Photo credit: LivewithoutPS/ CC BY-ND
I can recall seeing countless testimonials over the years of people noticing improvements in their heart health after switching to Paleo. These health gains have included risk factors such as obesity, diabetes, insulin resistance and other related blood markers.
Having followed the Paleo diet myself with great success in healing autoimmune disease, when I recently found out that my father had been diagnosed as having Atherosclerosis in one of his arteries, I started to wonder: can the Paleo diet reverse heart disease? Truly reversing plaque in the arteries is something that appears to be fairly elusive, despite decades of heart disease being the number one killer in the U.S. and many countries throughout the world.
Anyone considering any health program for something as serious as heart disease should work closely with their doctor. But as I was doing internet research for my father anyway, I wanted to give a kind of play by play of what I was able to find on the internet about this topic.
My father has always been a thin person, he exercises every day, and eats what would normally be considered a very heart healthy diet. Yet he was still recently diagnosed with plaque in his arteries and put on Statins by his doctor. I was hoping to find out if Paleo eating could possibly help people who have a genetic predisposition to heart disease as he has.
We cover the following....
The Paleo diet and Heart Disease
Although the medical community has been slow to embrace the findings coming out of research to-date about Paleo, some progressive health organizations have begun to slowly update their information.
For example the following article published on the Mayo Clinic website from mid-2014 acknowledges some of the existing research findings on health benefits of the Paleo diet published at that time. Specifically it includes preliminary results indicating the Paleo diet may have benefits over more generally recommended healthy diets in areas such as blood pressure and glucose tolerance, both factors in heart disease and metabolic syndrome:
Does the Paleo Diet Lower Cholesterol?
As it can be hard to measure directly whether plaque is accumulating in your arteries without invasive testing, one of the more commonly used measurement tools we have available are cholesterol levels: LDL, HDL, triglycerides, and other more recently discovered blood markers.
There is some disagreement within the Paleo community about how accurate cholesterol levels are in predicting heart health, specifically Total Cholesterol and LDL figures. But Cholesterol and blood test numbers are one of the few tools we have to go on to measure heart disease risk. As they are generally still used by the medical community, no discussion of heart health improvements would be complete without discussing changes in cholesterol levels observed on the Paleo diet.
Luckily, in trying to answer the question of whether the Paleo diet can consistently help to lower cholesterol I found some very recent studies on the topic, that give more insight than were available previously.
Metabolic Syndrome Improvements on the Paleo Diet
One recent study of studies published in August 2015 compared 4 clinical trials, each where one group of participants followed the Paleo diet while another group followed mainstream dietary nutrition guidelines. The studies all examined whether a Paleo diet could help improve several individual risk factors, known together as Metabolic Syndrome, a group of indicators that increase the risk of cardiovascular disease and type 2 diabetes at unhealthy levels. The five Metabolic Syndrome factors are waist circumference, blood pressure, fasting blood sugar, triglycerides, and HDL cholesterol.
By combining the results of these 4 studies, with an overall total of 159 study participants, the researchers indicated that the Paleo diet improved all 5 risk factors. Specifically the Paleo Diet showed improvements in waist circumference, blood pressure and triglyceride levels to a statistically significant degree above and beyond any improvements found for the participants in the government guideline based healthy diet group.
However, given that one of the four studies analyzed was only conducted for 2 weeks, it is still possible for critics to point out that this study only shows positive effects over a short period. Still, at least there is starting to be some data on the health effects of the Paleo Diet. My hope is that this spurs larger systematic review studies that critics would have a harder time challenging:
Is the Paleo Diet Good for High Cholesterol?
In another recent study, 40 volunteers with hypercholesterolemia (a genetic predisposition for very high levels of cholesterol in the blood) were put on a diet based on the American Heart Association guidelines for 4 months, then afterward on a Paleo diet for 4 months.
After the 4 months on Paleo the participants had a statistically significant drop in average Total Cholesterol, LDL, and Triglycerides even when compared to the period where they ate the American Heart Association diet. They also had a statistically significant increase in HDL.
Although this was a smaller individual study, these results are promising and start to build evidence that a Paleo diet can help lower high cholesterol levels, even for those genetically prone to high cholesterol:
http://www.ncbi.nlm.nih.gov/pubmed/26003334
Paleo Diet Heart Attack Risk: A Positive or Negative Influence?
