Can Your Cholesterol Be Too Low? Challenging the Paleo View on Cholesterol

Wednesday Jan 14 | BY |
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Some people, when they follow a low-fat vegan diet or a RAW diet, come back with interesting blood test results, with cholesterol levels so low that their doctor is puzzled and even worried. They’ve just never seen any patient with levels that low.

I’m talking about levels way below 150 mg/dl. For example, as low as 120 mg/dl, and sometimes lower.

Are low cholesterol levels a good thing or a bad thing? Many paleo authors claim that low cholesterol leads to depression and other health problems. Yet, hunter gatherer, the healthiest cultures around the world, most mammals, and even human infants have low cholesterol levels. What’s going on here?

When I started looking at this a few years ago, I had an open mind and wanted to find out the truth. Were the vegans right? Were the paleo folks right? What would be the right approach when it comes to preventing heart disease, and consuming animal products?

I was prompted to get down to the bottom of this issue when my dad died of a heart attack, and my own cholesterol readings did not put me in the healthiest range according to the vegan doctors.

The “contrarian” thing to say would be that cholesterol has nothing to do with heart disease, and in fact prevents heart disease (such a claim is made by the Weston Price Foundation).


But here’s the danger in this view…

What if they’re wrong?

TRUTH: Heart disease can be caused by a number of factors, but elevated LDL levels is the most important factor of all.

TRUTH: It’s almost impossible to develop atherosclerosis if one smokes, has hypertension, and doesn’t exercise… as long as LDL levels are under 80 mg/dl (some people say 70 mg/dl).

What’s Unique About LDL Cholesterol and Heart Disease

There are many causes to heart disease, but only one main factor that alone is sufficient to cause it. This factor is elevated LDL levels. Some quotes:

“There are many risk factors to cardiovascular disease but elevated cholesterol levels alone are enough to drive the disease.”1

“Among the many genetic and environmental risk factors that have been identified by epidemiological studies, elevated levels of serum cholesterol are probably unique in being sufficient to drive the development of atherosclerosis in humans and experimental animals, even in the absence of other known risk factors. In humans, the majority of serum cholesterol is carried by LDL particles.”2

“In contrast to feeding cholesterol and/or saturated fat, it is not possible to produce atherosclerotic plaques in herbivores by raising the blood pressure chronically, by blowing cigarette smoke in their faces for their entire lifetimes, or by somehow raising the blood glucose levels without simultaneously feeding them an atherogenic diet.”3

William C. Roberts.

You’ve just heard what scientists say on the topic. Let’s hear from the Weston Price Foundation on what apparently causes heart disease…


What Happens to People With Naturally High or Low Cholesterol

To try to make sense of this debate, let’s take a look at a unique piece of evidence.  Some people are affected by by a rare genetic disorder: they produce usually high or low cholesterol levels.

People with familial hypercholesterolemia have very high cholesterol levels and have to be treated with medications.

If you’re less lucky even (1 in a million chance), you can be affected by familial hypercholesterolemia in both chromosomes

On the other hand, another genetic anomaly is hypocholesterolemia, which is just the opposite: abnormally low levels of blood cholesterol.

What happens to those people?

People with familial hypercholesterolemia in both chromosomes can die of heart disease in their 20s, with no other risk factor involved.4

People withhypocholesterolemia tend to live longer than their peers because this defect protects them from heart disease.

How does the Weston Price Foundation explain this?

How Much Cholesterol do we Need?


The Weston Price Foundation talks about the importance of cholesterol. They are absolutely right: cholesterol, produced by our own bodies, is essential to health. But the question is… how much do we actually need?

What we need is in the range of 25-60 mg/dl for LDL, and total cholesterol of 110 to 150 mg. 6


  • Other mammals without heart disease have LDL generally less than 80 mg/dl.
  • LDL level in newborn humans is around 30 mg/dl
  • Infants have total cholesterol levels of 50-90 mg. 10
  • In humans raised on a low-fat diet, LDL stays around 50 to 80 mg/dl.
  • LDL of 100 mg/dl and above is customary in rich societies with high intakes of animal foods.7

Official Recommendations (Mayo Clinic) for LDL Cholesterol:

  • Below 70 mg for people at very high risk of heart disease
  • Below 100 mg for people at risk of heart disease

People claim that cholesterol is necessary for the body to perform essential functions. That is true, but the amount we need is very low. Other mammals have LDL levels well below 42 mg/DL and do just fine.

