Poor cholesterol—so misunderstood. All animal cells require cholesterol for proper structure and function. The vast majority of cholesterol in the body does not come directly from foods like eggs and meat, but from the liver, which can make cholesterol out of anything we eat. So, if cholesterol-rich foods don’t cause high cholesterol, what does?


Most people have no idea what cholesterol actually is.

Life without cholesterol would be impossible. Cell membranes, which wrap around and protect the inner contents of all cells, must contain cholesterol in order to function properly. Cholesterol contributes firmness to membranes and keeps them from falling apart. But wait, there’s more!

All of the following critical body components are made from cholesterol:

  • Estrogen
  • Testosterone
  • Progesterone
  • Cortisol (anti-inflammatory stress hormone)
  • Aldosterone (regulates salt balance)
  • Vitamin D
  • Bile (required for fat and vitamin absorption)
  • Brain synapses (neurotransmitter exchange)
  • Myelin sheath (insulates nerve cells)


Cholesterol is made of carbon, hydrogen, and oxygen, just like fat is, but it is not fatty; it is a hard, waxy substance that contains no fat. A molecule of fat looks like this:

whereas a molecule of cholesterol looks like this:

As you may be able to appreciate just by looking at them, they are very different from each other.

Fat is a simple long chain, whereas cholesterol is mainly a complicated combination of rings—3 hexagons plus a pentagon; in medical school we affectionately called it “three rooms and a bath.” Fat is relatively easy to build (11 chemical steps from acetyl-coA to triacylglycerol), whereas cholesterol is hard to construct—more than 30 chemical steps are required to build one molecule of cholesterol (from acetyl-coA to cholesterol). The body would not go to the trouble of making it for no reason. Especially since, as it turns out, once it’s built, it’s impossible for the body to break it down—we do not have any way to take apart its complex ringed structure.


How much cholesterol do we need to eat?


Cholesterol is so important that the body can make cholesterol out of ANYTHING—fats, carbohydrates, or proteins. You don’t have to eat cholesterol to make cholesterol. Even if you eat a completely cholesterol-free diet, as vegans do, your body will still make cholesterol. Type “vegans with high cholesterol” into your search engine and you will find plenty of accounts of vegans whose cholesterol is too high—despite the fact that they eat ZERO grams of cholesterol.

Which foods contain cholesterol?

Since every single animal cell contains cholesterol, all animal foods contain cholesterol.

Many people don’t realize that all muscle meats (chicken, fish, beef, pork, etc.) contain about the same amount of cholesterol per serving.

Certain animal foods—liver, egg yolk, dairy fats, glandular organ meats, and brain— are especially high in cholesterol.  Why is that?  Liver is where the body manufactures cholesterol. Egg yolks contain concentrated cholesterol because the growing baby chick needs it to build new cells. Milk fat contains lots of cholesterol because the growing baby calf needs it to build new cells. Glandular organ meats (pancreas, kidney, etc.) contain more cholesterol because glands make hormones, and hormones are made from cholesterol. Brain contains very high amounts of cholesterol in its myelin sheaths, which insulate its electrical circuits.

All plant foods are considered “cholesterol-free.” Well, it would be more accurate to say that plant foods do not contain any animal cholesterol. Plants contain their own special forms of cholesterol called “phytosterols”, but phytosterols are toxic to human cells, so our intestines wisely refuse to absorb them.

So, in most cases, animal foods contain some cholesterol that the body can absorb and use, and all plant foods contain cholesterol that our body cannot absorb. The only exceptions I know of to these rules are shellfish.

There are two types of shellfish: crustaceans (lobsters, shrimp, crabs, etc.) and mollusks (clams, oysters, mussels, etc.). Crustaceans—giant sea insects who hunt for their food—contain animal cholesterols that can be absorbed by the body, but mollusks—who gather nutrients by filtering seawater—contain a different type of cholesterol that we can’t absorb.

In fact, plant cholesterols and mollusk cholesterols are not only rejected by our intestinal cells, they actually interfere with the absorption of animal cholesterols. This is how margarines such as Benecol® work. The manufacturer has added a chemically altered form of plant cholesterol to the spread, which interferes with the absorption of animal cholesterol.


Yes, but only if your body needs more cholesterol.

The cells lining the small intestine each contain transporter molecules (NPC1L1) that absorb cholesterol. [The cholesterol-lowering drug Zetia® works by blocking NPC1L1 yet does not reduce risk of heart disease]. However, if the body doesn’t need any more cholesterol, there are other molecules (ABCG5/8 transporters) that pump the cholesterol right back out into the intestines to be eliminated from the body. This is one reason why it is virtually impossible for cholesterol from food to cause “high cholesterol.” The intestinal cells know exactly how much is needed and will not allow extra to be absorbed.

This is brilliant when you think about it (the body is so smart)—it is impossible for the body to break down the complex structure of the cholesterol molecule, so it would make no sense to absorb too much—once it’s inside the body there’s only one way to get rid of it, and that is to excrete it in the bile. Why take in more than necessary, if it’s just going to have to be eliminated?

However, if your body cholesterol levels are low, the intestinal cells will not kick it out, and it will make it into your bloodstream—because you need it.

What’s more, cholesterol is recycled very efficiently by our bodies, because it is so hard to make. Why make more from scratch if you don’t have to? Remember that it’s also impossible for the body to break down cholesterol, so the only way to get rid of it is to excrete it. The liver gets rid of any excess by excreting free cholesterol into the intestines along with bile. This free form of cholesterol is the only form that intestinal cells are able to absorb. Most of the cholesterol molecules in food (85 to 90% of them) are not free; they are in the form of “cholesterol esters.” [Cholesterol esters are just cholesterol molecules with a fatty acid attached]. Intestinal cells are incapable of absorbing cholesterol ester, which is the major form of cholesterol in food. Therefore, if the intestinal cells sense that the body needs more cholesterol, it will typically reabsorb most of what the body needs from the bile, not from food.

To summarize the relationship between food cholesterol and blood cholesterol:

  1. Most cholesterol from foods does not get absorbed unless body levels are low.
  2. The amount of cholesterol you eat has almost no effect on your cholesterol levels.
  3. The vast majority of cholesterol in your body is made by your body’s own cells. Remember that creepy line from the movie When a Stranger Calls? “The call is coming from inside the house.” The excess cholesterol is coming from inside your body, not from the food you eat.

How does the body make cholesterol?

All cells can make their own cholesterol, but liver cells are especially good at it. Only liver cells are capable of making more than they need for themselves—and shipping it out to other parts of the body.

Remember how it takes more than 30 chemical reactions to build one molecule of cholesterol? The most important of all of these steps is step #3. In this step, a critical enzyme called “HMG-CoA reductase” converts a molecule called HMG-CoA into another molecule called mevalonate. Once this step occurs, there’s no turning back, so it’s a big commitment. This reaction is the one that determines whether or not cholesterol gets made. Therefore, the enzyme that runs this reaction, HMG-CoA reductase, is very important—it’s like the foreman in charge of the cholesterol assembly line. This enzyme needs to be carefully controlled, because we don’t want cells wasting their time and energy building expensive cholesterol molecules willy-nilly.

The activity of this critical enzyme HMG-CoA reductase is controlled primarily by two things:

1) cholesterol levels inside the cell

2) insulin levels in the blood.

This is where things get really interesting. It makes sense that HMG-CoA reductase would respond to the cell’s cholesterol levels—if the cell’s levels are low, you want to turn that enzyme on, so you can make more cholesterol, and if the cell has enough cholesterol, you want to turn that enzyme off and stop making cholesterol. But what is insulin doing in the mix?

We think of insulin as a blood sugar regulator, but its real job is to be a GROWTH HORMONE. Insulin is supposed to turn on when we need to grow. What do we need to make in order to grow? More cells. What do we need to form new cells? Cholesterol. So, at times when we need to grow (babies, teenagers, pregnant women), insulin turns the enzyme HMG-CoA reductase ON, which tells cells to make more cholesterol, so we can build new cells.

What causes high cholesterol?

Why would the body make more cholesterol than it needs?

Now here’s the problem: when people eat too many sugars and starches, especially refined and high glycemic index foods, blood insulin levels can spike. When insulin spikes, it turns on HMG –CoA reductase, which tells all of the body’s cells to make more cholesterol, even if they don’t need any more. This is probably the most important reason why some people have too much cholesterol in their bloodstream. Sugars and starches can raise insulin levels, which fools the body into thinking it should grow when it doesn’t need to. This is how low glycemic index diets and low-carbohydrate diets normalize cholesterol patterns—these diets reduce insulin levels, which in turn lower HMG-CoA reductase activity.

“Statin” drugs, such as Lipitor®, which are prescribed to lower cholesterol levels, work partly by interfering with the activity of HMG-CoA reductase. If your cells happen to need more cholesterol under certain circumstances, but the statin drug is blocking this critical enzyme, your cells may not be able to make cholesterol when needed. And what’s worse is that the cholesterol synthesis pathway doesn’t just make cholesterol; branches of this same pathway are responsible for synthesizing a wide variety of other important molecules, including: Vitamin A, Vitamin E, Vitamin K, and Coenzyme Q. So, you may want to think twice before you artificially interfere with this pathway by taking a statin drug.

