Monday, June 25, 2012

Do Paleo Diets Result In Higher Cholesterol?

I came across the blood work of someone (27 year old male, 6'1, 195, no previous medical issues) who had been following what he called a "Paleo" diet. (The photo is not of him.) It was on a public forum:

I geeked. 18 monts Post Paleo, first Blood-test Results, PaleoHacks, February 2011

These were his numbers after 18 months of his diet:

Fasted Blood Glucose - 93mg/dL
Cholesterol, Total - 377
Triglycerides - 86 mg/dL
HDL Cholesterol - 72 mg/dL
vLDL Calc - 17 mg/dL
LDL Calc - 288 mg/dL
25-Hydroxy - 62.8 ng/mL
A1C - 5.5
CRP - 0.75 mg/L
TSH - 2.150 uIU/mL
T4,Free(direct) - 1.2 ng/Dl
T3 - 69 ng/DL

He said he was eating:
"... a cyclical ketogenic paleo diet. I eat probably 70% store bought meat/30% grass-fed meat. I take a tablespoon fish oil when I eat the standard meat (works out to be 3-4grams of EPA/DHA). Other fat sources come from pastured butter, coconut, avocado, some olive oil (only as dressing)."
A ketogenic diet, a diet that generates ketones, is a low-carbohydrate diet. If you are not eating much carbohydrate, you are eating mostly fat and protein, which jives with his meaty diet description.

I thought his total cholesterol, LDL cholesterol, and possibly his HDL (since high HDL is not always good) were high. I was surprised since he had recently lost weight (quite a bit, 22% of his former body weight, from 250 to 195), worked out regularly, and is in the youthful prime of his life, all factors that favor lower cholesterol numbers. Perhaps they are lower than his baseline numbers though, which aren't given.

There is one thing .. higher blood glucose tends to raise LDL because the LDL receptor, and the LDL particle itself, become coated in glucose.1 You can't clear these fats from your blood as easily. I saw that his fasting glucose and HbA1c are just a touch high. A high-fat diet is known to alter gut flora and increase insulin resistance, which can, by different mechanisms, result in higher blood glucose. Well, neither here nor there, is it ... I'm only speculating.

What I'm wondering ... Do Paleo diets typically result in higher cholesterol?
1 Hyperglycemia, Lipoprotein Glycation, and Vascular Disease, Angiology, 2005.
Photo from NPR: "Vlad Averbukh, 29, a follower of the paleo diet, eats raw meat along the Hudson River in New York in 2010."


Ezer said...

My diet is primarily plant-based (in volume), though I consume meat every day. I have reduced the quantity of butter that I consume after a blood test. Tough my HDL had increased and my trigs reduced, my LDL had increased too much.

>>Cholesterol total: 251 mg/dL
>>Trigs: 58 mg/dL
>>HDL: 80 mg/dL
>>VLDL: 12 mg/dL
>>LDL: 159 mg/dL

Ezer said...
This comment has been removed by the author.
Anonymous said...

Where are the carbs coming from to raise his blood sugar if he eats low-carb?

Bix said...

Well, the carbs could be coming from his body, from stored glucose (stored as glycogen), in a process caled glycogenolysis.

Another process, called gluconeogenesis, can also produce glucose. It gets raw material from the backbone of triglyceride (the 3-carbon glycerol), or from protein (from amino acids with 3- or 4-carbon side chains).

However, some degree of insulin resistance could be allowing his blood glucose to rise above normal, even when the source of the glucose is his own body.

The carbs could also be coming from his diet. He said he eats a "cyclical ketogenic paleo diet." So there is a time in his cycle when he is eating more carbs. Again, any level of insulin resistance could be making these carbs difficult to clear.

Steve Parker, M.D. said...

Frasseto's group at UCSF found a 22% drop in LDL cholesterol by switching to a paleo diet, and a 16% drop in total cholesterol.



Bix said...

It's an interesting 10-day study, Steve. From my reading I would say low-carb diets have benefit in the short term, but may be harmful in the long term. I wonder what these 9 people's numbers would be like after a year and a half on their paleo diet.

