Let's talk about cholesterol

There seems to be allot of misinformation/confusion regarding cholesterol, so lets talk about it. I’ll break down the issues one by one.

Is cholesterol absorbed in the body?
Yes, It is absorbed in the intestines

Does dietary cholesterol affect serum cholesterol?
Yes, dietary cholesterol can be absorbed in the intestines and become serum cholesterol.

So why do studies show that adding cholesterol to someone’s diet does not significantly effect serum cholesterol?
Cholesterol follows a reverse exponential curve in terms of its effects on serum, meaning that adding 200 mg of cholesterol to a diet that has, for example 500 mg in it already is not going to have the same effect as adding 200 mg to a diet with only 50 mg in it.

This dose response curve is also why things such as plant sterols and the drug Ezetimibe are able to lower cholesterol. Cholesterol is also excreted in liver bile, but can be reabsorbed which is why fiber helps regulate cholesterol.
Go fiber!

Why are there so many studies with this flawed design?
There is allot of money in heart disease and foods high in cholesterol.

So what happens if you have high levels of cholesterol?
Well it can speed up development of atherosclerosis, which is the arteries getting blocked due to build up of cholesterol and other materials on the arterial walls. This increases blood pressure, reduces blood flow and can even lead to a heart attack.
It has also been linked to Alzheimer, due to the brain’s blood vessels being blocked, getting less blood flow and the surrounding tissue dying, lower back pain due to that area needing clean blood vessels to deliver nutrient to the lower spine, and most famously erectile dysfunction due to blood flow to that area being restricted, which is why Viagra, a vasodilator, is able to treat it.

So what about the claims that cholesterol does not directly cause to atherosclerosis?
This is technically true, in the same vein that saying chronically high IGF-1 levels do not cause cancer, or flammable objects don’t cause house fires, its not really the cause but it is a huge contributing factor. A proper diet with lots of vegetables and low amounts of fructose lowers risk quite a bit, but I personally wouldn’t bet my life on it.

So what should you do?
Honestly its up to you, as long as you know the risk do what ever you want.
In the event you do want to lower your cholesterol reduce long chain saturated fats, hydrogenated oils, cholesterol and fructose consumption, eat more fiber and reduce your body fat percentage. To what degree you need to do this is dependent on genetics.
You can also do a fast every once and a while which I may write up a guide on if there is interest.

Other questions

Why did the FDA remove the cholesterol limit if cholesterol is so bad?
At the previous level it served little purpose, the difference between 300 mg and 500 mg is not that significant, so its now just a generalized “limit cholesterol and saturated fat”. They also list it as “not a nutrient at risk for over consumption” because of the way high intakes work.

Do I need to go vegan?
Ehh I don’t think so, it has benefits but strict vegan has allot of downsides.
If you want to get the health benefits without the big downsides/cost keep the gelatin capsules, fish oil, whey isolate when its cheap and any non-vegan things that are functionally identical to vegan options. Other then that don’t forget protein and supplements.

Should I take a statin?
First I am not a doctor, so if your doctor says something you should probably listen to him over me.
From what I can decipher if you are at a very high risk then yes, while you work to lower your cholesterol and become healthier. Statins are effective but they are over used and have allot of side effects.

Is it true carnivores can’t develop atherosclerosis?
They are more resistant to it and regulate cholesterol better then humans can, unless you feed them a large amount of sugar, or remove their thyroid in which case yes.

What about the keto diet?
I would wait on more research unless you are one of the groups that really heavily benefits from said diet. If its shown it can be done long term without raising cholesterol to unsafe levels it looks rather promising.

Does HDL or LDL particle size matter?
HDL seems to be an indication of good heart health rather then an actual protective factor, this is why HDL raising pharmaceuticals haven’t been approved as they haven’t been shown to do much.
Particle size does seem to have a very slight effect but it’s incredibly minor.


