Answer Day: What Causes High LDL on Low-Carb Paleo?

First, thank you to everyone who commented on the quiz. I enjoyed reading your thoughts.

Is High LDL Something to Worry About?

Perhaps this ought to be the first question. Jack Kronk says “I don’t believe that high LDL is necessarily a problem” and Poisonguy writes “Treat the symptoms, Larry, not the numbers.” Poisonguy’s comment assumes that the LDL number is not a symptom of trouble. Is it?

I think so. It helps to know a little about the biology of cholesterol and of blood vessels.

When cells in culture plates are separated from their neighbors and need to move, they make a lot of cholesterol and transport it to their membranes. When cells find good neighbors and settle down, they stop producing cholesterol.

The same thing happens in the body. Any time there is a wound or injury that needs to be healed, cholesterol production gets jacked up.

When people have widespread vascular injuries, cholesterol is produced in large quantities by cells lining blood vessels. Now, to repair injuries cells have to coordinate their functions. Endothelial cells are the coordinators of vascular repair: they direct other cell types, like smooth muscle cells and fibroblasts, in the healing of vascular injuries.

To heal vascular injuries, these cells not only need more cholesterol for movement; they also need to multiply. It turns out that LDL, which carries cholesterol, also causes vascular cells to reproduce (“mitogenesis”):

The best-characterized function of LDLs is to deliver cholesterol to cells. They may, however, have functions in addition to transporting cholesterol. For example, they seem to produce a mitogenic effect on endothelial cells, smooth muscle cells, and fibroblasts, and induce growth-factor production, chemotaxis, cell proliferation, and cytotoxicity (3). Moreover, an increase of LDL plasma concentration, which is observed during the development of atherosclerosis, can activate various mitogen-activated protein kinase (MAPK) pathways …

We also show … LDL-induced fibroblast spreading … [1]

If endothelial cells are the coordinators of vascular repair, and LDL particles their messengers to fibroblasts and smooth muscle cells, then ECs should be able to generate LDL particles locally. Guess what:  ECs make a lipase whose main effect is to decrease HDL levels but can also convert VLDL and IDL particles into LDL particles and remove fat from LDL particles to make them into small, dense LDL:

Endothelial lipase (EL) has recently been identified as a new member of the triglyceride lipase gene family. EL shares a relatively high degree of homology with lipoprotein lipase and hepatic lipase …

In vitro, EL has hydrolyzed phospholipids in chylomicrons, very low density lipoprotein (VLDL), intermediate density lipoprotein and LDL. [2]

Immune cells, of course, are essential for wound healing and they should be attracted to any site of vascular injury. It turns out that immune cells have LDL receptors and these receptors may help them congregate at sites of vascular injury. [3]

I don’t want to exaggerate the state of the literature here:  this is a surprisingly poorly investigated area. But I believe these things:

1.      Cholesterol and LDL particles are part of the vascular wound repair process.

2.      Very high LDL levels are a marker of widespread vascular injury.

Now this is not the “lipid hypothesis.” Compare the two views:

  • The lipid hypothesis:  LDL cholesterol causes vascular injury.
  • My view:  LDL cholesterol is the ambulance crew that arrives at the scene of the crime to help the victims. The lipid hypothesis is the view that ambulance drivers should be arrested for homicide because they are commonly found at murder scenes.

So, to Poisonguy, on my view high LDL numbers are a symptom of vascular injury and are a cause for concern.

Big-Picture View of the Cause of High LDL

So, on a micro-level, I think vascular damage causes high LDL. But what causes vascular damage?

Here I notice a striking difference in commenters’ perspectives and mine. I tend to take a big-picture, top-down view of biology. There are three basic causes of nearly all pathologies:

1.      Toxins, usually food toxins.

2.      Malnutrition.

3.      Pathogens.

The whole organization of our book is dictated by this view. It is organized in four Steps. Step One is about re-orienting people’s views of macronutrients away from high-grain, fat-phobic, vegetable-oil-rich diets toward diets rich in animal fats. The other steps are about removing the causes of disease:

1.      Step Two is “Eat Paleo, Not Toxic” – remove food toxins.

2.      Step Three is “Be Well Nourished” – eliminate malnutrition.

3.      Step Four is “Heal and Prevent Disease” – address pathogens by enhancing immunity and, where appropriate, taking advantage of antibiotic therapies.

So when someone offers a pathology, any pathology, my first question is: Which cause is behind this, and which step do they need to focus on?

In Larry’s case, he had been eating low-carb Paleo for years. So toxins were not a problem.

Pathogens might be a problem – after all, he’s 64, and everybody collects chronic infections which tend to grow increasingly severe with age – but Larry hadn’t reported any other symptoms. More to the point, low-carb Paleo diets typically enhance immunity, yet Larry had fine LDL numbers before adopting low-carb Paleo and then his LDL got worse. So it wouldn’t be infectious in origin unless his diet had suppressed immunity through malnutrition – in which case the first step would be to address the malnutrition.

Step Three, malnutrition, was the only logical answer. The conversion to Paleo removes a lot of foods from the diet and could easily have removed the primary sources of some micronutrients.

So I was immediately convinced, just from the time-course of the pathology, that the cause was malnutrition.

Micronutrient Deficiencies are Very Common

In the book (Step Three) we explain why nearly everyone is deficient in micronutrients. The problems are most severe for minerals:  water treatment removes minerals from water, and mineral depletion of soil by industrial agriculture leads to mineral deficiencies in farmed plants and grain-fed animals.

This is why our “essential supplements” include a multimineral supplement plus additional quantities of five minerals – magnesium, copper, chromium, iodine, and selenium. Vitamins get a lot of attention, but minerals are where the big health gains are.

Copper Deficiency and LDL

Some micronutrient deficiencies are known to cause elevated LDL.

Readers of our book know that copper causes vascular disease; blog readers may be more familiar with an excellent post by Stephan, “Copper and Cardiovascular Disease”, discussing evidence that copper deficiency causes cardiovascular disease. As I’ve just argued that cardiovascular disease causes high LDL, it shouldn’t be a surprise that copper deficiency also causes hypercholesterolemia:

Copper and iron are essential nutrients in human physiology as their importance is linked to their role as cofactors of many redox enzymes involved in a wide range of biological processes, as well as in oxygen and electron transport. Mild dietary deficiencies of both metals … may cause long-term deleterious effects in cardiovascular system and alterations in lipid metabolism (3)….