This large Swedish study I posted about recently found, again, a benefit in the short term which eroded over time:

"Initially beneficial and thereafter deleterious changes in blood cholesterol paralleled these trends in food selection."

Philippa said...

Gary Taubes posted his own numbers in this post:, and to my knowledge he's been eating this way for quite a while.

His glucose is 86, TC = 204, LDL = 116, HDL = 68 and vLDL = 19, so by & large it's in the same ballpark except for TC and LDL which are both considerably lower.

Another factor that can affect numbers is recent and ongoing weightloss. Dr. Davis warns that it can be better to measure one's lipids once the weightloss has stabilized.

Bix said...

Well, how about that. Thanks so much for posting this, Philippa.

I wonder ... if someone who ate the standard American diet had these numbers, would we say he was in good health? I mean, perhaps we would.

Bix said...

What Taubes eats:

"I do indeed eat three eggs with cheese, bacon and sausage for breakfast every morning, typically a couple of cheeseburgers (no bun) or a roast chicken for lunch, and more often than not, a ribeye or New York steak (grass fed) for dinner, usually in the neighborhood of a pound of meat. I cook with butter and, occasionally, olive oil (the sausages). My snacks run to cheese and almonds. So lots of fat and saturated fat and very little carbohydrates. A deadly diet, according to Dr. Oz. "

From the link Philippa posted.

Bix said...

If I ate like this I would be worried about cancer.

Philippa said...

It's certainly a lot richer than what I eat, Bix, but Taubes is a lot larger than me and I suppose it agrees with him.

After I posted the link to the GT post, it occurred to me to mention that C-reactive protein levels are probably a good objective gauge of whether someone is on the right track or not. The guy in your post above has CRP of 0.75 (generally a reading below 1 is considered low), and I don't know what GT's is. I also don't know whether CRP is a good predictor of cancer, but I do know that it flags underlying inflammation.

Bix said...

Good point about the CRP, Philippa. I noted that too, that it was low both in this gentleman and Taubes.

However, fish oil can lower markers of inflammation, like CRP. It can also lower triglycerides. And he was taking 3-4 grams. Which is not a small amount.

Here's one study:

I'm not saying it's good to take fish oil, I don't know. I also don't understand how lowering just a marker for a disease (like CRP, or even various cholesterols) (especially with drugs) can lower the development of the disease itself. Statins lower cholesterol, but do they make us live longer? I'm not being sarcastic or anything, I truly don't know.

Anyway, I'm glad you brought this point up.

Bix said...

High fat diets are also linked to lower sperm counts:

Bix said...

There were a few big epi studies out of Harvard recently that found those who ate the most meat had more cancer deaths.

Dr. Gregor said:

I think the most interesting finding in the new Harvard studies is that even after factoring out known contributors of disease, such as saturated fat and cholesterol, they still found increased mortality risk, raising the question: what exactly is in the meat that is so significantly increasing cancer death rates, heart disease, and shortening people’s lives? A few possibilities include heme iron, nitrosamines, biogenic amines, advanced glycation end products, arachidonic acid, steroids, toxic metals, drug residues, viruses, heterocyclic amines, PCBs, dioxins, and other industrial pollutants.

There just seems to be a lot of things in meat, or foods higher in the food chain, that could cause problems. Many of the things Gregor lists weren't around in paleo days, which may have made meat a safer food back then?

Philippa said...

If I understand you correctly, I think you're suggesting fish oil might only (temporarily perhaps?) artificially lower the marker for inflammation, and not the inflammation itself.

My understanding is that inflammation is inflammation, and while noone is healthy 100% of the time, the goal for a long & healthy life is to keep doing what it takes to reduce it over the long term. There are many studies that find a strong inverse relationship between CRP & cancer. This makes complete sense to me, if cancer is a disease that is borne out of chronic inflammation, or the body's inability to control inflammation, which are 2 slightly different things.

I suppose the real argument between the LC and the LF/vegan groups is about which foods are responsible for lowering that chronic inflammation.