When you eat less carbohydrate, you are not artificially blocking the pathway; you are simply allowing HMG-CoA reductase to listen to other more important signals (such as cholesterol levels and growth requirements) and decide naturally when it should turn on and when it should turn off.

So, to recap: refined carbohydrates speed up the cholesterol assembly line and statins slow it down. Which approach would you rather take to manage your “cholesterol problem”—taking a drug that artificially slows down this assembly line, or changing your diet so that the assembly line only runs when it’s supposed to? [Hint: Dietary changes require no monthly co-pays, and have no potentially dangerous side effects.]

Chances are: if you have “high cholesterol” you do not have a cholesterol problem—you have a carbohydrate problem.

Good Cholesterol and Bad Cholesterol

This gets into the very complicated relationship between cholesterol blood tests and heart disease risk. This is an enormous topic that will be covered in future articles on this site, but I’ll summarize some basic points here now.

When you get your cholesterol levels checked, you will see numbers for HDL and LDL, as well as triglycerides.  Triglycerides are fats, so we’ll set them aside and just focus on HDL and LDL.

HDL particles collect extra cholesterol from around the body and carry it back to the liver to be eliminated from the body if we don’t need it. It is typically thought of as “good cholesterol” so higher HDL levels are considered a good sign.

LDL particles carry extra cholesterol made in the liver out to the rest of the cells in the body. We used to think of LDL as “bad cholesterol” so lower levels of LDL were considered a good sign.

The cholesterol inside of HDL and LDL particles is exactly the same, it’s just that, for the most part, HDL is carrying it in one direction and LDL is carrying it in the opposite direction. The reason why LDL had been dubbed “bad” and HDL has been dubbed “good” is that numerous epidemiological studies (most famously, the Framingham Heart Study) told us that high LDL levels were associated with a higher risk of heart attack, and that high HDL levels were associated with a lower risk of heart attack.

We used to think that HDL was good because it acted like a garbage truck, clearing evil cholesterol out of our bodies, and we used to think that LDL was bad because it burrowed its way into our coronary arteries, depositing evil cholesterol there—forming plaques and causing heart attacks.

Cholesterol, Carbohydrates and Heart Disease

However, this simplistic way of thinking about cholesterol and heart disease is changing before our very eyes. It turns out that it is more complicated than this. LDL, for example, exists in a variety of forms. It can be big and buoyant and “fluffy” or small and dense and oxidized (damaged). The new thinking is that small, dense, oxidized LDL may be the only type of LDL that is associated with heart disease. Therefore, instead of thinking of all LDL as “bad”, it would be more accurate to say that all LDL is not created equal—big fluffy LDL is “good” and small, dense, oxidized LDL is “bad.”

Unfortunately, standard blood tests can’t tell you which type of LDL you have because it lumps all types of LDL particles together.  Standard tests can only estimate how much of your cholesterol is travelling inside of LDL particles.  They can’t tell you how many LDL particles you have, how big they are, how dense they are, or how oxidized they are.  [For a detailed explanation of the complexities involved in interpreting cholesterol blood test results, I recommend Dr. Peter Attia’s blog at]

What we do know from research studies is that people who eat a diet high in refined carbohydrates tend to have a higher number of “bad” (smaller, denser, oxidized) LDL particles. This makes sense, because we know that carbohydrates are “pro-oxidants” —meaning they can cause oxidation.

There is also lots of evidence telling us that refined carbohydrates can cause inflammation.  Just because doctors find cholesterol inside artery-clogging plaques does not mean that cholesterol causes plaques. It is now well established that heart disease is a disease of inflammation. It is not simply that an innocent, smooth, buoyant sphere of fat and cholesterol traveling through the bloodstream decides to somehow randomly dig its way into a healthy coronary artery. The first step in the development of a vessel-clogging plaque is inflammation within the lining of the artery itself. When doctors cut into plaques they don’t just find cholesterol—they find many signs of inflammation (such as macrophages, calcium, and T cells). Wherever there is inflammation in the body, cholesterol is rushed to the scene to repair the damage—because we need cholesterol to build healthy new cells. Jumping to the conclusion that coronary artery plaques are caused by the cholesterol found inside of them is like assuming that all car accidents are caused by the ambulances that are found on the scene.

The latest research suggests that diets high in refined and high glycemic index carbohydrates increase the risk of inflammation throughout the body, especially in blood vessels. Diabetes, a disease which is intimately associated with high blood sugar levels, is infamous for causing damage to blood vessels in the retina, kidneys, and tiny vessels that feed nerve endings in the feet. It is well established that people with diabetes are also at higher risk for heart disease. It should therefore not be a stretch for us to imagine that all people with high blood sugar and/or insulin levels due to diets rich in refined carbohydrates may also be at increased risk for cardiovascular disease.

Cardiology researchers are now turning away from the notion that saturated fat and cholesterol cause heart disease. After all, how could saturated fat and cholesterol, which we have been eating for hundreds of thousands of years, be at the root of heart disease, which is a relatively new phenomenon? Cardiologists are finding instead that refined carbohydrate (such as sugar and flour), which we have only been eating in significant quantities for about a hundred years, is the single most important dietary risk factor for heart attacks:

“Strong evidence supports …associations of harmful factors, including intake of trans-fatty acids and foods with a high glycemic index or load.”

“Insufficient evidence of association is present for intake of…saturated and polyunsaturated fatty acids; total fat,… meat; eggs; and milk.” [Mente et al 2009].


There are several plausible mechanisms for how refined carbohydrate could increase risk for heart disease and change cholesterol profiles:

  • Diets high in refined carbohydrate lower HDL levels and set the stage for high insulin levels, oxidation, and inflammation throughout the body, including in the coronary arteries.
  • High blood sugar and insulin levels turn big, fluffy, innocent LDL particles into small, dense, oxidized LDL particles, which are associated with increased risk for heart disease.
  • High insulin levels turn on the cholesterol building enzyme HMG-CoA reductase, forcing the body to make more cholesterol than it needs.

It is becoming increasingly obvious that cholesterol is innocent until corrupted by refined carbohydrate.

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  • bill

    Your 4 part series is very well presented. Thank you for doing this.

    • Thanks for reading it, Bill; I’m so glad you liked it.

  • Judith

    Why would someone who went from years on a major junk food diet (living on crackers, cakes, cookies, soda, noodles and occasionally a decent meal) actually have a significant increase in total cholesterol (from 240 to 280) and LDL cholesterol (from 160 to 180) even 2 years after following a clean, low carb diet with no weight loss in the past 1 year? (60 pounds were lost the first year.) HDL hasn’t changed from about 55. Fasting triglycerides have ranged up and down between 50 and 170 during this time. Fasting blood glucose is normal (87) and fasting insulin is 10. Daily total carb intake averages 30-50 grams.

    • Hi Judith
      It is actually fairly common for LDL (and total) cholesterol to rise on a low-carb diet, and it is not usually any cause for concern. As noted in the above article, LDL is a poor indicator of heart disease risk and overall health because it exists in various forms that are not routinely tested for. Triglycerides and HDL are more helpful indicators. High cholesterol is not generally a sign of trouble if everything else looks ok.

      • Judith

        Thank you. My doctor has suggested a statin drug, but I have declined due to concerns about the side effects. The only other concern is that my blood pressure has been hard to get and keep down. I don’t take anything for it, but I’m hoping to resolve somewhat high bp other ways, such as supplements. Everything else is normal.

        • Hi Judith
          Please do not think of my reply as medical advice for your particular situation, only as a general response about cholesterol patterns on low-carb diets. It would be wise to find a physician who understands the new science behind diet and cholesterol to guide you–luckily they are growing in number.

    • cavenewt

      There is something to keep in mind if you are on a low-carb diet. The LDL measurement in a standard test is *calculated*, based on certain assumptions. One of those assumptions is wildly off if one is on a low-carb diet. The result of this is an artificially elevated LDL reading. Better to get a direct measurement if you are able. That is, if you believe that cholesterol measurements have anything to do with anything.

  • Erika

    Hi Dr. Ede,

    Love the website!! It is really fun browsing around.

    So my husband has high cholestorol. Period. We are toying with the idea of ketogenic diet as a way to address this. However, if he does this diet strictly for let’s say, 3 months, his cholestorol profile will still be high when they check it. Correct? Is there a test that can differentiate the good and bad cholestorol in your body?


    • Hi Erika

      Glad you are enjoying the website–thanks for the positive feedback! Does your husband simply have high LDL or does he also have high triglycerides and low HDL? It is true that low-carbohydrate diets, including ketogenic diets, do not tend to lower LDL for many people, but they do tend to improve HDL and triglyceride levels. Yes, there are tests that can differentiate between good and bad LDL cholesterol. In fact, I had my own cholesterol fractionated recently with a test my doctor ordered called a VAP cholesterol panel, and will be posting the results next week as part of my ketogenic diet month 2 update. Your husband may not need to go to the extreme of a ketogenic diet to improve his profiles–he may simply need to try a low glycemic index diet or a low-carbohydrate diet. Cheers to both of you, too!