Several studies showed a clear correlation among copper deficiency and dyslipidemia. The main alterations concern higher plasma CL and triglyceride (TG) concentrations, increased VLDL-LDL to HDL lipoproteins ratio, and the shape alteration of HDL lipoproteins.  [4]

The essentiality of copper (Cu) in humans is demonstrated by various clinical features associated with deficiency, such as anaemia, hypercholesterolaemia and bone malformations. [5]

Over the last couple of decades, dietary copper deficiency has been shown to cause a variety of metabolic changes, including hypercholesterolemia, hypertriglyceridemia, hypertension, and glucose intolerance. [6]

Copper deficiency is, I believe, the single most likely cause of elevated LDL on low-carb Paleo diets. The solution is to eat beef liver or supplement.

So, was my advice to Larry to supplement copper?  Yes, but that was not my only advice.

Other Micronutrient Deficiencies and Elevated LDL

Another common micronutrient deficiency that causes elevated LDL cholesterol is choline deficiency that is NOT accompanied by methionine deficiency. That is discussed in my post “Choline Deficiency and Plant Oil Induced Diabetes”:

Choline deficiency (CD) by itself induces metabolic syndrome (indicated by insulin resistance and elevated serum triglycerides and cholesterol) and obesity.

A combined methionine and choline deficiency (MCD) actually causes weight loss and reduces serum triglycerides and cholesterol …

I quote both these effects because it illustrates the complexity of nutrition. A deficiency of a micronutrient can present with totally different symptoms depending on the status of other micronutrients.

Julianne had a really nice comment, unfortunately caught in the spam filter for a while, with a number of links. She mentions vitamin C deficiency and, with other commenters, noted the link between hypothyroidism and elevated LDL. As one cause of hypothyroidism is iodine or selenium deficiency, this is another pathway by which mineral deficiencies can elevate LDL.

UPDATE: Mike Gruber reduced his LDL by 200 mg/dl by supplementing iodine. Clearly iodine can have big effects!

Other commenters brought up fish oil. They may be interested to know that fish oil not only balances omega-6 to modulate inflammatory pathways, it also suppresses endothelial lipase and thus moderates the LDL-raising and HDL-lowering effect of vascular damage:

On the other hand, physical exercise and fish oil (a rich source of eicosapentaenoic acid and docosahexaenoic acid) suppress the activity of EL and this, in turn, enhances the plasma concentrations of HDL cholesterol. [7]

Whether this effect is always desirable is a topic for another day.

My December Advice to Larry

So what was my December advice to Larry?

It was simple. In adopting a low-carb Paleo diet, he had implemented Steps One and Two of our book. My advice was to implement Step Three (“Be well nourished”) by taking our recommended supplements. Eating egg yolks and beef liver for copper and choline is a good idea too.

Just to cover all bases, I advised to include most of our “therapeutic supplements” as well as all the “essential supplements.”

Since December, Larry has been taking all the recommended supplements and eating 5 ounces per week of beef liver. As I noted yesterday, Larry’s LDL decreased from 295 mg/dl to 213 mg/dl, HDL rose from 74 mg/dl to 92 mg/dl, and triglycerides fell from 102 to 76 mg/dl since he started Step Three. This is all consistent with a healthier vasculature and reduced production of endothelial lipase.

Conclusion

Some people think there is something wrong with a diet if supplements are recommended. They believe that a well-designed diet should provide sufficient nutrition from food alone, and that if supplements are advised then the diet must be flawed.

I think this is quite mistaken. The reality is that Paleolithic man was often mildly malnourished, and modern man – due to the absence of minerals from treated water and agriculturally produced food, and the reduced diversity and higher caloric density of our foods – is severely malnourished compared to Paleolithic man.

We recommend eating a micronutrient-rich diet, including nourishing foods like egg yolks, liver, bone broth soups, seaweed, fermented vegetables, and so forth. But I think it’s only prudent to acknowledge and compensate for the widespread nutrient depletion that is so prevalent today. Even when nutrient-rich food is regularly eaten, micronutrient deficiencies are still possible.

Eating Paleo-style is not enough to guarantee perfect health. Luckily, supplementation of the key nutrients that we need for health and that are often missing from foods will often get us the rest of the way.

References

[1] Dobreva I et al. LDLs induce fibroblast spreading independently of the LDL receptor via activation of the p38 MAPK pathway. J Lipid Res. 2003 Dec;44(12):2382-90. http://pmid.us/12951358.

[2] Paradis ME, Lamarche B. Endothelial lipase: its role in cardiovascular disease. Can J Cardiol. 2006 Feb;22 Suppl B:31B-34B. http://pmid.us/16498510.

[3] Giulian D et al. The role of mononuclear phagocytes in wound healing after traumatic injury to adult mammalian brain. J Neurosci. 1989 Dec;9(12):4416-29. http://pmid.us/2480402.

[4] Tosco A et al. Molecular bases of copper and iron deficiency-associated dyslipidemia: a microarray analysis of the rat intestinal transcriptome. Genes Nutr. 2010 Mar;5(1):1-8. http://pmid.us/19821111.

[5] Harvey LJ, McArdle HJ. Biomarkers of copper status: a brief update. Br J Nutr. 2008 Jun;99 Suppl 3:S10-3. http://pmid.us/18598583.

[6] Aliabadi H. A deleterious interaction between copper deficiency and sugar ingestion may be the missing link in heart disease. Med Hypotheses. 2008;70(6):1163-6. http://pmid.us/18178013.

[7] Das UN. Long-chain polyunsaturated fatty acids, endothelial lipase and atherosclerosis. Prostaglandins Leukot Essent Fatty Acids. 2005 Mar;72(3):173-9. http://pmid.us/15664301.

Leave a comment ?

367 Comments.

  1. This study’s authors state that butter is twice as potent as an LDL elevating factor compared to coconut oil: http://www.jlr.org/content/36/8/1787.full.pdf

  2. Thanks, Travis. Yes, every fatty acid has different effects, and palmitic seems to have the strongest pro-LDL effect.

    I’ll be continuing the LDL series at some point, talking about its immune functions, and that may be a good time to consider under what conditions butter is beneficial.

  3. Hi Paul,

    I suffer from a similar ‘problem’, i.e. high LDL with normal HDL and Triglyceride levels. I have been on some form of a low carb diet (carb-cycling to be exact) for about 8 months. I never had my lipid profile done when I was eating a standard diet, but after 6 months of following a LC diet, I got it and these were the numbers:

    TC: 376
    HDL: 81
    TRIG: 83
    LDL: 286 (calc) (Iranian: 248)

    I was shocked at the high LDL, so I decided to make a few changes in my diet. For one, my carb-ups at the weekend tended to be very dirty (pizza, pastries, etc) so I completely cut out junk food and focused on ‘healthy’ carbs like potatoes, grains and rice instead. I also reduced my saturated fat intake on the low carb days by completely eliminating butter and cream, though I do have cheese occasionally. Most of the saturated fat in my diet now comes from nuts/nut butters, dark chocolate, olive oil and a little bit from chicken (no red meat). I was always taking multivitamins and fish oil, but I’ve upped the dosage now. This is my lipid profile after about 2 months of these changes:

    TC: 274
    HDL: 52
    TRIG: 61
    LDL: 202 (calc) (Iranian: 177)

    Even though my TC/HDL ratio and HDL aren’t as good, I’m glad the LDL has come down. Problem is, it’s still pretty high and I’m finding it hard to convince those around me that this new lifestyle I’ve embarked upon is as healthy as I say it is.