I had a hard time locating any research looking specifically at whether the Paleo diet can influence heart attack risk, likely because this is not an easy thing to measure. But I did find one study that gives some possible insight.
This is an older study from 2012 carried out by investigators in India and Slovakia. It compared a “Paleo-like” diet of fruits, vegetables and nuts, along with whole grains, against their National Cholesterol Education Program Step I diet. So it is not a real Paleo diet, as the participants did eat whole grains and did not appear to eat meat. Still, it gives some insight.
The study involved 406 patients with diagnosed acute coronary syndrome following one of these two diets for 2 years. At the end of the 2 years, they examined the death rates based on any cause of both groups. A significantly lower percentage of deaths were found for those following the Paleo-like diet (14.7%) than those following the National Cholesterol Education Program Diet (25.2%), a pretty compelling statistic:
http://search.proquest.com/openview/5747f3f97d9b2914bca2d326a61a5509/1
Does the Paleo diet raise cholesterol?
Despite the evidence from the studies presented thus far. As with most things, I also came across a small study showing the Paleo diet had raised total cholesterol and LDL in a previously healthy group of study participants.
In this study, 24 healthy participants were put on a 10 week trial of Paleo while at the same time engaging in a crossfit program. The results showed LDL, n-HDL and total cholesterol went up in a significant way while triglycerides and HDL remained the same (a sub-group of people with the highest HDL had their HDL go down). At the same time participants lost weight and improved their cardiovascular endurance:
Paleo diet cholesterol results and Testimonials
Although research studies give one side of the story, it can be helpful to hear directly from those who have tried the Paleo diet to see if it has improved their overall heart health. Below are select testimonials I compiled from various discussions and articles throughout the web that were specifically addressing the topic of Paleo and heart health.
The below testimonial is from a primary care doctor who has switched over to suggesting Paleo for his patients struggling with chronic health and obesity related issues. He mentions that he has seen a consistent improvement in the health of his patients following the Paleo diet, in sharp contrast to his experience when he previously used to counsel his patients about generally accepted guidelines on healthy diet and exercise:
Paleo Cholesterol Numbers
In the below testimonials, several people have shared their before and after cholesterol numbers once they had followed Paleo for a period of time. I have found these testimonials by combing through the hundreds of testimonials and comments online within articles and forums discussing the Paleo diet looking for those containing blood test numbers:
Other select success stories include the following:
“I went ‘primal’ back in 2011. After 6 weeks I had blood tests done to compare them to old tests. Over the years I’ve become less strict but still eat by primal principles and continue to see good cholesterol results.
2007- F/21/ate low fat; low-mod protein; standard “healthy” diet with things like couscous, oatmeal, and scrambled egg whites; lots of fruit; avg. amount of junk food; milk & juice & starbucks but no soda
Triglycerides- 71
HDL- 52
LDL- 53
Total Cholesterol- 119 (marked “low” by the lab)
Chol/HDLC Ratio- 2.3
Fasting Glucose- 72
Vit D- 31 (>40 is optimal)
My doctor asked me if I was a vegetarian. I asked if 119 was ‘too low’ and he said “No! No! It’s amazing!”
2011-F/25/ 6-8 weeks after going Primal; high fat, predominately saturated fat; moderate protein; moderate carb (75-100 g a day); no grains/breads; very little processed food
Triglycerides- 38
HDL- 82
LDL- 96
Total Cholesterol- 184
Chol/HDL Ratio- 2.2
Fasting Glucose- 85
Vit D- 42 (>40 is optimal)
These were at a health fair so no doctor comments.
2013-F/27/after a few years of non-strict primal; eat more fruit; occasional rice or potatoes; eat a standard American diet when going out to eat at least once a week; still very little processed food at home; no soda; occasional juice or starbucks
(these are from memory so they aren’t exact)
Triglycerides- 36-38
HDL- 70’s
LDL- ? honestly can’t remember but it was near the HDL #
Total Cholesterol- 190’s
Chol/HDL Ratio- ?