  • justmeint

    Have been sharing this easy to read – what I have called Cholesterol 101 with many people who are considered statin damaged. Doctors insist on prescribing and telling people to eat less fat. They do not understand nutrition at all 🙁
    Thanks for the work you are doing.

  • Keith Taylor

    Dear Dr. Ede,
    I have found this website only now, but better late than never, as the saying goes. I am a strong proponent of a high animal fat and animal protein diet. The reason is that I literally “took my life into my own hands” when the medications and diet prescribed for a diagnosed angina pectoris appeared to make it WORSE! I switched to high fat and sufficient animal protein … and the angina “attacks” stopped almost immediately. It is now more than six years later and I need no medication at all.
    Thank you for a truly well-informed website: I will link to it in my blog.

    • Hello, Keith
      What a fabulous story–thank you so much for sharing it here with us! I am so glad you are finding the website helpful.

  • Jason

    Hi I was reading your site n found it very informativw. I have had low cholesterol for a while at 122, my hdl is 34 ldl 74 and triglycerides are 68. I eat a high protein n low carb diet. My hormones are hurting bc of it I think. Do u know reasons why its low or could it be something more serious. I was told it should be at least 160-180. Thank you

    • Hi Jason

      I can’t be sure, but you say that you eat a high protein, low carb diet, without mentioning how much fat you eat. It is possible that you are simply not eating enough fat…but more importantly, cholesterol levels are a terrible measure of health, especially LDL levels, so the question is whether you are healthy and feel well or not. I’m glad you are finding the website informative!

  • erin

    Hypocholesteremics will be dangerously misled by this. You need to change this and explain some people do not make enough cholesterol

  • 777serenity

    I started the 100 because I have been trying for years to find a way to lower my blood pressure and lose weight with out prescribed medicine. My doctor never had any solutions to my high blood pressure except to prescribe medicines with side effects The 100 specifically controls sugar carbs. I still eat carbs but this way has lowered my blood pressure and sugar cravings. I am losing weight at a healthy rate, have lost 20 pounds and still losing. I don’t get sleepy anymore after lunch. I can’t explain the sense of well being I feel physically. This website has explained so much to me about cholesterol that I will never hear in the mainstream heart disease protocol. I have been passing your message on. People I love need to know this.

  • Alice Licht

    Dear Dr. Ede,
    I thank you for being so accessible and teaching me the basics of sugars, carbohydrates, fats and cholesterol. I didn’t know anything about cholesterol so I Googled the word and the first hit was your blog. Thank goodness! You’re educating me.
    My doctor told me my blood pressure is too high and my cholesterol is too high. I am 78, female 5’7″ 135 lbs. and I exercise about 1 hour daily. Last year I gained 5 pounds because I was eating a pint of Haagen Daz almost every evening. I also regularly ate Hershey bars and any other chocolate I could find. I stopped eating candy made with dairy fats and loaded up on low fat candies. The doctor said I should stop eating all dairy products and I should be on Lipitor but I begged him to give me a chance to see what a more strenuous diet and exercise program would produce. I have an appointment with him in 3 months. I can’t test my own cholesterol levels so I have to “work in the dark” until I see him again.

    It has been 8 days since I stopped all dairy and began a “no salt” and all vegetable and fruit diet–every green imaginable, including broccoli, kale, romaine, and green beans. For fruits I eat strawberries, bananas, mangoes and apples. My BP has dropped from 165/80 to 128/71. I was thrilled to see that I could get results if I worked at it. I now fear statins like the plague.

    I occasionally snack on unsalted sweet potato chips. Now that I’ve read your blog I realize that sweet potatoes are carbs and now I think I will eliminate the carbs that I still eat.

    A friend told me about the Paleo Diet and I’m thinking that I should probably eat some organically-raised chicken and eat a proper amount of fats, something I’m presently not doing. I feared that fats would cause my cholesterol to rise. But since reading your blog I realize that cholesterol is naturally produced by the body when a high carb and high sugar diet (all those Hershey bars and ice creams — even the low fat candies) prompts the body to produce more cholesterol. OMG! Nobody ever explained that to me. And lobster! I love a lobster dinner occasionally but I haven’t eaten shellfish in over 7 years because the same doctor I see today diagnosed me with high cholesterol 7 years ago and told me not to eat shellfish. He was pleased that at the time my BP was 128/80. But over the years it had slowly risen.

    I don’t think I’m so unusual that other women don’t have the same problem that I have. I look healthy and live a healthy lifestyle. But if my body is producing more unnecessary cholesterol to offset my unnatural intake of sugars and other carbs, I will never be able to lower my cholesterol. Could you say what is an optimal diet for someone like me?
    Yours truly,
    Alice Licht

    • Wilma Laura Wiggins

      The body produces cholesterol even if you don’t eat any cholesterol at all because the body needs it. What you are eating sounds very healthy, but you may be using oil (all oil is bad for you). Your blood pressure drop is amazing. Congratulations. Sweet potatoes are very healthy as long as they are oil free and may help you stay on the diet without starving. You can make chips in the oven or microwave without oil.

      • Stephen Crouse

        I would make a statement, but won’t have time to respond/interact, so I’ll just ask the question:
        What is bad about a diet containing any oil?

  • Alice Licht

    Dear Dr. Ede,
    I mistook your explanation about shellfish. On rereading your blog I see that you said clams, oysters and mussels are not absorbed by the body but lobster and shrimp are absorbed. So I’m looking forward to a plate of mussels. No lobster. I can live without it.
    Best always,
    Alice Licht

    • cavenewt

      Alice, you will notice that she also said dietary cholesterol does not raise your blood cholesterol, unless your blood cholesterol is too low to begin with. So avoiding foods with cholesterol is unnecessary in most cases.

      • Wilma Laura Wiggins

        Who determines what “too low” is? Maybe it doesn’t raise cholesterol if it is already too high? All the studies which seem to show no difference are done on people who consume 30% or more of fats. Maybe 10% of fats is more healthful.and in fact studies do show people with that level of fat do increase their cholesterol when they eat more cholesterol.

  • Sindhu Ganesh

    Dear Dr. Ede,

    This is such a nice article which clears many myths about cholesterol. But still I have some doubts.
    You say that dietary cholesterol does not gets absorbed in our intestine, but how would you relate, eating a diet like french fries, pizza’s or burger or any other junk food for that case, which are rich in fat content to increased cholesterol levels(ultimately leading to plaque formation)???

    Do you say that foods that state “low-fat” which contains high amount of sugar content increase LDL levels? if so…how? could you please explain me on this.

    • Jane50

      I am not a doctor, but the foods you mentioned are high in carbohydrates (sugar).

    • Dear Sindhu

      My apologies for the delay in responding to you. Luckily, Jane50 below, came to my rescue! I agree completely with her that the foods you mentioned are high in refined carbohydrates (white flour, white potatoes, etc), and it is the carbohydrates, not the fat or cholesterol in these foods, which make them risky when it comes to disturbing the healthy balance of cholesterol in our bodies.

  • Iva Milanova

    Dear Dr Ede, I find your article very cleary and logical. But I have a question. If we can say that the Cholesterol is acting like an ambulance, can we say that IF we have high levels of LDL in our blood, we aslo have inflamation? Can we use such relation for sure? And if the answer is Yes, wich blood markers you use to find this inflamation? I am 34 years woman, very tin and have some medical problems. I have blood tests in December and only the LDL and TOTAL Cholesterol have been high. In March this year I make another test including C reactive protein CRP, ESR and WBC. All these parameters stay stable in normal ranges, but only the LDL is still going up. Can you explane this? My condition is very common to the Insulin Resistence, but it is not confirm yet. If I have some inflamation how to search it? Or the conection between Cholesterol and Inflamation is not absolutely always exist?

    I will be very grateful if you answer my questions, and wish you all the best.

    Iva Milanova

    • Stephen Crouse

      Basic sequence: Injury, Inflammation, Cholesterol, Corrected

  • Evan

    Very interesting information here. I wonder if you had an opinion on Beans and Chickpeas. We eat alot of both ( being vegan ) and recently discovered my ldl went up. Trying to isolate the cause. We don’t eat a lot of processed food (some but a small percentage of caloric intake) . I exercise 1 to 2 hours a day , so it’s not activity level. I’m at a loss, found this site realized everyone says legumes = low LDL, so we eat lots. But I’m not sure there is a correlation. Any suggestions would be great as to where to look. Thanks

    • Dear Evan

      Such good questions! You may be relieved to hear that LDL is useless when it comes to understanding health and heart disease risk, so a higher LDL may be nothing to worry about, especially If all of your other standard metabolic markers (weight, waist circumference, HDL, fasting triglycerides, fasting blood sugar) look good. However, if any of those other markers don’t look good, and/or if you wanted to be sure, you could ask your doctor if he/she would be willing to order a fractionated LDL test for you that could tell you whether the LDL increase you are experiencing is healthy or not.