I’ve read a little on his site, but being very young and healthy, I’ve never been concerned with heart health. As far as I know, the guy running the site isn’t a doctor, but rather an engineer who became concerned with his own heart health. He then decided to “reverse-engineer” the cholesterol issue. It’s certainly interesting and worth checking out his opinion.

The big thing you need to mention is that your cholesterol levels are genetic. So a person is born with a pre disposition to either have high or low levels. Fortunately, mine are low. Plus, your body utilizes and handles the cholesterol more efficiently from foods you eat than it does from the cholesterol it produces itself. So, eating foods raises your cholesterol that has been told to us for years, isn’t really accurate. This information came from my doctor. She knows her stuff!

Sorry but what exactly do you mean by this?

Could you elaborate?

It’s pretty self explanatory. Your body (your liver) creates more cholesterol itself than what you can consume in foods. How your body responds and processes cholesterol differs between people and that is determined by genetics. Only about 15%-20% of the cholesterol in your blood is from the food you eat. So I wouldn’t stress out about cholesterol unless your levels are high to begin with.


I saw this guy speak at KetoCon in Austin. Pretty hilarious, he figured out how to hack a cholesterol test using diet just three days prior to the test, and it works 90% of the time. Can basically make your numbers look like whatever you want… what a joke.

Was actually going to link to him when I got around to posting in this thread. I’ll post some studies I like in a bit.

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I’m totally following this thread. The whole genetics thing is confusing. I must have been switched as a baby. I’m the only one in my family with elevated cholesterol (174 mg/dL), low HDL (35), and high LDL (123), and high BP (140/90). Ironically, I’m the only one in my family who is in athletic shape.

(After the new year I’m going to start a thread about my dealings with high BP, when I have completed collecting a year’s worth of BP data.)

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A 20% effect is significant, The fat and sugar[1] that is consumed also raises cholesterol levels by triggering the liver to produce more cholesterol. The way that’s phrased is heavily misleading.

That statement also contradicts your earlier statement .

With the number of negative health effects high levels of cholesterol is associated with this is a irresponsible thing to say.

[1] Very high fructose intake increases serum LDL-cholesterol and total cholesterol: a meta-analysis of controlled feeding trials - PubMed
Yes, going to slightly up the anti with a study since the fructose bit is interesting.

Ya, genetics is weird and complicated, to my understanding everyone has a general baseline cholesterol level that is then influenced by a bunch of factors(weight, diet, hormone levels, very slightly exercise, omega 3 consumption, ect).
I look forward to the thread!
If you can keep track of your diet and macros for a bit and post them along with it, it would be interesting to see.

Yep, the test can be pretty easily manipulated, fasting cholesterol level is used to give a bit more control over the results. Ideally its done while the person is just going about their regular diet.

Regardless of the ability to be manipulated it is still a useful test, and there is little reason for someone to manipulate it.

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@Christianmelon Its all good but I guess we will agree to disagree. If you would have seen the junk I ate over my early 20’s and 30’s, my cholesterol has always been low. I got out of the service and my total level was 118. It’s only 136 now and I am 47. My body processes it very well evidently and Im thankful but like I said everybody will process it different. But no matter how it does, genetics will always be the most significant factor.

I’ve heard about what Mike was saying. I’m pretty sure he says he always has his cholesterol tests done fasted for better accuracy. The point is, by changing his diet, in only 3 days he dropped his cholesterol number super low (I think. To be honest I forget if he purposely got his number super low or super high, but either way, still interesting). But he got his numbers down by eating enormous amounts of saturated fat as I recall. I’d have to double check on all the details.

This just popped up on our Twitter feed from SatchinPanda

Cholesterol and heart attack risk are better measured historically, it’s like daily calories and obesity, if someone starts eating 1200 calories a day that doesn’t mean they aren’t still overweight. The risk with cholesterol is plaque build up which takes a while to go away, just like body fat does.

Its not a perfect test, but like blood pressure it does have its place.

Anecdotes are a very weak form of evidence. I’m not saying you’re wrong but I have no way to prove or disprove what you ate a decade ago or how it influenced your cholesterol.