What are Ideal Cholesterol Levels?

Ok, so now we know what’s the minimum amount of cholesterol we need. But what’s optimal? Let me give you the answer, and then I’ll show you the evidence.

Optimal for LDL seem to be 50 to 70 mg/dl. Lower is generally better and physiologically normal.

FACT:  Loren Cordain, promoter of the paleo diet, says that optimal levels of LDL should be between 50 and 80 mg/dl. (I found an interesting study he co-authored that I will reference below.)

FACT:  Hunter-gatherers have low cholesterol, generally about 70 to 140 mgl/dl (35-70 mgl of LDL).

FACT: Wild primates have total cholesterol levels below 120 mg/dl


“Cholesterol is an essential component of the cell membrane and an obligate precursor for bile acid, steroid hormone, and vitamin D synthesis. (…) Although individuals with serious chronic illnesses, such as cancer, often develop depressed LDL levels as a result of malnutrition, epidemiological studies show that people with naturally low LDL levels are associated with improved longevity.” 15

Why do Hunter-Gatherers Have Low Cholesterol Levels?

It’s a bit of a paradox that societies with a relatively high intake of animal products have low cholesterol levels, while people following a paleo diet nowadays have a high cholesterol level.

It seems to be that parasites could eat up excess cholesterol, and parasitic infections are common in those societies. 17

Even malaria (parasites) lowers cholesterol.

Also, a number of diseases cause cholesterol to be lower. So, that’s why people have lower cholesterol at the end of their lives.

Sometimes, this is why low cholesterol levels are associated with some diseases. The low cholesterol is a consequence of the disease… not likely a cause! 

For the hunter-gatherer societies, other explanations include food scarcity and genetic adaptation.



I tried to keep this article short and to the point, but it still took me dozens of hours to research! I started out with an open mind. My conclusions are simple:

If you’re at a high risk for heart disease, you should aim at LDL levels of 80 mg/dl or less.

If you exercise and do all of the right things, then youroverall risk of heart disease is lower, because some of these things will prevent the disease (in part).

But I still think looking at LDL levels or total cholesterol is a good idea. About 25% of heart attacks occur in people in the cholesterol range considered “normal…”

Finally, I can only conclude that the Weston Price Foundation is leading a misinformation campaign with their ideas on cholesterol, among other things…


1 SOURCE: (Arteriosclerosis, Thrombosis and Vascular Biology. 1987:7:612-619 – “Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake”)

2, 3 SOURCE: (Cell, Vol. 104, 503-516, February 23, 2001 Christopher K. Glass and Joseph L. Witztum Specialized Center of Research on Molecular Medicine and Atherosclerosis Other source: book called “Nutritional and Metabolic Bases of Cardiovascular Disease”)

4 Source: (Familial hyperalaphalipoproteinamia J Lab Clin Med, 1976, Dc,88(6)-941-57)

5 Source: (The Johns Hopkins Textbook of Dyslipidemia) – Peter O. Kwiterovich, Jr., MD)

6, 7 Source: (“A Receptor-Mediated Pathway for Cholesterol Homeostasis” – Nobel Lecture, 9 December, 1985 by Michael S. Brown and Joseph L Goldstein)

8, 9 SOURCE: (“Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia” – Circulation, 2008; 118:672-677)

10 SOURCE: (Serum Cholesterol Concentration in New-Born African and European Infants and Their Mothers) – American Journal of Clinical Nutrition, Vl 4, No. 8, 1962)

11-16 SOURCE: (James H O’Keefe, MD*; Loren Cordain, PhD†; William H Harris, PhD*; Richard M Moe, MD, PhD*; Robert Vogel, MD‡ J Am Coll Cardiol. 2004;43(11):2142-2146. doi:10.1016/j.jacc.2004.03.046

17 SOURCE: (“Role of cholesterol in parasitic infections” – Lipids in health and disease 2005,4:10)

Note: thanks to PlantPositive for inspiring this article.

Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.

Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.

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