work brings some solid backing to it.


Preston June 25, 2010 at 1:15 pm

Ben- that’s an interesting study.  Your statement that it finds that ‘nitrates when combined with protein and lack of vitamin C are bad for you’ is inaccurate.  The authors clearly state they do not know what ingredient of processed meats, nitrates/sodium/other, could be causing higher incidence of CHD and diabetes.
Also, keep in mind that it’s a meta-analysis with many confounding variables such as what ELSE the processed meat eaters are ALSO eating (i.e. refined carbs, high omega-6 fat content, etc) that may be contributing to health problems.  Unless you did a controlled trial where you could keep all other dietary factors equal, this practice of looking at one component of the diet in a vacuum is very problematic.  When you read the full text, it becomes apparent that the study, while interesting as a direction of future research, doesn’t tell us much at all.
I’d also like to see a controlled study looking at differences between factory grain-fed and free range grass-fed meats as a next step.  This quality of the meats being eaten is not looked at whatsoever in this study.
Regarding this post- To be fair, Krause’s meta-analysis on saturated fat has some confounding factors as well and even proponents of its conclusions, like Michael Eades, have found many problems with the paper.  It’s also true that refined carbohydrates should be limited in the diet but the temptation to replace a misguided Lipid Hypothesis with an equally misguided Carbohydrate Hypothesis (a la Gary Taubes) is not the solution.  Two wrongs don’t make a right.
That being said, this is a strong presentation and really good work Chris.  I’m enjoying combing through the archives.  Thanks for the food for thought!


tac99us June 30, 2010 at 2:14 pm

So I had a cholesterol test a while ago, found out i had high cholesterol. Found this site and changed the way i eat in february. Have been eating mostly local vegtables, local grass-fed meat, and local grass-fed dairy. Also eliminating grains and sugars.

I was really excited to go get my first VAP test last week. Well, i just got my results. I’m not sure I’m so excited anymore (results attached).

Total cholesterol was 307 now 382 (high number – yikes)
LDL was 236 now 306 (went up -ugh)
HDL was 50 now 58 (nice modest improvement)
Triglycerides were 107 now 64 (best improvement)

My LDL is well within the Pattern A zone. But i’m not sure this is totally good news. Am i in that zone because I have more pattern B then A. But my pattern A still way to high?

LDL1 (A) – 32
LDL2 (A) – 84
LDL3 (B) – 152
LDL4 (B) – 19

I don’t think that my new diet has made anything worse, but I was really hoping for a dramatic (or at least some) improvement.  Any advice or help is appreciated. i’m sort of dejected and rethinking everything now.


tac99us June 30, 2010 at 2:30 pm

sorry – wrote that wrong, like I said I’m confused . I meant to say – I’m in pattern A, which is good. But is my pattern B still to high? Just the even larger volume of pattern A skew it?


Chris Kresser June 30, 2010 at 6:50 pm

The important thing is that your HDL is going up and your triglycerides are going down. The ratio between HDL and triglycerides is a far more important marker than total cholesterol or LDL. A ratio of below 3.8 carries a lower risk of heart disease, and you’re at 1.1. You’re also in Pattern A as indicated on the chart at the bottom of your results.

That said, high LDL cholesterol can be an indicator of an underlying inflammatory process. LDL is a repair substance in the body, so inflammation can drive up LDL levels. Do you have an inflammatory condition?

Keep in mind that some people simply have naturally higher total and LDL cholesterol. As I said before, it’s really the triglycerides, HDL and LDL particle size you need to be concerned about.

In any case, the diet you’re eating is anti-inflammatory and will only continue to reduce your risk for heart disease.


tac99us July 1, 2010 at 5:25 am

Thank you for your reply. I appreciate it.

I do have a sore knee and swollen finger right now, not sure if this would be considered arthritis or not. They are old sports injuries that seem to flare up every so often.

Is this what you would consider an ‘imflammatory condition’?  I tried looking that up and really only saw arthritis, and its different forms, listed as inflammatory conditions. What other issues would you categorize as such?