    For reference, my daily Copper intake from the multivitamin is 4mg, while Zinc is 50mg and Iodine 300 mcg. When I was taking a lesser dosage, these were all half of what they are now.

    Do you have any suggestions as to how I could go about decreasing my LDL further and possibly increase my HDL too? Keep in mind that I weight train 6 times a week with a couple of HIIT cardio sessions thrown in occasionally. I’m also quite lean, around 10-11% bodyfat. This is down from about 18-19% when I started out. Any help you can provide would be greatly appreciated.

  4. Hi Jarri,

    Are you taking double the normal multivitamin dose? Those dosages for zinc and copper are pretty high. I would probably cut the multi in half.

    First let me ask: your health is good? No evidence of infection?

    I did a post on ways to raise HDL: http://perfecthealthdiet.com/?p=3204

    I’ll be doing an upcoming series on LDL like the HDL series, I’ll have better answers for you after that.

  5. Jarri, you reduced your LDL by 29% in 2 months. That is fairly remarkable by any measure. Though you will see the rate peter out, there’s no reason why you shouldn’t assume that continuing to do what you’re currently doing isn’t going to result in further reductions. I’d be surprised if you didn’t get to around 200 mg/dl or lower, though I’m not convinced that the widely accepted magic number is all that important.

    Similarly, I’m certain that chicken fat is far less healthy than ruminant fat due to the excessive levels of linoleic acid.

  6. Hi Paul,

    I recently bought GNC’s Mega Men Heart which supposedly helps reduce LDL. I don’t really know if it works, but the main reason I bought it was because it has 1600IUs of Vitamin D, much more than their regular multivitamin. For the last few days, I’ve been taking both multivitamins together which in hindsight was unnecessary. I’ve now reverted back to the recommended serving of the Mega Men Heart.

    Regarding my health, I’m perfectly fine physically. No infections, in fact I can’t remember the last time I got sick. Don’t know if it’s relevant, but I have some issues psychologically which I’ve self-diagnosed as OCD. Haven’t tried to do anything about it and I’ve had it for years. Also, I tend to get nervous and anxious in certain situations and that causes my pulse and BP to increase significantly. When I’m relaxed, everything’s fine.

    I read your piece on HDL, some great info there. My only concern is that some of the foods that raise HDL also tend to raise LDL and it seems I’m a ‘hyperresponder’ to saturated fat from dairy especially, as evidenced by my first set of numbers when I was eating butter and cream regularly. I’ve never tried coconut oil though, does it affect LDL too?

    The last 5 weeks I’ve been trying to lose some bodyfat and have been successful; I’ve lost over 7 lbs. I don’t do a lot of cardio, just short sessions of high intensity weight training 6 days a week.

    Hi Travis,

    Thanks for the positive feedback. My main focus is on decreasing my LDL to something more acceptable, even if it’s higher than the 130 which is typically considered ok. It’s not that I believe in these numbers myself, but my parents and doctor do. It’s kind of hard to get them off my case unless the LDL comes down a bit more. They pay little attention to the TRIG and HDL, that’s just the way people are conditioned here. I won’t be concerned even if my TC is around 240, as long as my TC/HDL ratio and LDL improve. I’ve made a conscious decision to incorporate 2 tbsp of extra virgin olive oil/day in my diet as I’ve heard it can improve both HDL and LDL. Now considering coconut oil, but concerned that it may raise LDL too.

  7. And about the chicken fat, I have as much as can be found in half a chicken (breast and wing only), virtually everyday. I sometimes have tuna instead, but red meat is rarely eaten here except on specific occasions. I’ll do my best to incorporate some in the future.

    Forgot to mention, I used to have 6 eggs a day but have now cut them down to 3.

  8. I think olive oil would only decrease LDL if it were replacing another fat. Simply adding it on top of a diet shouldn’t make a difference. Coconut fat wouldn’t raise LDL as much as butter, but it still will.

    Without butter and cream reloading your lipoproteins with cholesterol, it will gradually decrease as it’s used to create vitamin D in your skin, steroid hormones etc. It’s just a theory, but I think supplementing with vitamin D instead of manufacturing it in the skin from UV-B & cholesterol causes higher LDL-C levels. Not sure about your latitude, but if it’s possible to get some sun, it should accelerate the process.

  9. Hi,

    Yes, I used olive oil to replace some of the nuts/nut butters I was having. Total fat intake is the same.

    I will go for the coconut oil once I get my LDL down to an acceptable value. About the Vitamin D, my supplement provides just 1600IUs which is well below the 4000-5000IUs I’ve seen recommended, so I would hope I can get the rest of it from the sun. My Vitamin D level was recently tested as being 38, so it’s not that high. The temperature in my part of the world these days is in the 40s (degrees Celsius), so there’s only so much time you can spend out in the sun!

    I find it kind of strange that we in the paleo community talk a lot about the studies that show saturated fat raising cholesterol, specifically LDL-C, as being poorly conducted or misinterpreted or biased, etc. Many people have blog posts debunking this cholesterol raising effect of saturated fat, yet, I often find commenters on such blogs stating matter-of-factly that the various SFAs do in fact raise LDL (though they also raise HDL). There are some experts who say the effect is only temporary and/or modest. Yet, through personal experience and reading anecodotes from others, it’s apparently not so modest or temporary for everyone. I guess maybe genetics play a part? Or maybe some people are just hyperresponders to SFAs? It could simply be a case of the levels reflecting the diet, rather than indicating any specific problem. Whatever the case, I hope there will be some research into this so people like me who adopt a carb-restricted diet and end up being surprised with their lab reports can feel more at ease with their choice.

  10. Hi Jarri,

    A 25OHD of 38 ng/ml isn’t bad; but is rather low if it’s nmol/l. I consider 40-45 ng/ml (100-115 nmol/l) to be optimal for Europeans. 1600 IUs is a good dose if you can get some sun. 2 of those would be good when you can’t.

