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Cardiovascular Health and Cholesterol

Cardiovascular Health | The Paleo Diet

Dear Dr. Cordain’s,

I’ve written to you several times over the past year, generally expressing my excitement and dismay about Paleo: excitement for what its done for me, dismay at what others think/say.

I’ve now been Paleo for exactly one year. I’m a 62 year old plant ecologist, generally healthy and active, ex-volleyball athlete, summers spent backpacking in the Sierra Nevada; I thought I had a ‘good’ diet (good balance, no fast food, not too much fat, whole grains, lots of fruits and veggies, minimal pre-packaged foods, etc.) until I read your book The Paleo Answer. I now have two reviews on Amazon:  “sshhh” and “Gobsmacked”; I’ve bought 17 copies so far, so I think I can justify 2 reviews).

Anyway, I’m 5’7″, white male, no serious health issues except I’ve always had high cholesterol (286-308), slightly elevated thyroid marker (but no symptoms), minor psoriatic arthritis and psoriasis (pitted deformed nails only) for about ten years. Very active; hike vigorously weekly.

Weight   Total cholest.   HDL     LDL      Ratio tot/HDL     Triglyc.     TSH/T4            Vit. D   Homocyst.    CRP

2008:              145             299            74         206             4.0                    94            5.45/?                  ?              ?             < 10.0

2011               145              286            78         187             3.6                  105           5.98/0.8               22
(3 months
pre-paleo)

March 2012    134            249              92         148             2.7                    47           5.79/1.0                33
(3 weeks
paleo, + sun!!)

Aug. 2012        130            225              86        127              2.6                    58           5.37/0.9               44           8
(5 mo. paleo;
2 days after major
week backpack trip)

March 7, 2013  128           268 !!           96        162             2.8                      48           5.89/?                  43           9           < 10.0
(1 yr paleo)

In a nutshell, I’ve been wildly excited about my improvements (nails are clear, arthritis gone, sleep better, etc etc etc.), until yesterday when my blood work showed an increase in both total chol (up 40 points!) and LDL (same). Now I’m totally confused, bummed, and I can’t even crow to my family anymore. Yes, HDL continues to rise (cleaning up inflammation?), but what’s up with the LDL? I’m wondering if my habits immediately prior to this latest test would affect the numbers?  Strict Paleo (lots of smoked salmon), good hike the day before test, 14 hours fasting (too long?)…. slight cold for the preceding week (yes, I have gotten a couple of colds – I have a 5 year old in kindergerm… I mean kindergarten – but they hardly affect me), slight sunburn getting my Vit. D (yes, I live in Calif!)

Apologies again, but if you have any quick thoughts to share, I would GREATLY appreciate it. otherwise I will continue to slug it out with my dr. who wants to put me on statins and doesn’t ‘get’ paleo at all….  maybe retest in a few weeks with different lead-in behaviors?  I’m baffled. and yes, bummed. My wife now says I’m a fool for believing this stuff.

Charlie, Lafeyette, CA

PS  I’ve been corresponding with Lynda Frasetto and have a date scheduled to meet her and discuss if i might be able to help her develop their Paleo research program. Now I’m totally curious about longer term paleos.

Dr. Cordain’s Response:

Hi Charlie,

Many thanks for your long time support of The Paleo Diet over the years and for your positive comments about my books on Amazon.  Your questions about the Paleo Diet and its impact upon blood lipid and cholesterol levels are important and resonate across the Paleo Diet community.  I have taken the liberty to pass your blood workup results to professional colleagues: 1) James O’Keefe, M.D., world renown cardiologist at St. Luke’s and 2) Maelan Fontes, an internationally recognized nutritionist from Spain. Their input into your blood lipid figures are consistent with mine.

Essentially, your cardiovascular disease (CVD) risk has been reduced following your adoption of the Paleo Diet despite your increase in LDL cholesterol and total blood cholesterol (TBC).  First and most importantly for CVD risk is not your TBC concentrations, but rather your ratio of TBC/HDL Cholesterol.  From your numbers below, it is apparent the the TBC/HDL ratio declined following your adoption of the Paleo Diet.  Lower numbers for the TBC/HDL ratio represent reduced risk for CVD.  Your numbers are excellent.  Not only are your blood  HDL cholesterol concentrations exemplary and healtful, so are your low total blood triglyceride concentrations (TG).  The laboratory that measured your blood lipids failed to fractionate LDL into its two components: 1) small dense LDL, and 2) fluffy LDL.  Without these numbers, total LDL in regard to CVD risk is unclear.  Small dense LDL promote CVD, whereas fluffy LDL reduce CVD risk.  Based upon your TBC/HDL ratios and your low TG, it is almost certain that the elevations of your LDL and TBC are a result of fluffy LDL and increases in HDL, and not increases in small dense LDL.  Hence, your adoption of the Paleo Diet has significantly reduced your risk for CVD.  Keep up the good work.  Below are Dr. O’Keefe’s comments and those of Maelan Fontes.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

James O’Keefe’s Response:

LDL would definitely be large fluffy non-atherogenic particles. The HDL is near 100 and the ratio of Total Cholesterol to HDL is excellent. This is a low risk profile. Overall looks good.

Maelán Fontes’ Response:

When I look at Staffan Lindeberg’s data from Kitava I sometimes have doubts about what is normal or not. Their lipids profile is not excellent (LDL and TG not better than Swedes) but they don’t suffer from CVD at all. Perhaps a paleolithic diet is cardio protective independently of biomarkers, to some extent. A low anti nutrient/bioactive compounds (gliadin, lectins, saponins, miRNA, exorphins, etc, etc) diet may be the clue to the excellent result shown with the short term trials with paleolithic diets.

So, this patient with this low risk profile plus eating a Paleolithic diet shouldn’t have any problems.

All the best,

Maelán

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