Fasting Glucose- n/a
Vit D- n/a
My doctor said I must be on a ‘very low fat diet’ because of my triglycerides. I laughed. He then said “I could sell these numbers they’re so good.”
Source: comments section of https://www.reddit.com/r/Paleo/comments/231303/has_anyone_actually_had_a_checkup_hows_your/
“I’ve been doing paleo for just over a year and I went to get a physical and blood tests at the beginning of this year.
I currently eat a ‘strict’ paleo, with minimal dairy (mostly in Kerrygold and some cheese) but otherwise no other cheats. Previously I was up about 70lbs and not caring what I ate (like, Wendy’s 2-3x DAILY), so I don’t have anything to compare it to.
However, I’m now down to a consistent 160lbs at 6’1″, and no plans to drop more weight (and beginning to look at starting a lifting routine).
Here are my results, attached to which, my doctor sent along a note saying, “Keep doing whatever it is you’re doing!”
Results from my fasting blood panel:
Height: 6’1″
Weight: 162lbs
BMI: 22.91 kg/m2
Cholesterol: 218 mg/dL
Triglycerides: 67 mg/dL
HDL: 69 mg/dL
LDL: 136 mg/dL
Overall cholesterol and LDL are slightly high (just out of “normal” range) but, again, I was told to continue my regimen.”
Source: comments section of https://www.reddit.com/r/Paleo/comments/231303/has_anyone_actually_had_a_checkup_hows_your/
“About a year ago, three weeks into a strict Paleo challenge, I had my annual physical and some blood work done. Some of my cholesterol levels were higher than they were when I was in my 20s & 30s. I posted about it in r/paleo.
I recently had my annual physical and cholesterol levels checked. I had some interesting results.
Total Cholesterol
Last year – 214
This year – 220
Triglycerides
Last year – 97
This year- 57
That is a 41% drop.
less than 150 is considered optimal.
HDL
Last year – 50
This year – 63
That is a about a 26% improvement.
greater than 60 is considered an “optimal” level for good heart health.
LDL
Last year – 145
This year – 146
A 1 point increase. I’m tempted to ask my doctor to see if he can add the LDL test for puffy LDL, the good kind, vs dense LDL, the bad kind.
In addition to the blood level changes I dropped about 10 pounds. I’m below 10% body fat with a six pack (not easy for a 46 year old male). My blood pressure is down to 115 over 50 as well.
I don’t have any more hypoglycemic swings as long as I don’t stray too far from Paleo. I have fewer breakouts. I don’t have to use my 5% benzoyl peroxide soap anymore on my chest or back.”
Source: comments section of https://www.reddit.com/r/Paleo/comments/1b7nk6/after_1_year_of_paleo_some_interesting_results_in/
“Great post Steve. I’m sure you will get flamed by some for this article but I can say that my personal experience is inline with most of the points you made in this article. I changed my diet to paleo and within a year was able to drop my cholesterol and triglycerides significantly which helped me to eventually come off of statin drugs. This was after greatly increasing the amount of eggs, bacon, and fat in my diet but eliminating dairy and “grains”. My doctor was 100% opposed to my Paleo decision from day one, but after a year, he had nothing to argue about. YMMV but I know that for me, Paleo was the answer.”
Source: comments section of http://www.nerdfitness.com/blog/2014/05/22/is-cholesterol-killing-us-a-beginners-guide-to-cholesterol/
“Great article Steve – thanks. I’d been very worried about my cholesterol when I started my paleo/primal life back in August. For years (ever since I started getting my cholesterol checked) I was told it was high, but my ratios were good so no worries. I only recently came to understand what that meant. My doctor and I are very pleased with my numbers. Since going paleo, my HDL went up 20 pts. and my LDL dropped 22 pts. and my triglycerides stayed about the same at 53. Yes my total is still high at 276, but I have no other risk factors for heart disease. The body is a complex machine, and I think we all need to experiment with diet and lifestyle changes before resorting to medication.”Source: Comments section of http://www.nerdfitness.com/blog/2014/05/22/is-cholesterol-killing-us-a-beginners-guide-to-cholesterol/
Paleo & High LDL
Unfortunately, in reading through testimonials with reports of Cholesterol changes on Paleo, I also came across quite a few people discussing that in their particular situation, certain cholesterol numbers, specifically total cholesterol and LDL numbers rose on the Paleo diet.