    The LDL raising effect of saturated fat is specific to some fatty acids (eg palmitate) and depends on nutrient status. Also it depends on what you’re comparing it to — PUFA suppress LDL more than SaFA raise it, eating saturated fats is not much different than eating carbs for most people as far as LDL is concerned.

    But there is individual variability. My belief is that it has more to do with nutrient status than genes.

  11. Hi Paul,

    I’m Pakistani and I believe we tend to have poor 25OHD levels in general. So yes, 38 isn’t bad 🙂

    From whatever information I’ve gathered, it seems that myristic acid has the strongest LDL/HDL raising effect, which is in line with my n=1 experience with butter and cream. As you say, palmitic acid also raises LDL/HDL, ditto with lauric acid. In fact, the only SFA I can recall not really affecting LDL is stearic acid, which I believe is metabolised to oleic acid in the body. This is what I’ve gathered from whatever research I’ve gone through, though it may not all be foolproof.

    Could you elaborate on nutrient status? I’m not sure I understand what you mean by it.

  12. Hi Jarri,

    LDL has many functions in the body including immune and vascular wound healing functions. Malnourishment can produce high LDL levels if it induces oxidative stress in the vessels. I’ll have more in an upcoming blog series.

  13. Just got the results of my latest test:

    TC: 283
    HDL: 53
    TRIG: 61
    LDL(calc): 208 (Iranian 188)

    The numbers are slightly worse than my last test which wasn’t that long ago. It’s pertinent to note that I’ve been losing bodyfat regularly, lost about 3.6 lbs this last week. Could that explain the slightly higher Triglycerides and hence Total Cholesterol?

    For the LDL, I’m not sure if there’s anything I have not tried already. I’ve been gradually reducing total calories by reducing fat intake while keeping carbs+protein fairly constant, to keep the bodyfat loss going. I’ve used olive oil to replace the fat I was getting from nuts. I’m mostly avoiding exclusive sources of saturated fat, except a 40g serving of dark chocolate everyday. My multivitamin has 800mg of a phytosterol complex per and I keep taking it regularly. The only thing I’ve cut down on is fish oil. I was taking anywhere in the region of 2700-3600mg of EPA/DHA per day but it’s down to 900mg now.

    My Copper and Zinc seem to well covered and I’ve added 2000IUs of Vitamin D-3 to the 1600IUs I was already getting from the multi. Two things I’m not sure about are Magnesium and Iodine. My multi has 100mg and 150mcg respectively. Is that enough in addition to a low carb diet?

    Anyone with any ideas about how to bring the LDL down?

  14. Hi Jarri,

    Personally I would get rid of the phytosterols. Stephan has blogged about that: http://wholehealthsource.blogspot.com/2009/03/margarine-and-phytosterolemia.html.

    I think magnesium and iodine should be higher. Be sure to get enough potassium and salt too.

    Weight loss might be contributing, but I wouldn’t expect it to be the major factor. It’s good to continue the weight loss.

    Aerobic exercise will help. Fast-moving blood helps heal the vessels, and vascular damage leads to high LDL.

    Things I might try: NAC (N-acetylcysteine) for glutathione and antioxidant support, and more vitamin C. These will protect LDL against oxidation and also enhance immune function. Bone broth soups will enhance wound healing.

    Also, I wouldn’t go too low carb. Try to get close to 400 calories a day from starches.

    Best, Paul

  15. Hi Paul,

    Thanks for your response. I also heard Stephan say that phytosterols are ok in the short term to lower LDL (if someone wants to do that), provided long term use is avoided.

    I’m quite sure that I’m getting enough potassium and salt, but not sure how to increase the Magnesium or Iodine without further supplementation. Do you believe such supplementation would bring LDL down or do you recommend it for general health? The thing is, my health is perfectly fine and I seriously doubt I have any vascular injury which needs healing.

    I do high intensity weight training 6 days a week coupled with 10 minute sessions of HIIT cardio twice a week. Can’t do much more without burning myself out! I’ve reached a bodyfat percentage of below 9%, so I don’t plan on losing much further weight either.

    I get 300mg of Vitamin C from my multi and can definitely add some more. NAC I never heard of before, so I’ll try to look for it.

    I’m following a carb-cycling diet where my carb intake on the 6 low-carb days is around 60g (vegetables, dates/figs, a glass of milk, no starch) and on the high-carb day it’s around 400g (LOTS of starch).

    I’m thinking about adding some coconut oil to my diet to improve HDL, but I’ll take it easy just to be sure my LDL doesn’t rise too. I read an article by Mary Enig where she said that coconut oil tends to have different effects on lipids for different people. For those with high cholesterol, it typically lowers both total and LDL-C while simultaneously increasing HDL, whereas for those with low cholesterol, it raises both HDL and LDL. I’m hoping it proves to be the former in my case.

  16. Hi Jarri,

    Yes, I recommend magnesium and iodine for general health, but improving general health will usually improve biomarkers like LDL.

    I think your general approach and plan sounds good. You might find the NAC, C, magnesium, and iodine help significantly. Selenium is important too.

    Best, Paul

  17. Jarri,

    Are you dong any type of Intermittant Fasting? Going to 5 to 6 hours of eating and fasting the rest of the day lowered my LDL, and, probably more importantly, the percentage of small particle LDL measured directly.

  18. Ellen,

    That’s one thing I haven’t tried. Being a bit of gym rat, I’m a bit wary of not feeding for any longer than 12 hours at a strech. Regular meals throughout the day is usually how I operate.

    I’m thinking of giving IF a try. How often did you do it? Once or twice per week?

  19. Hi Jarri,

    I do it every day.

  20. Every day. I eat two meals a day, within 5 to 7 hours. I eat lunch and dinner. Usually around ll and 5. Find a schedule that is comfortable for you. Be flexible.

    I have been eating that way for years now. Much easier than three meals.

    I have read postings on the Fast-5 yahoo group from a number of people who are big exercisers who do this and feel great.

  21. I’ll try to incorporate IF eventually, but first I’m going to start supplementing with Magnesium, Iodine, NAC and Vitamin C as Paul suggested.

    The pills I bought have 500mg Magnesium, 500mg Vitamin C and 600mg NAC. I’ll get the Kelp tablets tomorrow hopefully.

    Adding up the contribution from my multi, I will be getting 800mg of Vitamin C and 600mg of Magnesium in total. Do you think this is a sufficient amount? At the moment, I get 150mcg of Iodine from my multi. How much more should I get from the Kelp tablets?

  22. Hi Jarri,

    Yes, that’s sufficient C/NAC/magnesium, maybe more than sufficient magnesium, I usually recommend 200-400 mg/day from supplements. You could consider taking the magnesium every other day.