Chris Kresser July 1, 2010 at 9:43 am

Arthritis is certainly an inflammatory condition, but I’m not sure it would raise your cholesterol. I was thinking of something more along the lines of an autoimmune condition, diabetes, etc. It may be that you are one of those people whose LDL is naturally high. In any event, your diet is anti-inflammatory now and I’d imagine that over time your lipids will improve. Consider adding Neptune Krill Oil at 2-3g/d. NKO significantly improved lipid profiles in one study (raised HDL, lowered triglycerides, and lowered LDL) in addition to lowering blood glucose.


LastDawnOfMan July 1, 2010 at 7:02 am

You could probably categorize those old sports injuries as a form of “osteoarthritis” which as far as I can tell is a catch-all term for joint wear-and-tear. Inflammation may not be the whole picture there but it is at least a big part of the picture.
In our pathophysiology course we learned that inflammation is a pretty ubiquitous response to all kinds of injury. Also, that an anti-inflammatory diet can help with all kinds of inflammatory issues, not just with heart disease. I treat my wife’s tendon/muscular injuries she gets at work with lots of icing down but also with lots of fish oil and avoiding pro-inflammatory saturated fats like what you get in red meat.
Keep in mind that anti-inflammatories can be a two-edged sword. Taking over 5 grams of fish oil a day can raise the risk of stroke. But, for the vast majority of first-worlders, too much inflammation and clotting is far more common a problem than not enough. Our diet is overloaded with inflammation-enhancing nutrients. It’s thought now that a large amount of the cancers we incur are due to chronic inflammation, and that being on an anti-inflammatory diet can reduce cancer risk considerably.


ClaireC July 1, 2010 at 8:12 am

I’ve read a great deal about low-carb vs high-carb (Gary Taubes, The Zone, etc) and often the French Paradox is mentioned.  But what about the Oriental Paradox?  I lived in the Far East for many years and noticed that the people there ate vast quantities of refined carbs (rice and noodles) every day.  Has any study ever been done to show whether the Chinese are more prone to heart disease as a result?  Would be interested in your thoughts.


Chris Kresser July 1, 2010 at 9:40 am

There’s probably a significant difference between various refined carbohydrates. Wheat products are likely to be more problematic, because they are more inflammatory, and heart disease is caused by inflammation. Refined sugars are even more damaging. And then there’s vegetable oil. In the U.S., the top three sources of calories are vegetable oil, flour and refined sugar. That’s the heart disease epidemic right there.


ben nguyen July 1, 2010 at 11:35 am

So bad to worse in terms of inflammation would be :
refined sugars
vegetable oils
and the (healthy?) chinese diet (noodes, rice (red yeast or otherwise)) would fall under the least bad, wheat?


LastDawnOfMan July 1, 2010 at 11:51 am

I don’t believe it’s just “wheat” it’s refined wheat, with all the fiber and nutrients stripped out. Whole wheat is still good, containing anti-inflammatory oils.
BTW — Watch out for breads that say “whole wheat” and when you read the ingredients it’s almost all refined wheat flour, then they add a pinch of whole wheat at the bottom just so they can lie to you on the label. And most of the brown color is just coloring agents on those. Make sure the first ingredient is “whole wheat.”


Chris Kresser July 1, 2010 at 12:06 pm

I’m not sure about whole wheat.  It’s high in lectins like WGA that are inflammatory.  Dr. Davis, who has treated thousands of patients for heart disease, writes about this on his Heart Scan blog.  I think that wheat of any kind is probably not a good idea.


kat July 24, 2010 at 11:19 pm

I’ve just found your great blog, and Im reading and absorbing info as fast as I can! I’m wondering how consuming saturated fats affects cholesterol in the digestive system, as opposed to in the blood.  With gallstones, for example, that are made of hardened cholesterol. Would eating saturated fats create more gallstones??


