Low Heart Disease Risk On a Low-Carb, High Fat, Paleo Diet

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My blood lipid panel on a low-carbohydrate, paleo diet

Recently I went to the doctor for a checkup, and he ordered a blood lipid panel, which indicates, or is supposed to indicate, heart disease risk.

The levels of various blood lipids are associated with heart disease, but lipids probably don’t cause it, even though mainstream medicine has tried for years to convince us that cholesterol, a required constituent of cells and a steroid hormone precursor abundantly manufactured by the body for its requirements, causes arteries to narrow by accumulating in arterial walls.

By now, most of us know that the absolute level of total cholesterol is not at all a good indicator of heart disease risk. Here’s Dr. Malcolm Kendrick demolishing the cholesterol hypothesis in about one minute. How anyone can believe in the cholesterol hypothesis after watching this is probably not even worth talking to:

A number of studies have overturned the conventional cholesterol wisdom.

For example, the Honolulu Heart Program found that not only was there no association between total cholesterol and heart disease, but that those with the lowest cholesterol levels, in the bottom tertile, had the highest risk of death. “Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1·64, 95% CI 1·13–2·36).” Other studies have found the same. Another study found no association between cholesterol levels and either heart disease or all-cause mortality in persons over 70 years of age. In fact, above age 70, high cholesterol is associated with better health and longer life. And no one has ever found an association between cholesterol levels and heart disease in women. Weird that this evil molecule that binds to arterial walls has no effect in women and is protective after age 70.

Cholesterol also seems to be protective against cancer and infections. For instance, take a look at this chart, which shows World Health organization data, for men, all-cause mortality by cholesterol level. (Borrowed from Zoe Harcombe.) It can be seen that the higher the cholesterol level, the lower the risk of death.

Others have dealt with the cholesterol hypothesis and demolished it, so if you’re not familiar with the arguments, you can read Dr. Uffe Ravnskov or Dr. Malcolm Kendrick or the above-mentioned Zoe Harcombe.

Triglyceride/HDL ratio, the most important lipid marker

So, total cholesterol is no indicator at all of heart disease or mortality risk; however, a strong association between lipid levels and heart disease risk has been found in the ratio of triglycerides to HDL cholesterol. In Fasting Triglycerides, High-Density Lipoprotein, and Risk of Myocardial Infarction, researchers found that those with the highest triglyceride to HDL ratio, in the top quartile, had 16 times the heart disease risk of those in the lowest quartile. The ratio in the lowest quartile in this study was about 1.3. Other studies have found similar results. These lipids are likely not causal of heart disease either, but are related to insulin resistance and are markers for it; diabetics, who have 2 to 4 times the heart disease risk of non-diabetics, typically have elevated triglyceride levels and low HDL levels.

It’s generally accepted that a ratio of triglycerides to HDL below 2.0 is ideal, with a ratio of 6.0 or above as “much too high”.

Before I get to my numbers, a word about diet. We’ve been told for the last several decades to cut the fat, especially saturated fat, from our diets. But I’ve ignored that, as smart people everywhere are now doing, and I’ve been eating a low-carbohydrate, high fat, paleo-style diet for the past approximately 6 years, a diet that in olden times doctors would have said was going to give me a heart attack. We now know how wrong that is; not only that, but the doctors preferred alternative, the low-fat high-carbohydrate diet, can raise triglycerides, so it may actually increase risk of heart disease. Indeed, higher risk with more carbohydrates has recently been found. Of course, the low-fat diet also contributed to the obesity epidemic.

Here are the numbers from my lipid panel:

Total cholesterol: 241
Triglycerides: 41
LDL: 125
HDL: 92

My ratio of triglycerides to HDL is 0.45, which is an astonishingly low number, with less than 2.0 as ideal. My ratio of total cholesterol to HDL, an older measure of risk still used by many doctors, was 2.6, and according to the American heart Association, the ideal ratio is below 3.5. Allegedly this gives me well under half of the average risk of heart disease.