“So glad to have found your website Chris.I had been on a very high carb diet and had low HDL and high triglycerides. TC was 185, so decided to try the Paleo diet. Right away my HDL soared to 67 within 2 months which was great. I always had a high carb, low fat diet and was always puzzled why everything was normal except my HDL which was under 40.Now a year after being Paleo, my results are not so good. TC was 240, LDL-156, HDL-57. But what was concerning was that my small diameter LDL was 56 and over 40 was high risk. The very thing Paleo is supposed to reverse? So maybe I went to much to the other side and getting an NMR profile done for baseline peuposes. Now Im going to try the Mediterranean version of the Paleo diet as for some reason my body is not liking the strict Paleo, Strangely I wasn’t really ingesting that much more saturated fat and most of it is already coming from olive oil and avocado.Will test again in 3 months.”Source: comments section of https://chriskresser.com/the-diet-heart-myth-how-to-prevent-and-reverse-heart-disease-naturally/
“I have been where you are Rory. After about 8 months on Paleo, my cholesterol went up to 14.2 mmol/L. LDL 12.14 , HDL 1.70, Trigs 0.8 mmol/L (as a vegetarian 10 years ago TC was quite high with over all Cholesterol of 6+ ,but HDL was high and protective, but I felt like shit as a vegetarian).It seems I need the carbs because my thyroid TSH was higher at 4.24 miu/L. Maybe hypothyroid is going on here for me, and I am slim at almost 10 stone so the doctor does not recognise a problem.I am trying the Ray Peat way this last little while and am hoping to get my numbers re-tested soon, and hope they are better.”Source: comments section of https://chriskresser.com/the-diet-heart-myth-how-to-prevent-and-reverse-heart-disease-naturally/
“Finally! Thank you, Chris – you have directly and concisely answered the question I have had for a year. Count me in as yet another Paleo eater who had LDL soar after transitioning to lacto-Paleo. I have high TC, high LDL, and high ApoB (which means high LDL-P), but all my other numbers and markers are excellent. In fact, you are describing me perfectly in the “Genetics” paragraph. Now to figure out how to transition to Mediterranean Paleo – I already eat a fair amount of fruit and starch, and mainly have to reduce dairy fat. Sigh.”Source: comments section of https://chriskresser.com/the-diet-heart-myth-how-to-prevent-and-reverse-heart-disease-naturally/
“Chris, In the Genetics section, you say ‘If you have high LDL-P, but normal triglycerides, HDL, small LDL-P and ….’ .Is the second one supposed to be LDL-C? I think I’m one of the hyper-responders you write about. After going paleo, my cholesterol and LDL-P skyrocketed. I am otherwise healthy, except I need to use bioidentical sex hormones. THIS ARTICLE IS A GODSEND! I am going to adopt a more Mediterranean paleo diet, add more soluble fiber, and learn about which foods to eat containing more monounsaturated fat than saturated fat. You are a blessing!”Source: comments section of https://chriskresser.com/the-diet-heart-myth-how-to-prevent-and-reverse-heart-disease-naturally/
Here are a few additional testimonials about cholesterol spikes on the Paleo diet:
“I’m a huge work in progress, but I thought I would give the other end of the spectrum!28/F/5’5″ Started Diet: Dec. 2013 Basic Cholesterol Check October 2013: Total: 243 – sorry that’s all I got! It was a free clinic and I was at $0 in the bank at the time! Start Weight/BF%: 172lbs/34% Current Weight/BF%: 138 lbs/27.6%I was feeling good financially and had been supplementing hardcore/been on Paleo since December, so I shelled out to WellnessFX to have all my stuff checked (I also wanted to make sure, for example, I wasn’t overdoing it on any supplements, turns out I’m not!). Anyway, in every way EXCEPT cholesterol, I am a specimen of perfect health. However, my cholesterol as of last week is:Total: 363 (!!!!!!!!) LDL: 284 (!!!!!!!!) HDL: 63 Triglycerides: 78 Apo (b): 210 ( :( :( :( ) Lp(a): <10 vLDL-C: 16My first instinct was to come running to r/paleo and r/keto crying, but after a couple days, I relaxed. All that stress wasn’t doing me any good, I’m just apparently one of those rarer cases of people whose cholesterol spikes when on a low-carb diet. Plus, I’ve lost 20 fricking pounds of fat in the 5 months! That has to count for something! The diet is working for me – it’s really become a lifestyle change. Instead, I took a look at my macros and decided this was a prescription for less butter coffee (I was up to about 600 calories of butter a day), and a ton more vegetables (which I eat, but I don’t love them and feel like I wasn’t reallllly trying).TLDR; my cholesterol, 5 months in, has jumped about 120 points, but who’s worried? My mother actually reversed artery blockages following paleo, and our main difference is that she voraciously eats those veggies! So, I’m adjusting diet, going to keep going, and re-test in another 6 months or so. Whooo!”Source: comments section of https://www.reddit.com/r/Paleo/comments/231303/has_anyone_actually_had_a_checkup_hows_your/