    Kelp – for reasons Mario has discussed, the various bromine and metal contaminants found in kelp, I would limit kelp to below 1 mg iodine per day, and then switch to potassium iodide for 1 mg or more. I think 500-700 mcg iodine from kelp would be a good target to stay at for a while (> 1 month) before switching to iodine. On our recommended supplements page there’s a 3 mg iodine tablet that you can switch to next; cut it in quarters with a razor blade for 750 mcg, or halves for 1.5 mg.

    Best, Paul

  23. Thanks for that Paul, much appreciated!

    I also bought me some coconut oil. From what I understand, it’s expeller pressed from copra. The brand name is C.B.C Pure White Coconut Oil. Don’t know if you’ve ever heard of it, but it’s made in Singapore and the only one I could find here in my city. I’ve heard virgin coconut oil is even better but this is the best I could find. Do you believe it might give me some benefit if I start with an intake of about 1 tbsp per day? Obviously, I would like to increase my HDL and lower LDL.

  24. Hi Jarri,

    Yes, 1 tbsp per day is a good start and will help raise HDL, especially if you take it while fasting.

    I usually recommend 1-2 tbsp per day as a good general health aid. You don’t need more unless for a therapeutic purpose, eg bacterial or viral infections.

  25. Thanks, Paul. My only concern is that it isn’t virgin coconut oil. I’ve heard that the polyphenolic content of VCO is one of the reasons for it’s positive effect on lipids, so I guess I’ll just have to wait and see if my CO (most likely devoid of polyphenols) does me some good.

  26. Ran into this thread today:

    http://www.marksdailyapple.com/forum/thread24019-4.html

    [The first post at the top of the page really struck a chord with me, specifically this part:

    Thank you. It definitely took some work. But finally it wasn’t the macros. It wasnt the SaFa. It was the fat loss. It was the high protein, less than optimal thyroid function, not enough fat and lack of micros resulting in low metabolic rate (which is goal of protein sparing fat loss I guess) resulting in excess LDL floating around in the blood stream.

    “…when the diet was changed so that it was low in fat but high in protein and with enough carbohydrate to prevent diarrhea, symptoms of hypothyroidism appeared. Cholesterol level in the blood became elevated…”]

    I read the rest of the thread too and Raj’s situation seems to be similar to my own, though I don’t have the benefit of knowing if my lipid profile was ever ‘normal’ since I never got it tested before going low-carb.

    I have been on a calorie-reduced diet for the best part of one year, trying to get as lean as possible. Starting March, I went about 2 months eating maintenance calories to ‘reset’ my metabolism; I had stopped losing fat no matter how little I ate: in other words, my metabolism had crashed. The strategy worked. On my latest cutting cycle, which is currently in it’s 8th and last week, I’ve managed to lose 11.6 lbs of fat and get down to about 9% bodyfat. However, it seems to have come at a price. The continually high protein intake (lots of chicken breasts) coupled with a calorie deficit that is over 1000 calories has probably resulted in a slowed metabolic rate. This in turn may have induced the hypothyroidism-like situation that Raj alluded to. I think this seems to be the likely cause of my high cholesterol, particularly LDL-C.

    I’m going to up the calories starting next week and reduce chicken intake. I’ll try to get hold of some seafood like salmon and other fatty fish. Also, beef and mutton if I can. I have to maintain the protein intake since I workout a lot but will try to get it from varied sources instead of chicken breasts as the main source. Will try to incorporate broths as well to get more glycine.

    I think this, in addition to the supplementation, should have some positive effects. I hope it does!

  27. Hi Jarri,

    As we often discuss, very high protein intake can cause problems from ammonia poisoning and feeding gut bacteria with glutamine.

    So it’s better to add carbs than protein after a certain point.

    I think hypothyroidism usually results from malnutrition but ammonia poisoning and amino acid imbalances may have something to do with it.

    I think in general our diet should get you pretty lean. Heroic measures to achieve leanness can easily be counterproductive.

    Best, Paul

  28. Thanks for the insights, Paul.

    I don’t know exactly what very high implies, but I target a protein intake of 184g per day. I get it from the following formula: 2.75*(lean mass in kg). This is just about par with what anybody who weight trains generally looks to achieve.

    To me, the problem more likely is the fact that I’ve maintained a calorie deficit for much too long and a fair amount of the protein has been coming from chicken breasts. They’re high in methionine and low in glycine. I probably have been malnourished when it comes to certain micronutrients and even some amino acids. I don’t know for sure if it’s hypothyroidism, but it very well could be.

    I am going to come off my fat loss phase at the end of the week, I’ve gotten as lean as I wanted to and have a nice set of six pack abs to show for it 🙂 My focus is now going to be on improving my general health and making sure I’m getting the proper nutrition.

    As a side note, the coconut oil I bought smells delicious and is delicious. I’m kind of confused. I thought it would be deodorized and tasteless since it wasn’t virgin oil, but it seems even expeller pressed oils can be pretty good if they undergo minimal processing.

  29. Jarri,

    while you are waiting for a response from Paul,
    this post by Paul on ‘Protein for Athletes’ may be of interest to you (if you haven’t already read it);

    “Protein for Athletes” http://perfecthealthdiet.com/?p=2712

  30. Thanks for that Darrin, I hadn’t read it before. I think it has a lot of interesting information, but I have the following concerns:

    1) In the real world, bodybuilders (both natural and drug-enhanced) tend to eat ungodly amounts of protein. I’m taking somewhere in the range of 1.5-3.0g per lb of bodyweight. I don’t believe that this is necessary but I also don’t believe that members of the bodybuilding community suffer from ammonia toxicity. Bodybuilding isn’t a recent trend and I think enough time has elapsed for any widely occurring negative effects of protein consumption to be reported.

    2) I don’t think any formula which uses total bodyweight to calculate protein requirements is very accurate. I think only lean mass is relevant. For example, I weighed about 188 lbs last year at 21% bodyfat and now weigh 161 lbs at around 9%. If I used my bodyweight to calculate my protein requirements initially, I’d end up with a big number. However, my lean mass has stayed virtually the same and on account of a lower bodyweight, my protein requirement as of now is suddenly reduced? Just doesn’t seem right to me.

    3) The conclusion of the article implies that even a moderately big guy almost always risks ammonia toxiciy if he tries to add muscle, even moreso when he follows a low carb diet. This could be true, but I’ve yet to see proof of it in the real world.

    I think there were some important points made and they certainly added to my knowledge, but I’m a bit sceptical of reducing my protein intake out of fear of ammonia toxicity, especially when my intake isn’t THAT high anyway since I’m not really a big guy.