Chris Kresser July 25, 2010 at 7:21 am

Whether or not someone develops gallstones depends primarily on the health of their biliary clearance system. If that is impaired, then yes, eating saturated (or any kind of fat) could cause more gallstones. But if the gall bladder is functioning properly, it shouldn’t be a problem.


ben nguyen July 26, 2010 at 9:27 am

interesting study that will examine wheat / wga on body fat!


ben nguyen August 1, 2010 at 12:21 am

Always good to examine both sides… for example this study finds correlation between whole grains and a REDUCED risk of type 2 diabetes:
while this study shows a correlation between processed meats and an increase in type 2 diabetes in women:


Chris Kresser August 1, 2010 at 8:19 am

Both of those studies are virtually useless in determining any causal relationships. The diabetes study was a prospective study that – as you pointed out – merely showed an association between higher whole grain intake and reduced risk of diabetes. That doesn’t tell us whether whole grains were actually responsible for reducing the risk. It could have been that people who ate more whole grains were more likely to eat less sugar and fructose and more likely to exercise. The processed meat study lumps so many foods together without controlling for the influences of one or the other that it’s impossible to tell which of them is responsible for the effect. For example, hot dogs are one of the most commonly eaten processed meats in the US. What do people eat processed meat in? A bun. The researchers assume that it’s the hot dog, and not the bun, causing the problem because that’s their bias. I think otherwise. That’s the problem with these epidemiological studies.

I recently posted a link on my Facebook page to a randomized clinical trial testing this notion that a diet high in whole grains (and low in fat) prevented CVD. It didn’t – much to the dismay of the researchers and medical community. This is far more reliable evidence than any epidemiological study.


Franklin Mason August 1, 2010 at 3:56 pm

Here’s the last sentence of the abstract for the article you mention:
CONCLUSIONS: Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk.
I laughed out loud when I read it. The point seems to be this: we have to reduce fat and increase carbs even more to get the desired result. The old paradigm is intatters, and all they can think to do is double down.


Chris Kresser August 1, 2010 at 6:03 pm

Didn’t someone define insanity as exactly that? Doing the same thing over and over and expecting a different result? Clearly the mainstream health authorities are insane.


Veronica August 11, 2010 at 10:42 am

I appreciate the information you present here.  I am trying to determine which test is better: the VAP or NMR.  Which do you recommend?  Thank you.


Chris Kresser August 11, 2010 at 10:43 am

They’re both fine, but some docs prefer the NMR because they think it’s more accurate.


Mike August 31, 2010 at 9:45 pm

hi Chris,
my NMR lypoprofile is like yours: high HDL, low triglycerides, high LDL comprised almost entirely of large buoyant particles. So, like you, I didn’t care about my high cholesterol either.
But I damn sure care now because I’ve been turned down for health insurance three times.
I even got a calcium heartbeat scoring. Got a perfect score: zero arterial calcification. Still, the health insurance companies think I’m on the verge of keeling over any moment.
Any advice?


Chris Kresser September 1, 2010 at 11:55 am

Our disease-care system is such a joke. They claim to have “evidence-based” policies and guidelines, yet their “evidence” is 25 years (or more) out-of-date.

Here’s something to consider. Krill oil at 2-3g/d has been shown to lower LDL substantially in one study. You could pound that stuff for a month and re-test to see if your LDL has come down to “acceptable” levels. Or you could try getting a letter from your doctor (if he/she is at least half-way clued in, he/she will know that TG/HDL is far more important than LDL a a risk factor) stating that you’re in excellent heart health. Not sure if that would help, though.


Mike September 1, 2010 at 12:31 pm

I may try your krill oil suggestion, Chris. I have tried the doctor letter approach to no avail. So I guess just take my experience as a word to the wise: if you have health insurance, do everything you can to keep it if you have cholesterol numbers that do not jive with current dogma.


Chris Kresser September 1, 2010 at 12:48 pm

Mike: I have also heard anecdotal reports of people lowering their LDL with flax oil or flax seed meal.  May be worth adding that to your regimen until you can clear the test.

Our insurance system is absurd.


Sandy October 12, 2010 at 6:47 pm

What about the effects of high cholesterol and strokes?   Doesn’t high cholesterol or bad LDL eventually cause thickening of the arterial walls, particularly in the brain -  increasing the chance for strokes?