Heart disease risk on a low-carb, high fat, paleo diet appears nil

In light of everything outlined above, it appears that my low-carb high-fat diet has given me an extremely low risk of heart disease, at least judging by lipid numbers. My father developed heart disease at about age 50, and lived with it the rest of his life (although he died at a ripe old age), so knowing that my heart disease risk is low is important to me. You youngsters in the audience may not care as much, since heart disease rates and deaths have been on a steady decline for decades now. But when I was growing up, the risk of dying of a heart attack when we got older was something you thought about a lot if you were the least bit health conscious.

Now for the funny part. My doctor looked at my LDL levels, which, according to my lab work, were barely within optimal range, and told me to go on a low-fat diet. Needless to say, I’ve ignored him and have no intention of changing the way I eat, as that would be positively counterproductive. It’s obvious that my doctor knows little if anything about the studies I’ve outlined in this post, i.e. he’s ignorant, not to put too fine a point on it, and I imagine that one could expect the same knowledge and advice from the average doctor. Fortunately, I have enough knowledge and resources to be able to figure this out on my own, but many people do not, and they are at the mercy of their doctors. It’s possible that some doctors would want to prescribe me statins given my age, sex, cholesterol numbers, and family history of heart disease. That’s the reality of modern medicine.

Oh, another thing. When he examined me, my doctor told me I was in great shape and asked me whether I exercised and in what form. I told him I lifted weights a few times a week, at which he then told me I should do cardio. I don’t have any intention of changing that either.

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  1. Baron says:

    By low carb, how low do you mean? Less than 100 g per day of carbs?

    • P. D. Mangan says:

      Yes, almost always.

      • Baron says:

        Interesting. I ate low carb for over a decade. Then when I started lifting heavy weights, I found I had to increase carbs to get through the tough workouts. I also found that the increased carbs helped with my mood, as I’ve suffered issues with depression. I still eat lower carb though – but more like 1/4 to 1/3 of my calories from carbs.

        • P. D. Mangan says:

          I’ve never had a problem with low carb and weightlifting. I can easily lift hard for 75 minutes with no diminution in effort.

  2. Derek Wolf says:

    Right on, Mangan. These types of posts are great.

    I salute this post as I look forward to my breakfast that’s been prepared for me today: free range eggs cooked in coconut oil, with home-made turkey breakfast sausage.

    Think of how great it’ll be in 50 years when the old, high-carb low-fat nonsense as been completely dispelled. I’d wager there’s still hundreds of thousands of men and women who are suffering (especially re: hormones) due to lack of cholesterol and saturated fats. But with each post like this, you help illuminate the room for them.

    • P. D. Mangan says:

      Derek, thanks so much. It’s too bad that, as you say, it could take 50 years for the low-fat nonsense to fade away. Hopefully it will be sooner. But even the generation before me, that of my parents, didn’t buy this stuff; the tide turned quickly thanks to a propaganda effort by the government. If you want to read about the real, shocking truth, the blatant fraud, and the ignorance of science behind the low-fat crusade, I highly recommend Nina Teicholz’s book, The Big Fat Surprise.

  3. eah says:

    Butter ISN’T bad for you after all: Major study says 80s advice on dairy fats was flawed

    Dietary advice from 1983 ordered cut of dairy fats and increase of carbs — UK and US governments ‘practically destroyed’ dairy industry with advice — Advice to eat more carbs ‘to blame for obesity and diabetes epidemic’

    Keep up the great work Dennis.

    • P. D. Mangan says:

      Thanks, eah, and great article you posted. The atmosphere at the time was, “We have a novel, untested, and uncorroborated theory on diet and heart disease, so let’s try it on the entire population. What could go wrong?”

  4. Matt Flannagan says:

    I’ve been eating low-carb/paleo for the past week. Health wise I feel fine, better than ever really, but I’ve noticed I don’t wake up with an erection anymore or get erection during the day. Also they seem harder (no pun) to maintain when I do get them.

    I’ve done some googling and it seems related to blood circulation. I’d like to know if Mangan or anyone else is familiar with this condition and if so does it pass after some time on the paleo diet?


  5. Joshua says:

    That’s an amazingly high HDL number there, especially for a man. (For some reason, women seem to naturally have higher HDL.) I guess the trick for raising HDL is to eat lots of fat!