    However, I definitely believe in balancing the amino acids, no arguments there. Also, I think that staying in caloric deficit for a long time while maintaining a high protein intake isn’t good either. Cutting cycles ought to be relatively short, a few weeks rather than a few months.

  31. Hi Jarri,

    I think the bodybuilders do suffer from ammonia toxicity at the high protein intakes. It would be interesting to track bodybuilders long-term and compare health outcomes to protein intake. I’m not aware that this has been done.

    The denominator for protein requirements is a complex topic, but I agree that lean mass is more appropriate for bodybuilders. However, body weight is more easily measured and is used in many studies.

    I agree that caloric deficits and fasting should be intermittent, not long-term (months) strategies.

    Best, Paul

  32. Hi Paul,

    Yes, a study that tracks ammonia toxicity in bodybuilders ought to be interesting and I am not aware if it has ever been done either.

    Anyway, I’d like to share my progress(?) in trying to improve my lipids:

    TC: 283->308
    HDL: 53->63
    TRIG: 70->112(??)
    LDL(calc): 208->215
    LDL (Iranian): 188->NA (Iranian doesn’t apply for TRIG > 100)
    TC/HDL ratio: 5.3->4.9

    I’ve been taking all the recommended supplements and yet the LDL has worsened, if anything. I’ve recently introduced coconut oil into my diet, starting out with just a tablespoon a day but for the last week or so, I’ve been using it for cooking, with the end result that I’m probably consuming close to 5 tablespoons a day. That probably explains the increase in HDL (good) but I’m curious as to whether my TRIGs have increased because of this too.

    The other major change I’ve made recently is reducing my protein intake by about 50g per day since I decided to take some time off from the gym for systemic recovery. I’ve also reintroduced almonds/walnuts and a couple of tablespoons of natural peanut butter since I got off my fat loss phase. Finally, I’ve gone off chicken breasts and started having ground beef and occasionally mutton instead. I’ve been eating to my heart’s content for the last week or so, but my weight’s still actually come down a tad.

    I really think that some people’s lipids probably just don’t respond well to so much fat, specifically saturated fat. Nonetheless, I’m not giving up.

    My plan is to:

    1) Cut down on the coconut oil and limit it to about 2 tbsp per day.

    2) For cooking, I’m going to go with olive oil for the time being (not the extra virgin because it doesn’t stand up to heat so well). I’d rather use ghee, but I remember my lipids soaring when I was eating plenty of butter, so olive oil is the safer option I guess.

    3) Add some fatty fish to replace the beef/mutton occasionally.

    4) Once I restart my exercise, I’m planning on having a potato with dinner (after my post-workout shake) for some healthy starch.

    In summary, it doesn’t seem like my high LDL is related to any micronutrient deficiency, rather it seems to be a reflection of what I’m eating.

    I’d like some input, of course.

  33. Hi Jarri,

    The biggest change I would suggest is to replace the peanut butter with tree nut butters (almond, cashew, any will work) or, better yet, egg yolks (more nutritious). Peanuts are atherogenic and will raise LDL.

    Walnuts are high in omega-6 and I would recommend other nuts.

    I think your plan is good – all of those changes should be positive or neutral. Fatty fish for omega-3s might make a significant difference. Reducing protein a bit and adding potatoes should be a positive change. I might continue cooking with coconut oil however, and just cut out the extra tablespoon(s), replacing those calories with egg yolks or liver.

    Am I understanding you correctly that you eat almost no starch as well as large amounts of protein? Your first post mentioned eating grains and rice http://perfecthealthdiet.com/?p=2547#comment-23421. If you are low in starch, I think you may significantly improve lipids by replacing 200-400 calories protein by an equal amount of starch.

    Best, Paul

  34. Hi Paul,

    I used to have a couple of tablespoons of natural peanut butter before I started my fat loss cycle; my LDL then was a bit better than it is now. I never imagined peanuts could be atherogenic and/or raise LDL. They’re high in MUFA, contain a moderate amount of PUFA and are quite low in SFA. I started having peanut butter again simply because I wanted a low-SFA source of calories. I already have a handful or two of either raw walnuts or almonds, so I thought combining them with some peanut butter wasn’t a bad idea. Anyway, I’ll eliminate the peanut butter once I finish this bottle and see how it goes.

    I started having a handful or two of walnuts just recently to alternate them with the almonds I’d been having previously, plus I’d heard walnuts are ‘heart-healthy’ and could lower LDL.

    Egg yolks I already have; a 3 egg-omelette made in coconut oil everyday for breakfast 🙂

    My only concern with coconut oil was the possibility that it had something to do with the sharp increase in my TRIGs, which have always been low ever since I started low-carbing. They’re now upto 112, even though I’d got them down to as low as 61 just over a month ago.

    Coconut oil is rich in MCTs, so I thought maybe there’s a connection with the raised TRIGs? I’m not having any coconut oil by itself anymore, just use it for making the omelette and for cooking. That alone equates to about 5 tbsp. As it is, I’m getting some saturated fat from the beef/mutton I’ve started eating, so I thought so much coconut oil is really going to bring the SFA count up. Replacing with olive oil would increase MUFA while simultaneously decreasing SFA, which ought to reduce LDL. I’ll still make my omelette in coconut oil, that’ll keep me close to about 2 tbsp per day which should still provide some HDL raising benefit.

    Regarding my starch intake, I was following a carb-cycling diet where I would load up on carbs (grains, potatoes, rice) for a 24 hr period once a week, totaling over 400g of carbs. For my low-carb days, I’d consume close to 60g which were starch free.

    Since I took time off from the gym this week, I didn’t see the point in carb-cycling. I just maintained a starch-free carb intake of between 50-100g everyday. I plan on keeping it this way now even when I go back to the gym, but with a slightly higher daily carb intake with the potato added in (maybe 100-150g). I’m going to lay off cycling my carbs, simply because I’m not comfortable with what 400g in a 24 hr period may do to my blood sugar.

    I reduced the protein from 180-190g to 120-130g for this week. However, I’ll probably up it back when I hit the gym because I’ll be having my post-workout shake which contains 50g of whey protein isolate. The rest of the amount just adds up naturally with my appetite for meat/fish, eggs, nuts, etc. I will up my carb intake to 100-150g per day though, mainly by adding the potato and occasionally replacing it with basmati rice.

    I hope the added starch improves my lipids like you say it might, thanks for the tip!

    I want to try and gain some lean mass now because I’ve gotten a lot of ‘you look so skinny’ comments ever since my successful fat loss cycle. Being around 7-8% bodyfat feels great, but at <160 lbs and 72.5 inches tall, I could do with some more muscle. Hence, I won't be eating conservatively from now on, just 'clean'.