Chris Kresser October 12, 2010 at 7:15 pm

No.  High cholesterol by itself doesn’t cause thickening of the arterial walls.  Oxidized LDL particles are primarily responsible for damaging the arterial lining.  Consumption of polyunsaturated oils – not cholesterol and saturated fat – increase levels of oxidized LDL.


woly October 22, 2010 at 7:58 pm

Hello Chris,
Great video series, I was just wondering if you would be able to provide a link to the study sources you use in your presentation?
Thanks for the interesting information!


Chris Kresser October 23, 2010 at 7:59 am

Woly: check out my articles in my special report on heart disease. You’ll find all of the references for the presentation, and more.


woly October 24, 2010 at 5:35 am

Thank you, Chris!


Chris Silk October 26, 2010 at 12:03 pm

About 3 years ago my cholesterol was 7 now it’s over 9. According to the doctor and concerned do gooders I should be watching what I’m eating and seeking medical advice.

As far as I can understand I am expected to regard this result with concern and for it to prompt me into making some ‘lifestyle changes’ especially as i’m in my late 40s. Actually though, thinking this through why on earth should I. Risk of a heart attack doesn’t really worry me- life is full of risks, i could get hit by a meterorite jogging back from the chemists with a backpack full of statins and low fat lettuce.

If taking action means having to eat food that i don’t enjoy, wasting my time taking pointless excercise that just bores me silly or going on some long term medication that sounds like it’s a place in rural Wales then I’m just not interested and can’t see the slightest reason why i should be frankly.
I’d far rather take my chances and if that results in a shorter but more enjoyable life then thats fine by me. Think of the family – well thats what life insurance is for and I’ve never heard anyone having their life insurance cancelled for having high cholesterol.


Mike November 1, 2010 at 4:13 pm

Hey Chris,

Looks like damning news (note sarcastic tone) from Canada: http://www.sciencedaily.com/releases/2010/11/101101142515.htm



Chris Kresser November 1, 2010 at 5:00 pm

What a ridiculous study. Before they concern themselves whether eggs have more cholesterol than a Big Mac, perhaps they should review the research clearly demonstrating that:

1) Dietary cholesterol doesn’t raise blood cholesterol levels in 70% of people.

2) In the 30% that do experience an increase, it is large, buoyant LDL that goes up – which is the type of LDL that is not atherogenic.

Honestly, I don’t know whether to laugh or cry when I see research like this.


woly November 8, 2010 at 7:41 am

Hey Chris,

While researching statins, I came accross this study
I know its a meta-anaylsis and the potential faults associated with that but I was wondering if you had seen this and what your thoughts were?


Chris Kresser November 8, 2010 at 9:20 am


Some studies show a benefit, most do not. I believe the risks of statin use far outweigh the potential benefits, especially when said benefits can be obtained and improved upon by simple dietary and lifestyle changes.


woly November 8, 2010 at 4:30 pm

Yes I couldnt agree more however I thought that study was interesting because the common theme for anti-statin arguments is that there are zero studies showing a reduction in all-cause mortality for healthy individuals. This study seems to say otherwise and if so, doesnt this study put a dent in that argument?


Chris Kresser November 8, 2010 at 6:22 pm


For me it’s all about the weight of the evidence, plus what I said above. I’ll try to make time to review the individual studies in this analysis, but I’m exceptionally busy starting my practice. Either way, the results of one meta-analysis wouldn’t be enough to change my opinion, especially considering the side effects and risks of statin use (which aren’t factored into their analysis).


woly November 9, 2010 at 12:43 am

Thanks Chris. Hope the practice is going well!


Catherine November 18, 2010 at 9:38 am

If I didn’t know better because of your work I would be very alarmed today. I just got the blood work numbers from the doctor and they advise me to go on a low fat diet, low sugar. Total chol.285
LDL.188. HDL,86. TRYGL,56.
glucose is 81 and A1c. 6,0 ? Dehydration? we don’t know but I am on a low carb,paleo diet. 3 meals a day, I don’t drink much at all.
I am 50 years old, French and my weight has always been stable except for the one year I lived in the US as an exchange student and ate an American diet and gained 15 lbs. Lost it quickly after return to France eating a traditionnal diet. I stuck to it since.
Really happy you are around to demystify the cholesterol myth.