      As for my opinion about beans and chickpeas–they are very high in starch, so people with poor carbohydrate metabolism can run into metabolic problems if they eat too many of these foods. Some of us are luckier than others in this regard, so it depends on your body. Carbohydrates are the strongest driver of cholesterol production in the liver.

      • Evan

        Thank you so much for taking the time to respond!! There is a little more to the story, before becoming vegan I was a steak pizza( with legumes and salad) kinda of carnivore , with weekends full of bacon egg cheese sandwiches. So my numbers and weight we not good. After going vegan I expected my LDL to drop, it actually went up. My hdl , tris and weight improved , but was shocked about the ldl. I’d say I eat substantially less carbs, with the exception of hummus and beans, which I use for protein and satiation. Also I no longer cook with oil, instead replacing those fats with a little avocado a few times a week, nuts and seeds. Not sure how to proceed.. Guess I’ll try to get the test you mentioned ( which I assume is something similar to what I read about tests for different ldl types. ). I’m up for anything to not go on statins, and to be honest I’m not a bit fan of going back to being an omnivore and other minor heath issues dissapeared after going vegan.

        • Dear Evan

          Interesting story. I sincerely hope that you will not be advised to begin a statin medication if the only “abnormality” in your metabolic profile is your LDL level. If all other metabolic parameters look good and you feel healthy and well, it would be difficult to justify prescribing a potentially risky medication to treat a number on a lab slip that more than likely has no bearing on your health or risk for disease.

          • since1911

            Can you explain how beans is digested in the body? I’m 23 and have tracked my blood pressure for the past year and it has been high. I recently switched to a majority protein diet (I still eat carbs in way less proportions or sometimes none at all) – my diet has consisted more of meat, fish, beans, plantains. When food is fried we use olive oil. I erased sodium from my diet – using salt at home. I have eaten processed snacks and restaurant meals which may have sodium. The goal is to bring my blood pressure down.

          • Hello, since1911

            Beans are very high in carbohydrates–most of them turn into blood sugar and some of them can’t be digested or absorbed, so the rest of them get fermented by bacteria in our colon. Plantains are also high in carbohydrates. High blood pressure is not always due to high carbohydrate, but many cases of high blood pressure are. If you have never tried a low-carbohydrate diet (10 grams of carbohydrate per meal or less), then that might be useful. For more information about this topic, please see my article about insulin resistance and low carbohydrate diet tips: Another useful website with practical advice about how to try a low-carb diet is Best of luck!

      • Wilma Laura Wiggins

        Could you please cite a source (or two) for the statement that carbs are the strongest driver of cholesterol production in the liver?

        • Hello, Wilma

          Absolutely. The regulation of cholesterol production by insulin is so well-established that it is published in biochemistry textbooks. The quote below is taken from the respected Lehninger Principles of Biochemistry (Nelson & Cox 5th ed, 2008, page 842).

          “Hormonal control is mediated by covalent modification of HMG-CoA reductase itself. The enzyme exists in phosphorylated (inactive) and dephosphorylated (active) forms. Glucagon stimulates phosphorylation (inactivation), and insulin promotes dephosphorylation, activating the enzyme and favoring cholesterol synthesis.”

          I should clarify that insulin is the most powerful hormonal regulator of this enzyme. It naturally also responds to cholesterol levels–if we don’t have enough cholesterol, this enzyme will turn on and if we have too much, it turns off. This is just another reason why eating too much cholesterol can’t hurt us.

          • Wilma Laura Wiggins

            I’m sorry but your language has changed from unfamiliar to incomprehensible. smile. After trying to understand the above using online dictionaries, the best I can figure this is talking about statin drugs being used to control an enzyme that is found both active and inactive in the body. Glucagon raises sugar in the blood which stimulates inactivation. And it says insulin activates it. It also says HMG-CoA is an intermediate on the pathway for synthesis of ketone bodies (I am familiar with the concept of eating high protein to make ketones) Do I have it basically correct? It is not obvious to me how this relates to carbs being the strongest driver of cholesterol production in the liver. Thank you for your patient attempt to educate me. I do appreciate it.

          • Hi Wilma

            Sorry, it wasn’t my language, it was a quote from a reference because you asked for a reference. Carbohydrates and dairy products (due to whey protein) are the foods that raise insulin levels the most, followed by protein (yes, protein can raise insulin levels too, which is why lowering protein can help–I’m not a fan of high-protein diets), and then fat (which has very little effect on insulin). Ketones are formed by the breakdown of body fat and are generated only when dietary carbohydrate is extremely low (typically 20 grams per day or less, and in my particular case protein must be limited to about 70 grams per day).

          • Wilma Laura Wiggins

            I can’t help but wonder, if carbs raise insulin the most (and I’m pretty sure it’s true) how is it possible so many, including myself, have reversed diabetes by eating carbs as in Dr. McDougall’s way of eating?

          • Stephen Crouse

            Without any familiarity with the McDougall diet, also not following everything you and Ms Ede discussed, but having personal associations with Seventh Day Adventist vegans and my sugar-level-monitoring dad, done some studying on Type 2 D reversal, and spent much time looking at the inflammation commonality of disease: perhaps the references made to REFINED along with HYBRID/GENETIC-MODIFIED and PESTICIDE/CHEMICAL-LADEN carbohydrates (first) and oils (next) are the primary problem triggers.

          • Wilma Laura Wiggins

            It is possible. Dr. McDougall espouses unrefined or at least less refined carbohydrates, low sugar and no oils, no animal. I don’t know if anyone has reversed T2 diabetes while eating this way plus adding in animals and/or animal products. But I know many have reversed it following his plan.

          • Wilma Laura Wiggins

            So it’s been 8 months and no answer to how it is possible that hundreds of people, including myself, have reversed T2 diabetes by eating HCLF (Dr. McDougal)

          • Wilma Laura Wiggins

            According to, what you just said is not true. Even if it were true, you seem to be equating insulin as equal to carb intake and I don’t think that is true either but what I asked you to offer a source for was that carbs drive cholesterol level and you gave me insulin drives cholesterol level, which is only part of the story. The fact is that many people (thousands) have *reversed* type II diabetes by eating a high carb very low fat diet while avoiding processed foods and oil and animal products. Most eating this way have also reduced cholesterol, but not all. If it is as you say, how can you explain this phenomenon which is not at all rare?

          • The page you link to essentially says that HMG coA reductase is turned off by cholesterol in the diet (which is why eating too much cholesterol can’t raise your cholesterol to unhealthy levels), and that insulin turns that enzyme on. A direct quote from the medicalbiochemistrypage you link to above:

            “Since the intracellular level of cAMP is regulated by hormonal stimuli, regulation of cholesterol biosynthesis is hormonally controlled. Insulin leads to a decrease in cAMP, which in turn activates cholesterol synthesis. Alternatively, glucagon and epinephrine, which increase the level of cAMP, inhibit cholesterol synthesis.”

            I would never disagree with anyone’s personal experience and believe your diet works for you. I think where we are getting our wires crossed is about WHY your diet works for some people. The biochemistry of carbohydrate and insulin levels is well-established, but it is both the amount and type of carbohydrate that are important. Carbohydrates raise insulin more than protein and protein raises insulin more than fat (which barely affects it at all). So carbohydrates are most important, but they don’t operate in a vacuum. Fiber slows absorption, which is why unrefined carbs are healthier. Dairy products raise insulin levels. And the nature of fats (omega-6 vs omega-3, trans fats, etc) influence how food is metabolized and how membranes operate, which may influence insulin resistance on a cellular level. There are many reasons why your diet is healthier than the average diet, as I have already acknowledged, but I just want to make it clear for readers that simply raising carbohydrate without regard to the quality of those carbohydrates and lowering fat intake is not generally going to be a healthy idea.

            Because thousands of people have also reversed type 2 diabetes eating a high-fat, low-carb diet, we must look to the things that your diet and their diet have in common. If both high-fat, animal-based diets and low-fat plant-based diets can be helpful for diabetes, it can’t be the fat , the cholesterol, or the meat that are the problem…

  • Mark

    Dear Dr. Ede,

    Great summary that shatters the myth! It’s been
    a while since this article posted. What are your thoughts on LDL-P —
    as in a (very) high number of LDL particles, regardless of ones
    cholesterol numbers? As a marker and as a reason to consider a cholesterol lowering drug?

  • cavenewt

    Thank you for the clearest explanation of cholesterol and statins that I have found.

  • Dave Chavez

    Wow – excellent information. I have learned to eat healthier the past two years. I have learned a lot about the benefits of certain foods and supplements. I already knew about cholesterol, its needs and benefits. But your site is the first one that really explained the difference between blood and dietary cholesterol ( I searched “what does the body do with dietary cholesterol), and I had heard from others that cholesterol is not the direct contributor to heart disease but you explained it so so well – Loved your ambulance analogy ! Literally understood your entire post without having to reread it multiple times. Thank you again for your information!

    • Hi Dave

      Thank you very much, I’m so glad you found the article helpful!