  35. I’ve been on PHD for a few months, and about a month ago went to the low-carb therapeutic ketogenic version of the PHD. After reading some of Paul’s posts, I believe that I might have a brain infection as a result of a head injury from more than a decade ago (Paul, if you recall, my condition has a lot of similarities to the one you once had). I started taking doxycycline a few days ago, and I have already noticed pronounced improvement (whether due to the diet or the antibiotic or both) in controlling the irritability and anxiety that have plagued me for years.

    I just went to the doc and had some blood tests, and I can add some more data to the high-cholesterol phenomenon linked to paleo-type diets.

    TC: 330
    LDL: 219
    HDL: 95
    Trigs: 78
    Glucose: 82

    The doctor apparently thought this was so alarming that the results they mailed to me instructed me to schedule an appointment immediately to address the (purported) problem. I can’t remember what my cholesterol was the last time I had it tested a couple years ago, when I ate a lot of lean meats and whole grains, but I know it was smack in the average range.

    I eat 3 eggs every day and liver maybe once every two weeks. I am slowly increasing my iodine intake to eventually reach mega-doses of it, but follow everything else in the PHD.

    The high LDL concerns me somewhat, but I definitely feel great since making the diet changes. My blood pressure, which has been creeping upwards over the last few years to 135/80 or so, is back down to 110/70. My testosterone is 824, and I am pleased to see that I maintaining my strength in the gym despite being on a ketogenic diet.

    Just one more data point . . .

  36. Hi Thomas,

    That’s great news! The positive reaction to doxy would seem to confirm that a bacterial brain infection is likely. You might want to add a second antibiotic like azithromycin at some point, combination protocols are often more effective. It typically takes months to significantly beat back a longstanding infection. The improvement of the first few days is due to protein synthesis inhibition, not clearing of bacteria.

    The high LDL problem needs further investigation, but I think it’s premature to worry about it. High cholesterol will help you clear your infection, and lipids may return to normal as your vasculature heals. Continued use of antibiotics and nutritional supplements may prove helpful here.

    That’s great, Thomas, I do recall your story and I’m glad you’re following my path. I hope it works as well for you as it did for me!

    Please keep me posted on your progress.

    Best, Paul

  37. Thanks for the response Paul, as well as all your help. If this works, I owe you my first-born child and then some! Ben Franklin (I think it was him) might have been right about health being the greatest blessing. The improvements I’ve seen recently have done more for my well-being than anything in the last decade, and I am profoundly grateful to you for all your excellent advice.

    One more question, if I may impose on your patience. I take 100 mg of doxy twice a day. Do you have any thoughts on that dosage in light of your experience with a brain infection? My GP doc readily prescribed it, but I’m sure he doesn’t run across questions about the proper dosage for brain infections too often. I think docs prescribe that amount of doxy for Lyme diseases, but I’ve also seen a study praising doxy’s effects when taken at higher doses.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489684/

    Then again, I seem to be seeing improvements after just a few days at my current dose, so maybe I should stick with that for now.

    I definitely plan on doing the combo thing with another antibiotic once I give the doxy a little more time.

    Thanks again!

  38. Hi Thomas,

    I think that’s an excellent dose. I don’t think it’s known what the optimal dose is. I would probably add a second antibiotic with a different mechanism of action before increasing the doxy dose further.

    Keep up the ketogenic dieting / intermittent fasting, that will help. Also, N-acetylcysteine helps.

    Best, Paul

  39. Hi Paul,

    I got my latest test results in and here’s the summary:

    TC: 288
    HDL: 78
    LDL: 191(calculated), 161.52(Iranian)
    TG: 54

    Obviously, this is a big improvement and I’m happy about it. Looks like some of the changes I made did work. I would of course love to bring the LDL (Iranian at least) down to around 130.

    I got my Thyroid panel as well and here are the results:

    T3: 75 ng/dl (Normal range: 58-159)
    T4: 7.0 ug/dl (Normal range: 4.9-11.7)
    TSH: 1.92 uIU/ml (Normal range: 0.4-4.9)

    Can you help me interpret these as I have no idea what a good value is. Is there a possibility I might have a thyroid issue? If so, would further improvement in my thyroid help my LDL too?

    Regards,
    Jarri

  40. Hi Jarri,

    Optimal LDL is between 80 and 160, so you’re close. HDL is great, TG is great, and total TC is pretty good if slightly high. Congratulations.

    Sometimes healing can take time — my health kept improving for several years after we finalized the diet — so I would be happy and would look for continued improvement.

    Your thyroid numbers are not perfect but they’re better than the median American. Most people with these numbers would be symptomless in terms of hypothyroid symptoms. Many would have a mildly reduced cold tolerance. Ie it would be difficult to swim in 17 C / 63 F water.

    Unless you have hypothyroid symptoms, these would not indicate that you should seek treatment. Rather, you should look to selenium/iodine supplementation, probiotics, infection clearance, toxin clearance, and similar steps to make the last final improvements in your health. It may be that only time is necessary.

    Best, Paul

  41. Thanks for the positive reinforcement, Paul. I feel much better now 🙂

  42. I got a retest to see if I was making further ‘progress’:

    TC: 280
    TG: 60
    HDL: 81
    LDL: 179 (calc), 155 (Iranian)

    My HDL is as high as it’s ever been and LDL is at it’s lowest.

    I am unsure if I need to focus on getting the LDL down further. I consider myself in great health and my workouts are continuously improving.

    I was thinking of adding butter and/or cheese to my diet. My worry is that they will drive up my LDL which I have worked so hard to bring down. Do you believe this fear is unfounded?

    The only dairy I have now is a mug of fresh milk everyday. I boil the milk before use as per the instructions on the pack. I guess that’s still better than pasteurisation?

  43. Hi Jarri,

    I guess you’re close enough to normal/optimal that I wouldn’t worry as long as you continue to feel great. In the absence of other symptoms it’s hard to get too concerned about slightly off blood lipids.

    I think butter is a healthy food and I wouldn’t exclude it just because of lipids.

    Yes, boiling is better than pasteurization.

  44. Hi Paul,

    I’m reading these entries again out of concern for my husband’s latest cholesterol readings. We have been Paleo since Christmas 2011. After going Paleo, my husband had his regular labs done and ended up with a LDL cholesterol going from 140 (we were vegans) to 167. I was so concerned that I asked Mike Eades about it on his blog and he said that was a common occurrence due to the body releasing cholesterol after the change in diet (at least that’s the way I understood it.)and that the numbers would settle down eventually.