Everyone seems to be in agreement about the effects of sugar and refined carbs. The issue is whether it's fat and meat, or grains. Although my bias is against a wholly plant-based diet (I simply don't understand the rationale for a diet that doesn't include pastured eggs), I also find it hard to believe it's good for anyone to eat bacon and sausages every single day.

Since there are so many good arguments and increasingly, research, from both sides, I have to wonder if both groups can be right, as long as you don't mix them up together, don't eat in excess and ensure you add in plenty of exercise.

john said...

honestly speaking, I have on a paleo diet for 2 months and my cholestrol level have lowered down according to my doctor. As long theres no refined or processed food, you should not worry about high cholestrol level. This video explains everything. It also includes how it also helps with weight loss. visit at paleo diet

Bix said...

Yes, I'm of the opinion that you can do things that will change your numbers without that necessarily improving your health.

The authors of that CRP link said:

"Atherogenesis is a complex process involving both a low-grade inflammation and a disturbed lipid profile. Although dietary fish and fish oil improve the latter of these two risk factors, their impact on the former is less clear."

So, although fish oil decreased CRP and IL-6, it's not clear, to them at least, how or whether that improves artery health.

Regarding inflammation and cancer, I have come to understand that the immune system's inflammatory processes can both inhibit cancer and cause it. And of course cancer can cause inflammation. I am really humbled by it all.

Anonymous said...

If you're going paleo, it should be with wild game meat from environmentally decent areas; or at the least, certified organic meat from free range animals, such as buffalo.

Paleo on commercial meat is just foolish.

Bix said...

Philippa, I woke up this morning and thought I was being too defensive yesterday. And I wanted to say, now that I'm a little less knee-jerk, that a lot of what you said makes sense, and I agree with it. I find a low-carb diet, such as the one Taubes eats, as well as a vegan diet, too extreme. I think a healthful diet, for most people, lies somewhere between those poles.

I also thought that the last thing you said, about both groups being right, was really a wonderful take on it. Something I can learn from. I'm more apt to say both groups are wrong. But if I say that I'm shutting out their good arguments, as you said. And "don't eat in excess and ensure you add in plenty of exercise,"... how is that not good advice!

Anonymous said...

If the Paleo Diet fad was so healthy and responsible for brain growth, then why didn't the Neanderthals survive and thrive? They had 300,000 years in Europe following the diet to make themselves into "Einsteins!" Speaking of Albert Einstein, this is what he had to say on the subject of health and survival: "Nothing will benefit human health and increase the chances for survival of life on earth as much as the evolution to a vegetarian diet." &

Low Carb vs. Plant-Based

Laurie Endicott Thomas said...

Why I think the Paleo diet is silly:

Ben P. DaSalt said...

Bix asked,
“Do Paleo diets typically result in higher cholesterol?”

Yes, well, the more low carb paleo diets. There’s plenty of debate on within the paleo blogosphere whether paleo needs to be low carb or high meat per se.

In general the paleo camp tends to reject the notion that high cholesterol is undesirable. Many proponents may even consider high cholesterol favorable.

Bix said,
“There were a few big epi studies…”

Camp paleo/low carb tend to write off epidemiology as uninformative so there isn’t much use in bringing it up, at least not to them.

And of course, the high amounts of meat is horrible for the environment. There was yet another recent study stating exactly this.

And no. grass-fed cattle doesn’t mitigate this problem and arguably exasperates some concerns.

Re: Taubes,
For a science writer, a person who one would think feels strongly about where the science should direct us, one would think that Taubes would have something to say about the environmental impact if everyone followed his way of eating.

I generally notice that if the paleo advocates even mention the environment, they tend to be the libertarian strain that doesn’t accept climate change of feels that environmental problems associated with animal foods is far left leaning liberal bunk or fall back on the popular, “the scientists are all wrong” or corrupted, misguided, etc.

If paleo advocates do mention environmental concerns of meat production, it’s in promotion of pastured, natural production without much supporting research to support that this is at all a viable alternative. Yes, I know there are plenty of popular sources of this idea (books and films), but very little in the way of studies done claiming that:

a) pastured livestock rearing makes any substantial difference, or
b) that it is even all the feasible for most everyone (China and India too) a have diet like Gary Tuabes and have it be from pastured sources.
c) also, I hardly hear fishery depletion addressed at all.