  • Cindy

    This is the BEST article I have ever read, thank you! I would like to ask, I am seeing some cholesterol increase in the 3 months I have been on Femara, an aromatase inhibitor, for breast cancer. Do you know of any other information in addition to the above mechanisms that is at play in my body that would make a low carb diet less effective? Are there other unmentioned puzzle pieces that I can tackle as well?

    • Dear Cindy

      So glad you like the article, thank you! I

      Interesting question. I found this research paper that reviews the effect of each of the different aromatase inhibitors on cholesterol levels: and this paper that says that only women who were first treated with Tamoxifen and then later treated with an aromatase inhibitor show increases in LDL cholesterol, triglycerides, etc.: I don’t know if you were on Tamoxifen in the past or not. Regardless, I wonder if you have seen increases in your LDL only, or in triglycerides as well? LDL values alone don’t tell us much about health, but triglycerides and HDL can be very useful numbers. Do you already eat a low-carb diet, and if so, how many carbs do you eat?

  • Rob Harrison

    Just a theory. Knowing that cholesterol is a growth stimulator and reacts to inflammation, is it not possible or even very likely that the same enemy foods to the body,(carbs and glutens), have caused the spike in cancer that we have seen in the last hundred years? Not mind you as a cause but as an enabler? What percentage of cancer patients had high cholesterol before the onset of cancer?

    • Wilma Laura Wiggins

      Another theory is that we have increased our consumption of oils and also we have increased our use of chemicals on foods. We even spray wheat and other grains with glyphosate to help dry them for heaven’s sake. Not to mention gmo’s being widely fed to food animals.

  • Rob Harrison

    I further clarify, is it possible or even likely, since cancer is a growth explosion that cholesterol is the fuel by which it lives? Thusly, cancer patients would theoretically have lower cholesterol than most since a runaway growth engine would be sucking up all the fuel?

    • Hi Rob

      Excellent reasoning, in fact! Sugar increases insulin which promotes growth in part by increasing cholesterol production. This is precisely how cancer cells thrive and reproduce! It is very interesting what you propose: to think of “high cholesterol” as a marker for increased cancer risk!

      If you haven’t already seen my articles about sugar and cancer: and if you haven’t already seen my article about how high sugar diets and insulin resistance are at the heart of cancer as well as high cholesterol and heart disease: Thanks for the thought-provoking questions!

  • Rob Harrison

    thank you for your kind reply! I think you are really on to something here. Heart disease, Diabetes, Cancer and alzheimers seem to have developed exponentially with the advent of modern living,i.e., refined sugars and flour. Cars out the yazoo. I appreciate your detailed explanation of the problem. god bless!

    • Wilma Laura Wiggins

      Check how we have changed to refined oils since the 50’s. Huge increase. Most things made with the refined sugars and flour contain oil. They are all horrible but the oil is the worst.

    • Yacon

      I agree with your general conclusion, but another factor in the increasing rates of cancer and heart disease is that human populations are living longer. We die less often from things like a bludgeon to the head, smallpox, and other formerly common diseases that used to affected more young people.

  • Rob Harrison

    Another interesting stat might how many people on statins for an extended period of time have contracted cancer and the severity. I personally know a man who contracted at 80 and beat cancer with one radiation treatment. He had been on lipitor for many years. He was also an electrician in a steel mill until retirement.

  • Rob Harrison

    Another interesting connection, sugar(carbohydrate and fungus), funny how fungus relies on carbs and the higher one being white sugar to survive. Can you say HMmmm?

  • Jon

    Hi Dr. Ede,

    thanks for the great info on this blog! Question on LDL particles…why do the low carb supporters (lumping you in there) claim that the large fluffy LDL are harmless, when in reality (according to lots of good studies as far as i understand) the large fluffy LDL are really just less atherosclerotic, but far from harmless?

  • Rob Harrison

    I enjoy spreading the word SOoo much! Thank you doctor Ede for this life changing information, it gives me a chance to help others change their lives! I can’t help but remember the big deal a few years back about children with high cholesterol. I knew at the time there was something very wrong with putting children on medicine for cholesterol. They are growing and have so far to go! Using this medicine would seem to scar them for life, literally. I have been sugar free for over a month. Recently my wife and me made some chocolate chip cookies from coconut flour and agave syrup. What a wonderfully satisfying adventure! The cookies were great. We also made some for family members who wanted the traditional. As usual, after finishing up I had to eat the batter off the beaters. It was TERRIBLE! these used to me my favorite recipe. Sugar it seems is a taste that is forced on us at a young age. It does NOT taste as good as we have been programmed. I urge everyone to try and remove this “slow poison” from your diet. You will be glad you did! God bless.

  • Im a vegetarian who only eats dairy/eggs if I buy a muffin, which is rare, and I don’t have them at home, don’t buy many foods/snacks that have them in their ingredients. I eat a lot of hummus, high fiber (organic, etc) cereal, vanilla/choc soy milk, tofurky, coffee, vegan bread, mostly vegan foods in my fridge, but I have just been informed I have 53/158 cholesterol, being a bit low in HDL (good) and bit high in LDL (bad). I do eat an occasional avocado, vegan “butter” with omegas and good ratio of fats, and an occasional tablespoon of olive oil in my soup, salad pasta or to dip bread into. I hardly ingest a high amount of “good fats” or “bad fats”. My sugar was 105, considered a little high/pre-diabetic, and told to cut back on white bread, pasta, etc. I rarely eat pasta anymore, like once a month, but, do go through about a loaf of bread a week, that being about 14 slices, which doesn’t seem like much, as that is one sand which a day. I was told I should see a nutritionist and get more exercise. I do swim, “laps” in a pool at the local YMCA at least 30-40 minutes three to four times a week. Any suggestions?

    • Hi Corey,

      First of all, your cholesterol numbers may be just fine–LDL needs to be fractionated (separated) into different categories in order to know whether it is “good” or “bad.” What’s more important is your triglycerides–if they are low, then it is likely your lipid profile is healthy (see blood test recommendations and target values on my post )

      However, your blood sugar is a little too high. You want to aim for fasting morning blood sugars in the 80’s. To reduce your blood sugar into a healthy range, eat more fat and less carbohydrate. There is no need to avoid healthy fats like those in eggs, avocados, and nuts. The carb sources to consider reducing in your diet include cereals, breads, sweetened soy milk, and hummus. There is more advice on the post I referenced above if you’re curious.

      Good luck!

      • Wilma Laura Wiggins

        Reduce hummus? Why?

        • Hi Wilma

          I listed it as a food to consider reducing in your diet because of it is high in carbohydrate. You may not need to reduce or eliminate all sources of carbohydrate in your diet in order to see improvement in blood sugar, and for sure the ones most worth paying attention to are the ones that will cause the strongest spikes in blood sugar (refined cereals, bread, and the soy milk if it’s sweetened with sugar). The important thing is to reduce your overall carbohydrate intake until your blood sugars come into the healthy range (80’s).

  • deadca7

    Question: how do we know that the problem is too much cholesterol generation and not too much cholesterol re-absorption? In other words, why HMG-CoA enzyme can be a problem and ABCG4a levels can’t be? Thanks in advance, great work!!

    • Hi deadca7

      Great question. Turns out that the ABCG transporter proteins in the intestine work perfectly unless you have a rare genetic disease that affects those proteins, so it is extremely unusual to have a problem with ABCG levels or function: Role of ABC transporters in lipid transport and human
      disease [Tarling EJ et al Trends Endocrinol Metab. 2013 July ; 24(7):
      342–350.] Note: this review article came out after I wrote this cholesterol post and leads me to a correction in the name of the cholesterol transporter. Instead of ABCG4A it should read ABCG5/8. I will update this in the text above now.

      Healthy, properly-functioning HMG-CoA enzymes are designed to listen to insulin. More than half of the general population has high insulin levels, so overactivity of HMG-CoA is an extremely common, and easily reversible problem.

  • gf

    Why is my cholesterol (223) all of a sudden high? My HDL 81 and LDL 130 are normal triglycerides 59 normal?

    • Hi gf

      If your numbers suddenly changed, I’m assuming you changed your diet or lifestyle in some way recently? It is common to see total cholesterol rise on low-carbohydrate, high-fat diets, but this is almost always a healthy change and nothing to be worried about.

      Your triglycerides are nice and low and your HDL is nice and high. This means that you can probably ignore your total cholesterol, since total cholesterol is a lousy measure of general health. Triglycerides and HDL are far more meaningful. Please see my post about insulin resistance, which includes a free downloadable PDF listing some additional lab tests you can request from your doctor to be sure that your metabolism is on the right track:

      • Tim

        Hi Dr Ede just discovered your website.
        I was puzzled by the same thing. When I went from high carb to LCHF and lots of exercise my cholesterol shot through the roof. This is still the case even though FBG (4.4 mmol) and Insulin are very low and ketones high (2-5 mmol) through IF mainly. I am still searching for an explanation. Other than cholesterol I am in great health so not worried. I did a ton of research and came away convinced higher was better than lower, particularly at my age, just shy of 70. However I am still searching, maybe its just genetic all my family have it, keep up the good work.