    In April, I found your blog and we started adjusting our eating to Perfect Health Diet. He had his regular appointment and labs were done by our doctor 10 months after the previous. Now,his LDL is UP to 178 from 167, but his HDL has also gone UP to 101 from the previous 73. His triglycerides previously were 80. I forgot to ask the doctor what they were this time, but a copy will be sent to us soon. (The calculator below put them at 60, so they would also be down.)

    I did a lot of reading on ratios and found a cool calculator at http://www.hughchou.org/calc/chol.php. When I plugged in the numbers that I had, it came back:

    Your Total Cholesterol of 291 is HIGH RISK
    Your LDL of 178 is HIGH RISK
    Your HDL of 101 is OPTIMAL
    Your Triglyceride level of 60 is NORMAL

    RATIOS:
    Your Total Cholesterol/HDL ratio is: 2.88 – (preferably under 5.0, ideally under 3.5) IDEAL
    Your HDL/LDL ratio is: 0.567 – (preferably over 0.3, ideally over 0.4) IDEAL
    Your triglycerides/HDL ratio is: 0.594 – (preferably under 4, ideally under 2) IDEAL

    That made me feel better, except for the Total Cholesterol and the LDL being at High Risk.

    I realize that his HDL being at 101 is raising the Total Cholesterol number. If 40-59 is average, then by doing simple math and subtracting 40 or 50 from 291, he’d be
    at 231 or 241. Even on Mike Eades blog, however, I found out that the recommended total cholesterol should be between 180 and 220, so he’s still high. As his TSH is 1.24 with T4 of 6.6, it does not appear to be thyroid related.

    Our doctor wants to put him on medicine, but we have decided no. We feel that the statins risks are greater than the risk of heart attack.

    Still, I’d like to get his LDL down. We are already taking the regular supplements that you recommend. Perhaps I should add an extra multi-mineral? We currently eat eggs daily and calves liver once a week, so I don’t want to overdo it.

    If we don’t get the LDL down, I’m afraid the doctor is going to really start pushing the medicine option.

    By the way, he feels great, and never gets sick, and the guys at work ask him if he has discovered the “Fountain of Youth.” (We’re both 59.)

  45. Hi Mary,

    First, the fact that he feels great is much more important than blood lipid levels.

    Regarding his lipids, everything looks great except his LDL is a bit high. I usually quote 80 to 160 as a normal range for LDL, so 178 is a bit high. Not something he should be stressing about overly much, but worth exploring to try to understand whether some nutrient deficiency or pathology is the cause.

    One possible reason for high LDL is eating too low carb. See http://perfecthealthdiet.com/?p=4457 and two previous posts (http://perfecthealthdiet.com/?p=4383 and http://perfecthealthdiet.com/?p=4446) discussing the impact of low-carb diets on the thyroid. If he adds some rice to his diet the LDL will probably go down.

    Also, nutrient deficiencies affecting glucose utilization, the thyroid, or antioxidant status can impact LDL. Our recommended supplements are all important, so it is good that he is taking them. Additional supplements that might help could include some B vitamins (B1, B2, B5, B6, biotin). I would recommend B1, B2, and biotin the most. He might also look at whether his zinc:copper ratio is out of whack. Some people have copper-rich water or copper-rich diets. In general, the zinc:copper ratio should be around 15:1 or 10:1. He might try the “Zinc Balance” supplement which supplies zinc and copper together, rather than a copper source (if he is supplementing for copper instead of eating beef liver).

    Another thing to try is eating more salt and drinking more water. If he is dehydrated that might affect his lipids.

    I guess the first step would be to add more carbs, add salt and water, maybe supplement a few more nutrients, and get a thyroid panel (with T3 and rT3 along with the TSH) measured along with his lipids the next time he’s at the doctor. A high rT3:T3 ratio would suggest he’s eating too few carbs.

    I would absolutely resist going on pharmaceutical medicines. You want to fix this naturally. He needs to utilize his doctor for diagnosis, not as a drug source.

    Best, Paul

  46. Thank you, Paul! My husband was delighted to hear that he could eat more safe starches, although we are eating sweet potatoes, white potatoes, white rice and rice bread (for toast with egg), he was keeping the total safe starch calories low. I alone had recently upped mine due to recurrent fungal problems about which I’ve written to you previously. Finally, those have cleared up and have not come back, so that’s good news. My husband, however, was keeping his lower, thinking too many carbs might RAISE his cholesterol!

    We will also up the supplements a bit, at least until next doctor appointment and labs, and take your advice on the total thyroid panel. Our doctor usually just checks his TSH and T4, which have been normal. From what I’ve been reading a check on T3 and rT3 may be in order as well.

    My overall body pain issues have finally cleared up with the addition of a natural estrogen/progesterone cream called Ostaderm. (It took two months of use.) Although my neutrophils remain low at 1.5, they have risen somewhat since last labs. None of the specialists that I have seen knows why they are low. I’ve written before that I feel that it may be due to epstein barr virus in my system. My titers are high. I AM feeling better now, more like my old self. My hypothyroidism is under control with Armour thyroid. I take 60 mg with an extra 30 mg on M-W-F, and that’s a lower than the former 90 mg daily, as I have been supplementing with Lugol’s solution (I’m up to 2.5 mg) and selenium (L-selenomethianine 200 mcg).

    I found out at my rheumatologist appointment today that MY total cholesterol is also high at 245. My previous was labs were a total 220 (on a vegan diet!), but my HDL was very high, and being menopausal my doctor wasn’t worried about it. Needless to say, I will be taking the same recommendations that you made for my husband!

    Lastly, lately I’ve been having gallbladder tinges. I’ve read that gallbladder issues and hypothyroidism go hand-in-hand. Years ago, I had some trouble, but was able to clear it up with vinegar in water after eating, along with Swedish bitters after eating and some homeopathic remedies. The doctors were ready to take it out. It’s been 10 years, since I’ve had any trouble, and it’s nothing really bad, but concerning nonetheless.

    Thank you for your continued work. We will continue to update you periodically on our progress with the Perfect Health Diet.

  47. Hi Paul,

    I just discovered that the coconut oil I’ve been using is of the RB (Refined and Bleached) type, also known as “Cochin” oil. It’s considered to be an inferior oil to virgin and RBD (Refined, Bleached and Deodorized) oil, though it’s less refined than RBD. It still has an aroma and taste because it hasn’t been deodorized but I hear that means it also has more contaminants or impurities than regular RBD coconut oil, which is odourless and tasteless. It has a yellowish color because of the mold that tends to remain in oils extracted from copra, but the high temperatures during refining render it sterile and harmless.

    This is the only brand I have here and I would like to continue using it as long as it’s not considered harmful, because of whatever impurities it may contain.

  48. Your tinhknig matches mine – great minds think alike!

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