One popular retort to environmental pressure of everyone eating meat is to simply state that human population is the problem and that there should be fewer people around similar to our hunter-gather ancestors. This assertion is of course worthless. There are seven billion people here now. Nine billion people will be here in the near future. No one is going to enact birth control laws or offer to ”relocate” a few billion souls off of the planet.

Taubes said,
“A deadly diet, according to Dr. Oz.”

Um. No. According to mainstream nutritional organizations. Though I don’t think they would say “deadly,” more that there are associated risk factors. Dr. Oz doesn’t create the knowledge he espouses and he isn’t being irresponsible by promoting ideas of the scientific establishment. I’m sympathetic with Taubes’ attempting to right what he views as bad science, but the debate shouldn’t be between a science writer and a television personality. We can’t really fault Bill Nye the science guy for opening science texts books and basing his show scripts off of what’s inside. Taubes should confine his criticism to the health organizations that compile the scientific literature and reached the conclusions that they did.

Re: Dr Gregor,
You can’t really cite Dr. Gregor as entirely impartial because he’s in the plant-based diet camp. Don’t worry, your hands are not tied because there’s plenty of disagreement in the paleo/low carb/ancestral health blogosphere. There’s not nearly as much consensus as the paleo diet label suggests. Whose paleo diet? Which guru is someone following?

One time paleo promoter, Kurt Harris, sums it up.

BIx said,
“Many of the things Gregor lists weren't around in paleo days, which may have made meat a safer food back then?”

More like it was irrelevant whether or not anything may have caused cancer or reduced longevity back then so long as it our ancestors could live long enough to reproduce and raise successful offspring. That’s all evolutionary fitness means.

Bix said...

I just watched that YouTube the anonymous commenter linked:

There was a statement at the end I agree with: "People getting rich selling diet books are fair game." If people place themselves in the public eye, voluntarily, they invite criticism. Still, calling someone fat in such a public way strikes me as mean-spirited.

I would expect someone promoting a weight loss diet to be slender, to use themselves as an advertisement. But we don't know what other conditions, mental or physical, these people deal with. Also, to point to one person who fails on a diet (or, for that matter, succeeds) is just a testimonial, not statistically worthwhile.

The video employs ad hominem arguments, "attempts to negate the truth of a claim by pointing out a negative characteristic or belief of the person supporting it."

Ben P. DaSalt said...

Bix said,
“The video employs ad hominem arguments,”

That’s not the best demonstration of the term ad hominem. It’s more of an ad hominiem if the characteristic being pointed out isn’t at all relevant. (i.e. “Atkins didn’t like puppies! So don’t listen to him!” (Or whatever).

But if someone is making claims regarding weight control and overall health, it is somewhat valid to point out that they are overweight because if the diet works so well, surely they would practice it and surely the results would be tangible on their own person. If you hire a personal trainer, you’re just going to be more confident in achieving results if that person has a decent physic than if they don’t.

Ben P. DaSalt said...

Bix said,
“I just watched that YouTube the anonymous commenter linked”

The problem with the linked video is that it isn’t all that obvious that all of those low-carb proponents are overweight.

Low-carb’s main shtick is weight loss, so It’s not entirely unfair to point out that many of their gurus have body mass index scores in the range of overweight. Evelyn at Carb Sane Asylum is a low-carb practitioner who has been the most critical in pointing out this discrepancy. I don’t think she’s being unfair.

With that said, I’m not all the keen on that video. Vegans who are more into social justice than health dieting for the sake of ultimate longevity aren’t thrilled with this video either because of issues of promoting body size as some ideal or resorting to fat shaming. I agree.

On the other hand, low-carb gurus tell people that they will get fat by eating fruit or grains or beans or whatever, sometimes it does take someone like Durianrider to smack his flat stomach on a YouTube video and laugh in their faces.