Chris Kresser November 18, 2010 at 9:48 am

Those cholesterol numbers are fine; good, in fact. Your ratio of triglycerides to HDL is excellent.

Your fasting blood sugar is fine, but A1c of 6.0 is too high. Since your fasting blood sugar is relatively low, and your A1c is pre-diabetic range, that tells me you’re having significant high blood sugar spikes throughout the day. These blood sugar spikes are more accurate predictors of future diabetes and cardiovascular disease than both fasting blood sugar and A1c.


Catherine November 18, 2010 at 8:41 pm

Thank you so much for your answer. That A1c number is disturbing and confuses me especially that it appears on last years results too. The doctor (in Germany) didn’t seem alarmed!in 2009 my fasting blood sugar was 64. cholesterol was 188, trygl.48, HDL,74. LdL 109 and A1c 6 !.
I am actively trying to read all your articles and will keep a log on what I eat and how much water I drink. Also purchased a glucose tester.
Thanks again.


Henry December 15, 2010 at 1:19 pm

Chris – love your site and the work that you are doing. Would love to get your thoughts on my lipid results and how they have evolved over the last few years. My major concern is with the cost of my insurance going up. Do you have any other “hacks” or ideas for lowering it before my next test? I will try krill oil.

39 Year Old Male, ~10% BF, 185 lbs

3/2008 Pre-Paleo/Primal TOTAL: 166 LDL: 103 HDL: 44 TRIG: 116 Ratios Total/HDL: 3.77 TRIG/HDL 2.64 LDL/HDL 2.34

11/2009 After just a few months 100% Primal TOTAL: 176 LDL: 78 (Iranian Calc) HDL: 67 TRIG: 55 Ratios Total/HDL: 2.63 TRIG/HDL 0.82 LDL/HDL 1.16 Notes: Very happy with my ratios, the increase in HDL and drop in Trigs

10/2010 Over a year of 100% Paleo TOTAL: 274 LDL: 118 (Iranian Calc) HDL: 110 TRIG: 47 Ratios Total/HDL: 2.49 TRIG/HDL 0.43 LDL/HDL 1.07 Notes: Excellent ratios, LDL a bit on the high side, some concern about insurance company dropping discounts (they want total <200)

11/2010 VAP TEST A WEEK FOLLOWING PREVIOUS TEST TOTAL: 295 LDL: 163 MEASURED HDL: 97 TRIG: 66 Ratios Total/HDL: 3.04 TRIG/HDL 0.68 LDL/HDL 1.68 Notes: Still decent ratios, but concerned that these are going in the wrong direction. However, my VLDL is excellent and my LDL is the "good" kind. Should I concern myself with these??


Chris Kresser December 15, 2010 at 1:33 pm

In a word, no.

I understand your desire to avoid an insurance rate hike, but other than that, there’s no need to continue testing. Your lipid profiles are excellent. A few points here and there isn’t a significant difference. There’s a lot of variation from day to day. You’re doing the right things. Kick back, relax and enjoy.


Henry December 15, 2010 at 1:42 pm

Thanks for the immediate reply Chris! Just hearing this from you will make the “kick back, relax, and enjoy” advice actually possible. THANK YOU!!


Jana January 20, 2011 at 6:43 am

Hi Chris,
I read many of your posted articles and I’m interested about them.
I’m 45 years old.
High level of cholesterol was found 15 years before. My cholesterol
level is 15 years in interval 7,9 – 9,5 mmol/l. My diagnosis is
Heterozigot familiar hypercholesteremia.

Here are my current values from October 2010:
TK:113/70 Weight:54 Height: 164 BMI:20.8 Total cholesterol: 8,800
HDL-C: 1,460 mmol/l
LDL-C: 6,699 mmol/l
Apo-B: 1,980 mmol/l
Apo-AI: 1,690 mmol/l
RI1: 4,588
RI2: 1,172
TG: 1,410mmol/l

High cholesterol level 7,4 mmol/l found also at my 20 years old dother.
My 82 year old father has cholesterol at level 7,0 mmol/l and 81 year
old mother has 6,4 mmol/I. There are healthly.
Dr.Davis wrote in Herth scan blog:
articles: Saturated fat and large LDL
If, on the other hand, your small LDL is genetically programmed, then
saturated fat will increase small LDL. In other words, saturated fat
ends to increase the dominant or genetically-determined form of LDL .
(eg, variants of the gene coding for cholesteryl-ester transfer
protein, or CETP).
This means that sacharids, also unsaturated oils and saturated oils are
bad for my genetic familiar hypercholesteremy ?
My question is simple. How to lower my cholesterol level without statins ? Does exists any natural way ?