        • Hi Tim

          Yes, you’re absolutely right! In most cases, changing to a LCHF diet will raise total cholesterol and LDL cholesterol, but those numbers are not useful unless you have them fractionated by density and have a particle number determined. You can get a good sense of how you’re doing even without getting a special fractionating test by looking at your HDL and triglycerides and ignoring your LDL and total cholesterol. Your FBS and insulin are fantastic. To see target ranges for HDL and triglycerides please see my post

  • Neal

    Dr. Ede,

    Wow, this is the clearest and best communication I’ve ever heard about cholesterol. But the only area not addressed, which may be outside of your interest, is genetic. What part do genetics play in producing cholesterol? I am a vegan and have a cholesterol count of 150 for the last ten years. But now I got angina and am told that one of my heart chambers in not getting the oxygen it needs. So the doctor put me on statins and blood pressure medicine before I get a stent. What does Niacin and Red Rice Yeast do? Can they be as helpful as statins without the side effects?

    • Dear Neal

      I’m so sorry to hear about the angina and the low oxygen problem that is occurring for you. These are very concerning, and provide additional evidence that having a low total cholesterol count tells us nothing about our actual risk for heart disease. I wonder why your doctor is prescribing a statin for you if your cholesterol is “normal.”

      I have not researched Niacin or Red Rice Yeast, but in general believe that the most important thing you can do for your health is to examine the quality of your diet and see if there are improvements you can make that could spare you from needing to take medications and requiring possible stent placement to protect your heart’s oxygen supply.

      Total cholesterol is a useless number. What are far more important are triglyceride levels, HDL level, blood sugar, and insulin levels. Please see my post about insulin resistance for a helpful list of blood tests and target values that will give you a much clearer picture of your overall metabolic health:

      Vegan diets are poor in the important omega-3’s EPA and DHA. They also can be high in sugars and starches, just like meat-based diets can be, depending on food choices. Please see my article about vegan diets for information about how to reduce the risk of nutritional deficiencies

      Vegan diets are completely cholesterol-free, but this unfortunately doesn’t protect vegans from heart disease, because cholesterol doesn’t cause heart disease:

      I would also encourage you to consult with a physician in your area who understands the new thinking that heart disease isn’t caused by saturated fat and cholesterol. If you tell me where you live, maybe I can help you find someone in your area.I wish you the best of luck in your journey to improve your health.

  • Hello, Wilma

    Thank you for sharing your experience here–that’s wonderful that you have reversed diabetes and CHF! I took a look at the website and see that the diet removes refined grains and many sources of sugar, as well as dairy foods and refined vegetable oils (high in omega-6). I agree with all of those recommendations. My personal view is that a diet based on whole plants and animal foods is even healthier than Dr. McDougall’s plan, but his diet is definitely healthier in key respects than the standard diet. High-carbohydrate diets are not unhealthy for everyone; some of us can tolerate them and some of us can’t. I’m glad that his program works for you!

    • Middleearthian

      Dr. Ede
      Yes, high carb diets aren’t for everyone. But plant based diets certainly are. As a doctor, I don’t see why you find any reason to continue to eat animals/ animal products. Humans are frugivores. Everyone is capable of eating a vegan (plant based) diet.

      • Yacon

        I cannot eat a plant based diet. I have a rare disorder that causes my kidneys to become overproductive when I consume grains, beans, soy, nuts, and seeds. No matter how little I drink, I spill copious amounts of urine, along with electrolytes and other nutrients. I dehydrate, and my potassium and magnesium levels plummet. Before my doctors and I found the sources of my sensitivity, after eating any of the offending foods, I sometimes ended up with heart attack symptoms from low potassium levels.

        • Middleearthian

          Go raw vegan then. Yeah, everyone seems to be allergic to ONLY plants when “veganism” pops up. Funny thing is, going vegan might actually HELP that. Raw vegan is eating only uncooked fruits and veggies (mainly fruit) so that means a lot of smoothies! You could defiantly go vegan, along with the rest of the humans in this planet. Let’s be real here.

          • Yacon

            I actually tried an all plant foods diet at one time and ended up in the emergency room in potassium collapse. Raw makes it worse for me. I even tried soaking raw beans, nuts, and grains (to sprout before eating). Soaking and and then cooking was better for me than soaking alone, but neither make a livable situation for me. I even tried natto and other fermented soy and wheat products, but to no avail. When I ate that way I went through two gallons of urine per day (and if I did not drink 2 gallons of water, I dehydrated, thereby spilling all major minerals. I really do much better on animal products with limited fruits and vegetables.

          • Middleearthian

            Well then there’s obviously something wrong with you lol. Not to mention, you probably hadno idea how to do the raw vegan diet- it can be very hard to get right. Humans are frugivores though. We’re not made to eat animal products AT ALL. Especially dairy, which you still probably consume. There’s no excuse for dairy. Nobody needs it.

          • Yacon

            Anyone who makes such an exclusive claim about a complicated issue with such confidence is an ideologue. You would probably reject any evidence to the contrary because your mind is set. Yet, even our most vegetarian animal cousins eat some meat, and the evidence in the fossil record and in our DNA and metabolic processes clearly show some dependence on animal products increasing over the last 2 million years. B12, carnitine (which we can still make, but many of us benefit from more), bioavailable iron, vitamin D3, DHA, and several others. Sure, you can get compounds related to B12 from some algae, but most of our ancestors would surely have not had access to that or known where to look for it. They had to have animal food products to thrive. Vegans can supplement to maintain their health today (though I cannot because of my reactions to vegetable products), but that need to supplement clearly illustrates the faults in the diet itself without such supplementation. If you think you really don’t need B12, you are deluded. If you force that diet on your children without supplementing B12, you are retarding their development.

          • Middleearthian

            Why would I reject evidence? I’d like to learn more about this rare issue I’ve never heard of. What causes it, and how it affects the body? You don’t seem to be providing any evidence, so I have no reason to believe you.
            K, so you seem to have no idea what B12 even is. B12 is a bacteria. This bacteria is ONLY n a t u r a l l y found in soil and on algae. That being said, since we don’t eat things straight from the ground (and as a civilization we disinfectc EVERYTHING) B12 isnt very rich in produce anymore. The animals you eat are SUPPLEMENTED with B12 because they’re kept in cages all day. Vegans easily get B12 from B12 fortified foods such as cereal, non-dairy milks, and others. Or you can just sprinkle some nutritional yeast on your food occasionally and you’re god to go. I take absolutely no supplements, further proving that humans can surely thrive on this diet. Why do people think we need to take supplements lol? You don’t see gorillas doing that…

          • Yacon

            One more point: B12 is not the bacteria itself. It is a compound made by bacteria. If your food contains it, sterilizing your food would not eliminate it. B12 was never rich in produce.

          • Middleearthian

            No, B12 IS a bacteria produced by microorganisms. So, because it is a bacteria, bacteria eliminating sterilizers will get rid of it. It is found in soil, and veggies grow in soil. So, natural and organic produce (that is unwashed) would have B12 on it.

          • Yacon

            B12 is an organic compound C63H88CoN14O14P. A bacterium is a single-celled organism with a simple organization inside a cell membrane (it does not contain the complex organelles of higher organisms). B12 is NOT a bacterium. B12 is not a living thing. I left another comment with a link that makes this point clear, but it is pending approval and will come through later.

          • Middleearthian

            I never said B12 was living. It’s a bacteria. Keep it simple. And go back to the original argument: Vegans don’t need supplements and you can be vegan.

          • Yacon

            I told you what bacteria are. Bacteria ARE living things–single celled organisms without complex cellular structure. Please go look it up, you are making yourself look like a fool.

          • Middleearthian

            You’re the one making yourself look like a fool lol. I never said bacteria wasn’t a living thing?

          • Yacon

            You said two things that are in conflict: “No, B12 IS a bacteria produced by microorganisms. So, because it is a bacteria, bacteria eliminating sterilizers will get rid of it.”, and “I never said B12 was living. It’s a bacteria.” But bacteria ARE living, so claiming that B12 is a bacteria is a claim that B12 is alive.

          • Middleearthian

            No. Let me rephrase: B12 is a vitamin. B12 isn’t living. B12 is produced by bacteria, which is living.
            But I said, keep it simple and call B12 a bacteria. Isn’t not hard to understand.

          • Yacon

            It’s just wrong, and it leads to incorrect conclusions, such as your argument that a pesticide could destroy b12 already on a plant (which would not naturally occur there anyway because it is an aerobic environment).

          • Middleearthian

            I never said pesticide. I said if someone were to sterilize or wash off a plant (clean it) The B12 that was produced from the bacteria IN the soil, would be washed off.

          • Yacon

            Even if that were true, the B12 on the plant is in such trace amounts that you would need to eat more than a cow to get any amount of value (the cow makes far more inside its digestive system anyway). The trade-off for not washing our food is bacteria that lead to food-borne illness. Organic produce cannot avoid that, since birds flying overhead, for example, can drop their excrement on it. Yum.