For the majority of the population no, there are some genetic outliers who have naturally high or low cholesterol, for which this is true, but for most of the population diet is a much more significant factor.

I like this study:

It concludes on ratios of total cholesterol to HDL, moreso than total numbers or the ratio of LDL to HDL.

Low-fat diets don’t improve that ratio though - they primarily decrease HDL (per Volek 2005), so I fear that many who are worried about cholesterol could be going in the wrong direction by “intuitively” lowering cholesterol intake.

Also, nobody gets the size of their cholesterol particles tested, which seem to be important. NMR LipoProfile could be useful to someone concerned, but I’ve never had that test.

Long story short, I’m anti low-fat diets :stuck_out_tongue:


I’m borderline obsessed with butter. I add it to pretty much anything I cook. I’d hate a low fat diet.


“Let’s talk about cholesterol”

Proceeds to state a bunch of unproven opinions (and also admittedly interesting points), but not prompt any discussion.
I’m glad people interested in cholesterol ended up contributing some interesting info! About to go back through and drop some likes. I think it’s interesting you didn’t mention cholesterol ratios or their relevance, and you called out Jeremy or Brawn for the weakness of anecdotal evidence when you didn’t post any evidence at all. Anecdotal evidence is much stronger than no evidence IMO.

Ok let me go though it

Dietary cholesterol absorption; more than just bile - PubMed
This study give information regarding its absorption, including the bit about it being absorbed in the intestines also mentioning plant sterols.

Ezetimibe effectively reduces plasma plant sterols in patients with sitosterolemia - PubMed
This study on the drug Ezetimibe, which I explained inhibits cholesterol absorption also inhibits plant sterol absorption, because they have very similar metabolism.

Carotid atherosclerosis promotes the progression of Alzheimer's disease: A three-year prospective study - PubMed
This study shows a link between Carotid atherosclerosis, two large blood vessels in the brain and progression of Alzheimer’s.

This study goes over LDL’s role in atherosclerosis.

Hypertriglyceridemia and atherosclerosis | Lipids in Health and Disease | Full Text
This one focuses on high triglycerides as a risk factor but goes over LDL and mentions it is a independent risk factor.

This study goes over the heart health benefits of flax seed, which is high in ALA(the omega 3) and fiber.

This meta analysis goes over the outcomes of drug trials of HDL raising drugs and find no benefit.

If there is a point not covered here quote it and I will respond.

I do briefly mention HDL in the last question, it does not have a direct protective effect, low ratios are bad but its a indicator of something else going wrong not a direct protecting factor in of itself. Yes it is a good indicator but even with a perfect ratio if your cholesterol is high it will cause problems.

I didn’t link any studies in the original post, which yes I should have done, but I have explained the mechanisms and given examples of them working in practice, I also linked to a study that disproved his statement “eating foods raises your cholesterol that has been told to us for years, isn’t really accurate.” in that post.

When we are talking about medicine no, anecdotes and uninformed opinions get people permanently crippled or killed.


Yes TC to HDL is a good measurement of risk factor, but this is a sign of something else being amiss, IE a very poor diet leading to low HDL or high LDL levels.
The ratio is a good indicator but lowering LDL is more effective at reducing risk then raising HDL, which is why most of the the approved heart disease medications focus on lowering LDL cholesterol or total cholesterol rather then raising HDL.

As for the study that found it lowering HDL they found it also lowered LDL and in the conclusions it said “The effects of fats on these risk markers should not in themselves be considered to reflect changes in risk but should be confirmed by prospective observational studies or clinical trials.”
Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials - PubMed
It was also comparing it to fats that raise HDL

I’m also not in favor of low fat diets mainly due to retention issues outweighing most of the benefits. Plus the benefits over a good moderate fat diet are fairly minor.

I’ll have to find the research later but the effect seems to be minor at best in comparison to total cholesterol levels.

Did you ever check the link I posted?

I have, Is there anything in particular you wanted me to see?