“i think its irresponsible because he does not have high cholesterol and does not deal with it, nor has he been treated by a doctor for it. This is a situation where what works for some people does not work for everyone in this case. it is very much a case by case basis on what works/doesnt work for people so I think that needs to be taken into account, instead of giving out blanket advice. I think you find studies on pretty anything you want to prove/disprove in the medical community. Speaking of dietary guidelines, I tried to eat paleo for a while and it made my cholesterol sky rocket. So, like I said, health issues are something to be dealt with on a case by case basis and advice should not be given on a topic like this where everyone is affected differently.”
Source: Comments section of http://www.nerdfitness.com/blog/2014/05/22/is-cholesterol-killing-us-a-beginners-guide-to-cholesterol/
Low cholesterol Paleo diet?
So where do these various opinions and data points leave us? Is there a low cholesterol Paleo diet that can consistently improve our chances of avoiding heart disease?
Given that a portion of people writing testimonials did see certain Cholesterol numbers spike on the diet, it is important to work with your doctor to monitor your situation carefully, especially with changes in diet. Any topics related to heart health can literally be life or death for people who are at a risk of heart disease, and everyone’s situation is different, so although the different findings can be useful background information, you will want to work carefully with your doctor to come up with any plan for tackling health changes. Some of the changes observed in many of the testimonials and comments list appear to be individual and may also represent differences in how different people are eating, even under the overarching Paleo guidelines.
After reviewing all of the research presented and testimonials, I did personally suggest to my father that he should try to incorporate the Paleo diet for a period of several months and see if it appears to make a difference in his heart health indicators.
Despite the varying experiences, the research seemed pretty compelling to me overall. I think there is a good case of for giving the Paleo diet a shot to see if it could improve risk factors for cardiovascular disease.
The testimonials appear to me to be on the whole positive about the effects of the Paleo diet on heart health indicators, especially on things like Triglicerides and HDL levels, despite the percentage of people who saw spikes in their LDL numbers after going Paleo. (For a more in depth discussion on possible causes of these spikes in LDL on Paleo, see this interview: http://chriskresser.com/chris-masterjohn-on-cholesterol-and-heart-disease-part-3/)
Personally taking a big picture look at everything referenced it sounded to me like the big wins on the Paleo diet for heart health are cutting out sugar, refined carbs and processed foods and eating lots of whole vegetables, a moderate amount of whole fruit in their natural state and wild fish and seafood high in Omega-3s. More controversial aspects sound like cutting out whole grains, dairy, legumes and eating higher amounts of meat.
As my father doesn’t eat meat, I suggested he could try the Paleo diet eating only fish as I do. This is generally the approach suggested in the “Pegan” eating protocol promoted by Dr. Mark Hyman specifically for heart health reasons: http://drhyman.com/blog/2014/11/07/pegan-paleo-vegan/
Ultimately, cholesterol numbers do not appear to give an exact picture of heart attack risk. There is much about heart disease that is still unknown and unexplained. But given the articles and testimonials listed, I do think it might make sense consider giving a sugar free, grain free, dairy free diet try in concert with your doctor.
When you consider the alternative of a lifetime of sub-optimal health and chronic disease often associated with typical western diets, I would argue that 3 months of doing something a bit challenging to see if you can improve your risk factors for heart disease might be worth the effort.