This works in reverse of course. I know plenty of thin meat-eaters and there are fat vegans. Though sure, in general, vegetarians tend to have lower BMI.

I have some sympathy for overweight low-carb gurus because they usually used to be obese and it’s not like someone is going to go from very obese to slim, they’ll still be overweight, but be much lower in size.

But then again, the amount of vegan bashing that takes place in the low-carb blogosphere is obnoxious. They are always comparing low-carb to vegan, which is odd since their issues should be with the mainstream. Incidentally, I notice that the tone of a few low-carb and paleo blogs can be abrasive and off-putting, calling people stupid, etc, where I don’t really witness this so much on other diet advocacy sites.

Some low-carb and especially certain paleo advocates make a career out of bashing vegetarians. So while I don’t see myself generating or endorsing such content as the low-carb versus plant-based video, some obnoxiousness delivered back at low-carb doesn’t seem all that unjust.

Some of the low-carb advocates shown in the video don’t engage in much vegan bashing though. Even though Dr. Davis considers himself an ex(health)vegetarian, I haven’t read anything by him that was aggressive towards vegetarians. He’s just doing his thing; what he thinks is right. A couple of the others conduct themselves well. Then again, a couple of them do have low-carb empires that peddle all sorts of products that have nothing to do with the diet they propose.

This is one general distinction between low-carb and plant-based diet advocates. Sure, the gurus all pitch books, but the plant-based one’s don’t have much else to sell you, maybe some choice supplements, but they pitch a whole-foods plant based diet, so their isn’t much else to sell (I can think of one exception). A few of the low-carb gurus sell plenty of junk foods, supplements, and weight loss concoctions that outright contradict what they advocate.

Health vegans do feel the need to contrast what they are doing with other diets, but I don’t engage in it on a combative level because I don’t see my veganism as comparable to a weight-loss strategy or longevity diet. I have wider motivations in mind that influence how I eat other than personal health. Anyway, I’m just glad the video compared plant-based versus low-carb and didn’t conflate the term vegan.

Finally, it’s just part of the game of diet advocacy that once you become a public figure, all eyes are on you and people are going to track when you get ill and when you die.

As a vegan, this happens to me once people find out I’m vegan. They size me up, visually measuring my fitness, as if that means anything. I haven't even made any claims. I’m tall with a normal BMI, actually on the high side of normal, but if people find out I’m vegan they will say that I’m too thin, clearly due to my diet. Of course, if I were at all overweight, I’d probably face far worse criticism for that.

Ben P. DaSalt said...

Philippa said,
“I have to wonder if both groups can be right, as long as you don't mix them up together, don't eat in excess and ensure you add in plenty of exercise.”

Health wise, I agree with you to an extent. Ethics (as low-carb is practiced) and environment wise? Not so much. But I’ll constrain the topic to health.

I heard Dr. Atkins say in an interview once that there are two ways to get to Tahiti (since we live on a globe) offering that low-carb and low-fat were on a circular path that met around the other side. There’s no reason to assume that only one way of eating is correct. We can debate minutia and extrapolate some possible outcomes, but really, we won’t know for sure until there is more real world data on long term low-carb outcomes.

One problem with low-carb is that a person without a weight problem doesn’t really have an incentive to sign on. It’s overweight people who gravitate toward low-carb with hopes of losing substantial body mass, which already skews the data set of their group. These people are going to be generally bad at staying on a diet and even if they lose weight, they will probably be slightly heavier than average.

It’s this original weight loss aspect of the diet that is a problem as well. By now, most people understand that low-carb can offer impressive weight-loss results for certain overweight individuals. Okay. We also know that losing weight can promote healthy biomarkers. Great. But what we don’t have much good long-term epidemiological evidence of, is whether low-carb is a good idea for people over the long haul. I tend to think that if someone can only control their weight with low-carb, they should probably do so; hopefully the lowered disease risk of being less heavy will offset and potential negative risks.

I don’t think otherwise “normal” weight people should bother with low-carb though. What for?