  6. Mark Sanders says:

    I’ve been trying to figure out a good health strategy for years as my mother was diabetic and my father died of heart disease. But my experiment with low carb/high fat that I tried for about a year and a half was a disaster. I developed all the standard symptoms of hypothyroidism — cold hands and feet all the time, sleeping 10 or more hours a day and still having low energy during the waking day, hair falling out, skin drying up. Then my cholesterol readings went into the stratosphere (they’ve have always been on the high side). Long story short, I ended up with an attack of angina and in the panic at the ER was convinced into getting a stent to open up a clogged artery in my heart. Also note that even though my blood sugar readings after eating were always good doing low-carb, my HbA1c readings were not – they were always over 6.0.

    I wish it had worked, because I never felt so calm in my life (perhaps I couldn’t make any adrenalin), and I discovered that wheat was the cause of my chronic heart burn.

    My point here is simply that some people react to certain diets and foods differently than other people.

  7. sabril says:

    What do you make of the fact that life insurance companies charge you extra if your cholesterol is high?

    I am willing to concede that cholesterol per se might not be as much of a problem as some other factor for which cholesterol is a proxy.

  8. tracy says:

    ha ha ha, well done. Love to prove the docs wrong, get them thinking outside their pharmecutical box eh. well done. I like this report.My mother wants me to advise her so I have to take into consideration her angina, and this report boosted me. thanks.

  9. Ole says:

    Heart attack is one thing, telomere length is another. This study found that SMSFA (raw butter, whole milk) affected telomere length. The exact reason is not fully understood, but inflammation could be the culprit. Chronic low-grade inflammation is associated with telomere shortening

  10. Paleo may be ok for folk who work out and burn the excess fat and protein. But the post paleo biblical diet was about 65% barley as baked loaves or cakes plus goat milk, and cheese, seldom lamb or beef. And the patriarchs lived to 80 y, some over 120 years like Moses, many leading strenuous lives. Of course living on vegetarian manna for 40 years without the diseases of the civilized Egyptians was a miracle, no longer applicable.
    Re cholesterol, 101 year old spritely and still active biochemist Dr Fred Kummerow argued for 50 years that oxidation products of cholesterol and lipids not the native lipids deposit as plaques in atherosclerosis, presumably avoidable by consuming anti oxidants, especially mega doses of ascorbate. Wikipedia has detailed info on Fred including his 2 diet books.

  11. Pieter says:

    Very well explained. I calculated my ratio and it’s 0,81. Breakfast has been 3 eggs with butter for the last 2 to 3 years.

  12. Very good, this article. These days people do not have time for anything else. They do not feed properly, thus generating various health problems.

  13. Isac says:

    What is your recommendation for anyone who wants to start a low carb diet?

  14. pzo says:

    Just discovered your most interesting site, sir.

    I discovered paleo/primal in 2009; lost 70 pounds, put some back on, on and off over the years. Just depended on how much I adhered to recording foods and exercising.

    Anyway, in January I was at about 240 pounds; a lipid panel showed my HDL/trig ratio to be actually negative! High HDL, low trigs and calculated LDL. Total was around 170, IIRC.

    Since then, I’ve lost 40 pounds, my morning blood glucose is usually around 85, no more metformin. Oh, I’m 71.

    Not on topic, but following advice on other men’s health sites that mirror yours, I started taking zinc, boron, and L. Reuteri probiotic after “low normal” testosterone results also in January. I have taken at least twenty years off of my decline. My already big balls are even bigger, Righty is 3″. Easy to erect with almost no stimulation. Literally slept with an ex-lover last month and I was so hard it hurt. (I respected her boundaries, as I always have.)

    I give blood as often as I can, FYI. I eat sat/monun/polyun fats in a 4:2:1 ratio. But I don’t shun some fun, a bit of pie or commercial fries. “the dose makes the poison.”

    Carry on!

  15. Very good, your tips and your tips, we know that heart disease is killing a lot of people around the world and I need to do a well controlled diet thanks for sharing.

  16. Laura says:

    The high HDL might also have something to do with exercise, although supposedly the effects are small.

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