          • Middleearthian


          • Yacon

            Anaerobic bacteria in some herbivores long digestive tracts can synthesize B12. Deer also get it by eating bird eggs and occasional small animals. So do chipmunks and squirrels. I once saw a chipmunk eating a dead snake.

          • Middleearthian

            Yes, I already know that. But they need to be healthy in order for their own intestines to contain the bacteria that synthesizes the B12. They would still be consuming the plants that have the B12 rich soil in them anyway. It has also been theorized that humans are capable of doing this too. However, it “apparently” happens too far down into the digestive tract where it cannot be absorbed.

          • Yacon

            Our digestive tracts are shorter than those of most herbivores, which results in our poorer absorption of B12, so we cannot thrive by eating only large quantities of coarse plant foods that might have traces of B12 on them. Since we naturally eat some meat and animal products, our digestive tracts do not need to be as long as those of more pure herbivores, since these foods have higher concentrations of B12. Our digestive tracts are functionally more like those of pigs and bears than like cows or dogs. Our ancestors were opportunists, eating whatever they could find, dig up, catch, pick, or kill that they found as reasonable for food. This type of varied diet is the reality of our past, even if some vegans or “paleo diet” people argue otherwise. It gave our ancestors a nice survival advantage when climate changed or when they needed to emigrate. Different people in different parts of the world and at different times of the year ate different things. To call them herbivores or frugivores is myopic. They survived because they ate and could survive on whatever was available. Some ate mostly meat. Others ate mostly vegetables and fruits. Most of them ate at least some kind of animal product.

          • Shaggy

            I’m not sure what ya’ll are arguing about anymore but… it isn’t just the length of the tract, but the presence of a functioning cecum that allows many herbivores to digest plants (the rest are ruminants). Simple stomached herbivores, including gorillas, horses and rabbits, have a working cecum. Ours is small and nearly useless (the appendix and the area just before it are all that remains), closer to the size of carnivores than herbivores. In herbivores the cecum holds bacteria and provides a place for fiber to be thoroughly covered with bacteria and broken down. We can do some digestion and have longer guts (than carnivores) to help with absorption, but we don’t get enough out of it. However, if you look at rabbits, their poop is really a nutrient supplement made to bypass the stomach and allow the contained nutrients to be absorbed by the small intestine. Bacterial supplements taken by Vegans, like yeast, are basically the same thing. Bacteria, in all cases, is the edible source of B12. Funny how we are all, even plants, completely reliant on bacteria to survive.

            Our ancestors were frugivores (our reliance on vitamin C is proof of that) who supplement with meat and insects for B12 (like chimpanzees). Of course we eat anything we can, even dirt. Plus we have been cooking food longer than we have been a species. We have also been eating whole grains for over 100k years. The modern issues are mainly tied to a lack of exercise, overeating and a diet consisting of an overabundance of chemicals and refined foods. Even the lack of starvation and temperature controlled environments may be causing some issues.

            Personally, it is easier to eat meat so I do that. Vegan can work, but it is just too much of a pain and for every successful vegan, there is another who looks sickly and has nearly no muscle because they failed to eat enough protein. 🙂

            Oh and lastly, Yacon, don’t get bitten by a tick. There’s one that will cause you to become allergic to meat if it bites you. (seriously, it’s a thing – Alpha-gal allergy)


  • Rob B

    Nothing personal but this is all bullshit. Low carb high protein animal based diets are for complete morons. Anyone who fallows low carb or Paleo are idiots. Those authors are dropping dead of CAD as fast as they can pump out their books. Look at that fat fuck Jimmy Moore. Bragging about seeing his numbers finally drop into the 300s. That asshole will be dead in less than 10 years. My LDL, Tot Chol and Triglyceride levels are ultra low. I used to be borderline very high and within 4 months of dropping meat and eggs and cheese from my diet they plummeted down to the very low levels and have stayed there ever since. So has my fasting glucose levels. Telling people to add meat to a veg based diet is ridiculous. You can spin all this horseshit anyway you want it to appeal to the paleo/low carb uneducated sheeple. You probably get funding for your studies from the assholes in the meat and dairy industries. These people look for any reason to keep stuffing their fat American faces with meat. Its Vegans who outlive meat eaters by 10 years not the other way around sister. Those are the facts regardless of how you throw all this horseshit around. Im sure you will not even post this since it goes against your bullshit. Go visit a slaughterhouse and then tell people to eat meat.

  • Rob B

    Keep up with your starch based diet. Dr McDougall is light years ahead of this bullshit. When this chick reverses heart disease in long term studies then listen to her. Caldwell did it, Ornish did it and no meat eating Cardiologists have done it. That says it all.

  • Chuck Harrell

    If not eating dietary cholesterol has almost no effect on cholesterol level in my blood please explain to me to me and your readers how after one year of consuming no animal products at all and taking no medication, I went from 275 to 180 Total!!! That is a lot more than almost no effect. Horray for whole foods plant based diet. Thanks you.

    • Dear Chuck

      Good question! What I meant was that eating too much cholesterol can’t cause high “bad” cholesterol.

      Even the very conservative US dietary guidelines committee finally announced this past year that cholesterol in the diet is harmless and that there is no reason to limit how much cholesterol we eat:

      “Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol…Cholesterol is not a nutrient of concern for overconsumption.” [Part D, Chapter 1, Lines 642-646].

      You’re probably referring to your total cholesterol level, which could be either “good” or “bad”, depending on the type and amount of carbohydrate you eat, as well as whether you have insulin resistance or not. It is very confusing because it is high bad LDL that is unhealthy, and high bad LDL is not something that standard blood tests measure.

      Total cholesterol and standard LDL cholesterol values are the numbers which are the least important when evaluating overall health. It is HDL, triglycerides, and LDL-P (particle number–a measure that has recently come into favor when breaking down standard blood panels and that wasn’t talked about much several years ago when I wrote this article) that give us information about heart disease risk. It is common on low-carbohydrate, high-fat diets for total cholesterol to go up, and on low-cholesterol diets for total cholesterol to go down, but this unfortunately doesn’t tell us anything about health. Low-carb diets typically raise HDL (good cholesterol) and lower LDL-P (bad cholesterol).

      It is the type and amount of carbohydrate that is most important in determining how healthy your overall cholesterol profile is, regardless of whether you eat a plant-based or animal-based diet, and if you are eating a WHOLE FOODS plant-based diet, which it sounds like you are, then that is MUCH healthier for your cholesterol metabolism than a diet that includes refined carbs and refined vegetable oils, whether it includes meat or not. As long as your triglycerides and HDL are in a healthy range, your risk is likely quite low [for target ranges and other tests please see

  • tastyvapour

    Hi Dr. Ede,

    I really have to say that I have learned more about cholesterol from your article that I have in my entire life! I was wondering, if bile is the body’s only way of removing cholesterol or transporting it for recycling than what would a cholesterol test have anything to do with gallbladder stones? I had an ultrasound of my stomach because I have been suffering from extreme pain for years and it showed that I have 15mm gallbladder stone. The doctor decided that he wants my cholesterol levels checked now. Thanks in advance for your reply.

    • Dear tastyvapour (interesting name!)

      Thanks for the great question! Over the past 10 years or so it has become clear that it is high sugar diets and insulin resistance which lead to gallstone disease. The thing that “high” cholesterol and gallstones have in common is that high sugar diets and insulin resistance can cause both, not that high cholesterol causes gallstones, if you follow me:

      Below is a quote from the 2008 article on this topic:

      “Recent data suggest that insulin resistance is sufficient to produce not only glucose intolerance, but also increased biliary cholesterol secretion, atherosclerosis, and cholesterol gallstones.”

      • tastyvapour

        Hi Dr. Ede, thank you for your reply. I tried the link you provided but unfortunately it’s no longer available, not to worry as I have researched this topic since my last post extensively. You would be happy to hear that I have been on a LCHF diet for about 2 weeks now and have had no biliary colic attacks since. Where as before I would have one a few hours after eating anything carbohydrate related. I have to say that “eliminating” carbs and sugars from my diet has been a eureka moment! I always put the blame on fat before and tried to limit the amount of fat I had in my diet but the gallbladder attacks never went away. Switching over hasn’t been easy and I went through all the associated symptoms of withdrawal but what kept me going is knowledge. I knew what to expect and the fact that my gallbladder isn’t trying to crawl out of my stomach for a change has been a massive bonus and proof that I am finally on the right track.

        I was wondering about your thoughts on gallbladder removal, I am worried that my doctor is going to want to remove mine and I feel that I should atleast try to dissolve the gallstone naturally. I go by the basic idea that we have gallbladders for a reason and removing them might not be so smart. I looked into a medicine named Ursodiol and I was hoping to get some of your input regarding my predicament.

        On another side note that is related. During my last attack my blood work showed elevated glucose levels 8.4mmol/L or 150~mg/dl. I have never been diagnosed diabetic but knowing what I know now, I was definitely pre-diabetic. I purchased a meter and have been experimenting with it during my LCHF diet, my fasting levels are 4.2mmol/L / 75~mg/dl and my post food consumption levels barely budge (4.8mmol/L / 86~mg/dl) now on this life saving LCHF diet.