Mindy January 20, 2011 at 1:50 pm

For Chris, an update….
For Jana, our experience

My husband and I have been following the Primal lifestyle now for 7.5 months. We had our VAP tests done and while my numbers were great, his were a bit concerning/confusing. He was Pattern B. After looking at his family history we felt he had a genetic disposition to make VLDL. We stuck with the Primal lifestyle, but my husband added SloNiacin, CoQ10 and upped his Vitamin D. We continued with the exercise of body weight exercises 3x per week and hiked on the weekends. We recently got another VAP test done. My numbers/ratios improved yet again and my husband is now Pattern A!! Most of his ratios are in the good range now. His numbers are moving in the right direction! We are so excited to have this confirmation to how good we feel otherwise. We are both losing weight, gaining muscle and our energy is great (despite having an 8 month baby :) )
Thanks again to you, Chris for helping us. We also tested our post meal blood sugar to keep it that in check. We are now helping my step-dad change his lifestyle so that he won’t have to go on insulin….. Thanks again!


Chris Kresser January 20, 2011 at 2:55 pm

Your welcome, Mindy! Thanks for the update.


Jana January 21, 2011 at 3:39 am


to update my informations. I have 54kg and 164cm. I’m walking everyday to job and back by feet. During weekend I have some medical walks at last 3 – 5 km. I’m also making exercise on medical ball for 1 hour.

I think my body is well trained and there is no issue with food. I’m eating only baked and grilled food, not fried.


Maxie February 14, 2011 at 4:02 pm

Wanted to ask you about my lastest lipid results.
I’m a newly diagnosed Type 2 diabetic.
Fasting b/s average in the 80′s
A1C was down to 5.1 in Dec and up in Feb 2011 to 5.7.
Am doing a high fat, high protein very low carb diet.
My lipid results
Cholesterol 230
Trigs. 66
HDL 69
LDL 148

What should I be doing differently. I know that this new low carb diet and high protein will probably take about 6 months to adjust and will repeat my lipids then.
Any advice?
Thank you.
(love your blog and your website).


deanna March 12, 2011 at 5:52 am

How is a fasting blood sugar in the 80s be diagnosed as Type II diabetes?


Maxie February 14, 2011 at 4:03 pm

Just wanted to add:
I’m not taking any meds or insulin.


Jim Sutton March 29, 2011 at 3:17 pm

Chris, that was great.

I sent it to all (6) of my friends. Of course, since ‘a prophet is not without honor, save in his own country’, it will be completely ignored.


Damien May 10, 2011 at 10:40 pm

@ Deanna

im t1 diabetic.. a very low carb diet will generate a fasting blood sugar in the 80′s in many cases (especially for a T2)


Damien May 10, 2011 at 11:40 pm

Hey Chris,

great presentation..

I have a great TG/HDL ratio of 1.03 BUT my LDL is at 220 aprox (whereas prior to low carbing it was only <100… Question is when ones LDL converts to pattern A via low carb high, saturated fat eating diet (as is my diet) does this cause the LDL to become elevated on lab tests becuase the particle size has increased -so it weighs more (as it is the weight that is being measured)?


SY May 31, 2011 at 11:33 am

Well said!


Joe Kunkel June 5, 2011 at 3:55 am

Chris, I think you are brilliant and very generous to share your time and knowledge. I believe you could have saved my mother’s life if we had this info 8 years ago. No one will ever know the extent of how many people you are helping by sharing your research and sharing it in a way that laymen can understand. Thank you.


Cancel reply

Leave a Comment

Previous post:

Next post:

Designed by Evan Haas & Soy Pak