I’m sympathetic to low-carbers. If I were overweight, and nothing else worked to reduce my size, I probably would be convinced of low-carb diets. With a high population of overweight individuals in the United States, there is a legitimate question as to whether low-carb should be an option for this demographic. It’s a reason I’ve kind of made a hobby of following the low-carb blogosphere. The nutritional science is interesting.

What has never jived with me is such statements as, “Carbs make us fat.” Well, based on personal experience alone, no, not with me they don’t. And there is certainly plenty of literature to the contrary. Low-carb advocates would do themselves a favor by dropping such claims.

Ben P. DaSalt said...

Re: Fish Oil
“I take a tablespoon fish oil when I eat the standard meat”

The addition of fish oil in the posted diet to compensate for industrial meat is misguided. The assumption is that pastured meat is a good source of omega-3s. Yes, comparatively, pastured meat is “higher” than industrial meat, but both of them are lousy sources of omega-3s. If he wanted to replicate the amount of omega-3 of pastured meat in industrial meat, he should probably dip his pinky fingernail into that tablespoon of fish oil.

Curious Cook: Good Fats In Grass-Fed Beef?

Harold McGee:
“So is grass-fed beef a meaningful source of omega-3s? No. An entire grass-fed beefsteak contains hundredths of a gram of long-chain omega-3s, and less than a quarter of a gram of linolenic acid. You can get the same quantities from a couple of walnut pieces and a few grams—a very small bite—of salmon or oyster. Beef is wonderful stuff, and grass-fed beef is especially lean and flavorful, but it’s still beef.”

Some more from McGee on the topic here.
Curious Cook: Grass-Fed Beef vs. Farmed Salmon

(McGee seems unbiased on this issue, that’s why I cite him.)

I tend to think omega-3s are hyped in general, yes it’s important and beneficial, but so long is a diet is relatively healthy, and by that I side with the general consensus that whole-food colorful plants are a good idea to eat (whether mainstream, plant-based, low-carb, paleo, whatever.)

Too much omega-3 supplementation isn’t a good thing either, we have enough studies offering that omega-3 supplements either do a whole lot of nothing, or correlate with negative health risks. This notion that we suffer an imbalance of omega 3 to 6 is an idea that hasn’t been close to be proven true.

But I’m sure omega-3’s will come up in a post soon and I can add some more info then.

caulfieldkid said...


Bix has addressed the Omega 3s in the past.

You can look



or here

You can probably go back further, but I think that covers the relatively recent.


Ben P. DaSalt said...

Thank you caulfielkid,
I’m very aware of Bix’s past posts on omega-3, the one with the chart is one of my favorite. If I were making a more comprehensive comment on the subject, I would even cite the posts you did.
The omega-3 to 6 ration idea that some people are basing their entire dietary strategy is still speculative, an evolutionary hypothesis that grew legs without much real world evidence. I’m not entirely out on a ledge on this.

UK Food Standards Agency Workshop Report (2007) Older than the study you linked to, but I

“On the basis of this review of the experimental evidence and on theoretical grounds, it was concluded that the n-6:n-3 fatty acid ratio is not a useful concept and that it distracts attention away from increasing absolute intakes of long-chain n-3 fatty acids which have been shown to have beneficial effects on cardiovascular health.”
Harvard Medical feels that high omega 6 sources are protective
Again, I’m not saying omega3’s and 6’s aren’t important, it’s just that the hype and amount of concern surrounding the subject is overblown. Eat well. The essential fatty-acids will sort themselves out.
I’ll use the Okinawan example. No supplements and not as much fish as you’d think.
Fanatic Cook: Traditional Okinawan Diet: Sweet Potatoes

“Fish, which I assumed would have constituted a fair portion of their diet, didn't. At 1% of total calories, it's about one 3-ounce serving of fish a week.”

There are other examples of long-lived people not eating as much fish or “high” omega-3 sources as most people tend to assume they do.

deepika malhotra said...

Paleo Diet is basically what our ancestor used to eat millions of years ago, before agriculture came into existence . It is also referred as “Hunter’s Food” as they used to gather it from here and there by hunting animals or collecting from plants and trees