        So to the people out there reading this, please consider what Dr. Ede is talking about, because it’s life saving type of stuff!

        Thanks again Dr. Ede for my eureka moment! 🙂

        • Dear tastyvapour,

          Wow, congratulations on your remarkable health turnaround! You are a rock star–stable, healthy blood sugars, no more biliary colic–that’s wonderful! I unfortunately don’t know much about gallstones but here is a nice post by Dr Andreas Eenfeldt from his terrific site, including lots of helpful comments from readers about LCHF and gallstones:

  • WendyWavverly

    Dr Ede,

    I am confused. I was diagnosed with diabetes on 12/10/2015 A1c = 12.4, fasting blood glucose 355. I declined my doctor’s advice of medication and immediately went on a High Fat Low Carbohydrate diet, which seems to have been effective: by 3/22/2016 my numbers were A1c = 5.9, fasting blood glucose = 105. So thank you for your very valuable information. However, it is clear that my total cholesterol is high (roughly constant at ~240) and my LDL cholesterol has risen from 140 to 160 in the same few months. My doctor is very concerned, showing me mortality calculators from the AHA and Framingham Study that calculate my ten year likelihood of a “cardiac event” at 15-25%. Supposedly, if I go on a statin, the probability that I will experience a cardiac event goes to around 10%. Are these statistics applicable, meaningful and significant? Is there cardiac data on a statistically significant number of people who have gone on HFLC diets that would permit one to make comparisons with the AHA and Framingham studies?

    Presumably, my HFLC diet means that insulin levels should be going down in response to lower blood glucose levels. If insulin levels go down, shouldn’t cholesterol levels decline as well? How can we explain why I observe a 15% rise in LDL cholesterol at the same time as I experience a 210% decrease in A1c? I understand that you are not providing medical advice but help me make sense of the data. I’m considering following my doctor’s advice (for once!) and going on the statin. Is it premature to do this – is it likely that the cholesterol numbers will go down without statins in response to the lower blood glucose levels? What are the trade-offs I should keep in mind when considering the statin

    Peter Sisk?

    Thank you very much,

    Peter Sisk

  • linda h

    Dr. Ede, I have just been put on Zetia, supposedly due to over absorption of cholesterol in my intestines. This doesn’t seem to line up with the info in your article. Can you shed any light on this? Thank you .

  • Ms Sincere

    This is an AWESOME! article…now I have a much better idea of what’s going on and will watch my diet and get my body’s signals back on track…! I used to work out 5-6 times a week – now not so much…will get back on track to save my health. Thanks Dr, those commercials are only the partial truth and be careful of Big-Pharma or everything else will also be off track!

    • Hi Ms Sincere

      Thanks for the kind feedback and I’m so glad you found the article helpful! Good luck in reaching your health goals!

  • Hriday

    Dr. Ede! just wanted to say. Superb and so informative article to clear so many myths. Thank you for taking your time to share so much of information.

    • Hi Hriday,

      I’m so glad you found it helpful! Have a great day~

  • Alesha Rose

    Hi Dr. Ede,

    I came upon your article after doing a google search as to why both myself, and my 22 month old granddaughter, both have high blood cholesterol (both of us are 5.5 on the Australian scale). I am a 46 year old vegan, and my granddaughter is dairy and gluten free due to health issues.

    From what I understand from your article, the issue for us may well be pasta for me, and potatoes for her. Neither of us eats a lot of sugary foods, but we do enjoy a bowl of Organic Corn Chips twice a week.

    Any insight would be appreciated.

    • Hello, Alesha

      Yes, the majority of cholesterol problems are due to excess carbohydrates (particularly refined carbohydrates like sugar, flours, and juices). I don’t know what other carbohydrates are in your diet, but I agree completely that the pasta is a prime suspect, since it is made of flour.

      The fact that people who eat a vegan diet can still have cholesterol issues is proof positive that cholesterol problems have nothing to do with meat, saturated fat and animal cholesterol. Regardless of what type of diet any of us chooses to eat, getting rid of the refined carbs is always a good idea:)

      If you happen to have insulin resistance, you may need to remove most of the carbohydrate from your diet, not just the refined carbs, but one step at a time!

      There is more information about the connection between refined carbohydrates and cholesterol in these posts that I hope you may find useful: (includes food recommendations and list of blood tests to monitor) (explains strong connection between sugar and cholesterol, triglycerides, and heart disease)

      Thanks for writing in!

  • Alyssa Thompson

    Thank you for all the info! I’ve gone to the drs for blood work and for the last 3 years my cholesterol has been low (88 total, 42 Hdl and 40 ldl), and my Drs always just say the same thing “I’ve never seen numbers so low! Try eating more foods with cholesterol!” But, as a vegan, that’s impossible. Are there any risks to having that low of cholesterol? I feel very healthy and don’t have any ailments, but my Drs can never give me an answer about it, and everything onlin is about high cholesterol. Thank you in advance.

    • Hi Alyssa

      Great questions! The science on this topic is very scarce. One epidemiological study found that people with low cholesterol seemed to be at higher risk for a certain type of stroke (caused by bleeding in the brain): I can only access the summary of this article right now, not the full report, so I can’t comment on the quality of the study.

      In addition to your cholesterol numbers, you also want to look at your triglycerides, blood sugar and insulin levels, as they are usually much more indicative of your overall metabolic health:

      • Alyssa Thompson

        Thank you, dr. Ede! I checked my triglycerides, blood sugar, and insulin levels and all the numbers look good. I guess I’m just a low cholesterol anomaly

    • Tay

      If you ever start having hormonal disruption due to too low cholesterol, all you would have to do is eat plant based sources of saturated fat, as they stimulate the liver to produce more cholesterol. So coconut products would do that! And you wouldn’t need much.

      • Alyssa Thompson

        I’m not sure what hormonal disruption is, but I’ll take any easy to eat a bit more saturated fats in my diet! Thank you!

  • Shreeram Ghate

    Hi Dr.
    A very good article for sure. One question, in the case of high sugar, which my cousin is suffering from, has a problem of low insulin production. Is he safeguarded from high cholesterol problem as a byproduct?

  • Dan

    I eat 4-6 whole shell raw egg / day change your life put muscles back on you skin tone etc ///

  • Constantin Tofan

    Hi Dr. Ede,

    That is really helpful. I feel like I won to the lottery by reading this article. I still have a question: does saturated fats plays any role in our human body? Do you need to eat saturated fats? Or is the same story as cholesterol ?

  • Joan B

    In your article, it seems as though you are suggesting two things: firstly, eating too many carbohydrates causes too high cholesterol levels and, secondly, eating too many carbohydrates causes inflammation of the blood vessels, which cholesterol seeks to repair. Can I ask what you think the harmfulness of having too much cholesterol in the body is?

  • Tommy

    Great article. Enjoyed reading it. Could you please tell me which article you cited for this information, “Wherever there is inflammation in the body, cholesterol is rushed to the scene to repair the damage—because we need cholesterol to build healthy new cells”?

  • Sara

    This article is so spot on, as a cell & molcular biology major I just have to applaud you on this..Perfectly explained in laymans terms.

  • Dale

    It’s interesting you bring up inflammation because Thomas Cowen said that inflammation of the small blood vessels are a big reason why heart attacks happen and he linked high blood sugar as one of the reasons. He also talked about how people with around 95% blockage of one of the coronary arteries still go on without heart attacks and if this was the primary cause someone with a 95% blockage would have already had a heart attack. He also mentioned the inneffectiveness of stents and by pass surgery.


    What a brilliant article. Thank you! I am prediabetic and overweight and it made some connections for me.Have you any links to places where they give easy ideas of food on the table using this advice? I have got as far as incorporating an omelette and protein shakes for my breakfast. I always feel that other eggs need something else under them. But what?!! OK so salads for lunch is as far as I’ve got. Protein and veg seems a bit limited for tea! Does it keep people full? Have you developed a sample what you could eat in a week to follow this advice? I would appreciate this! Is there a limit of how many eggs can be eaten in a week? Many thanks

  • Sam Young

    Fascinating. Thank you!

  • vladimir prieto

    What a simple way to explain a complicated stuff.

    Do you have/know a similar post to this one but about triglycerides?


  • MajorMatt

    Hi Dr. Ede,
    Fantastic article. I’ve been on statins for years because both my HDL and LDL levels were in the “gray area”. My athletic father had quintuple bypass surgery 25 years ago when he was 52 (I’ll be 52 next year) and his doctors at the time said it was because his “good” cholesterol was too low. So my doctor thought it prudent to put me on statins. I was fine with this as I had no side effects to the drug (I thought) and didn’t look into them much. Now I have been doing a lot of research and find I may be suffering several ill effects because of those drugs. And so I am probably going off the statins at the end of this month after a blood test. Also, I have been in a zero carb diet for the last few weeks and feel terrific.
    My question is: Do cholesterol/ triglyceride tests have any real use? Is there any reason to pay attention to the numbers and if so why?
    I really appreciate all the work you are doing on this subject.

Last Modified: Dec 15, 2015