Chris Kresser, the author of Your Personal Paleo Code and Chris Masterjohn the author of Cholesterol-and-health.com had a series of interviews on the topic of cholesterol a few years ago, which I just recently stumbled on.  I found these amazingly insightful and chock full of information that I had never come across before, so I decided to take some detailed notes on the interview.

If you want to listen to the entire Part 3 podcast, you can click here.

There is also a link to the entire transcript too.

Reading through the entire interview transcript didn’t quite feel structured enough, so I did what I could to organize things.

If you want to get caught up you can check out my notes from the previous sessions:

• Chris Kresser and Chris Masterjohn On Cholesterol: Part 1
• Chris Kresser and Chris Masterjohn On Cholesterol: Part 2

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Notes from Part 3

• They do a good job of summarizing Parts 1 and 2, so if you’re too lazy to read through everything I typed up, you can just listen to the first few minutes of this episode.
•  Kresser brings up a lab test measuring oxidized LDL, which at the time of the podcast was only available in research settings, but there is now a lab staring to offer this.
•  Masterjohn thinks it might be helpful, but it’s too early right now.

What to do and what not to do about high cholesterol after changing to a Paleo / Weston A. Price / Primal diet:

There are good reasons and bad reasons for increases in cholesterol.

Fatty Liver Disease

• One reason cholesterol can increase is if we’re clearing lipids from the liver.
• For example, in someone with nonalcoholic fatty liver disease (which results from lipids getting stuck in the liver and failing to be released), so once the fat is finally being cleared, this can cause an increase in blood cholesterol.
•  This is a good thing because nonalcoholic fatty liver disease is dangerous for the liver AND is a very strong predictor of cardiovascular disease.
•  In a study done in Japan, they found that fatty liver disease increased the risk of cardiovascular disease five fold; whereas LDL cholesterol predicted it somewhat, but wasn’t statistically significant do draw a connection.
•  Choline is a nutrient that helps the liver release its fat. The best sources of choline are liver and egg yolks.
•  Folate actually reduces the need for choline.
•  So if you’re increasing your intake of liver, egg yolks, and leafy green vegetables, it’s very likely that if you do have fatty liver, you are going to contribute to its resolution, because choline is needed to package the fats in the liver and export them into the blood to be metabolized by other tissues.
• Fatty liver is diagnosed by biopsy, or MRI or Ultrasound.
• Kresser points out that FibroSURE is a test that can be done to diagnose fatty liver disease.
• In an obese patient with insulin resistant who is losing weight and doesn’t want to have a biopsy or imaging, it’s pretty safe to say that fatty liver is a very likely candidate for why blood lipids may increase, but they should normalize with time.

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Decreased clearance of lipids from blood due to 3 possible things:

1. Thyroid Dysfunction – Another thing that can happen is decreased thyroid activity due to extreme/chronic carbohydrate restriction.
2.  Iodine deficiency – If you have increased your intake of plant goitrogens and haven’t included enough iodine-rich foods, especially sea foods.
3. Familial Hypercholesterolemia

Thyroid-LDL connection

• The thyroid is the messenger hormone that communicates that our body is in a state of abundance. That we have the food and nutrients that we need and that it’s time to use those nutrients for the purposes of reproduction, high physical performance, etc.
• Cholesterol is the precursor to a lot of these key hormones like sex steroids as well as bile acids that re used for digestion.
• Thyroid hormone communicates that these nutrients are available, and our cells respond by taking in LDL cholesterol from the blood and making lots of good things out of it, like testosterone.

Goitrogens

• One of the things that happen when people start increasing their intake of fruits and vegetables, and decreasing their intake of grains, which is typical in the paleo community, is that the intake of plant goitrogens is increased.
• Goitrogens are compounds that can inhibit the production of thyroid hormone.
• In some cases if someone is not eating iodized salt, and they’re living in an area where the iodine quality of the soil is poor, and they’re not eating seafood, which is the most reliable source of iodine, they may not be getting enough iodine to deal with the goitrogens .
• Kresser says that he does a 24 urine iodine test in most of his patients with thyroid issues, and estimates that 80% of them are either iodine deficient or have excess bromide, which can causes symptoms of iodine deficiency.
• A problem he sees is that people aren’t eating enough seafood because of concerns with mercury. Another issue is when paleo people switch from iodized salt to natural salt, which has less iodine.

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• Masterjohn describes a few different classes on goitrogenic foods.
• Crucifers which include broccoli, brussel sprouts, cauliflower, cabbage, collard greens, kale, kohlrabi, mustard, rutabaga, turnip, bok choy, arugula, horseradish, wasabi, watercress, and maca, have natural pesticides called glucosinolates.
• Glucosinolates can be activated when crucifers are chewed or chopped up, and become a chemical called isothiocyanate, which our bodies metabolized into thiocyanate. Thiocyanate is the chemical that decreases uptake of iodine into the thyroid gland.To protect against thiocyanate simply requires getting enough iodine in the diet.
• Fermentation of crucifers actually doesn’t decrease the concentration of the goitrogens. Steaming decreases the concentration by about 30%. Boiling eliminates 65%. Boiling along with getting rid of the water afterwards eliminate 90%.Masterjohn estimates that taking up to 1 mg of iodine for supplementation would be sufficient to counteract this.
• Other foods include cassava, which goes by tapioca, manioc, yuca. Flax, lima beans, cherries almonds, plums, peaches, pears, raspberries strawberries.Sweet potatoes contain a small amount.
• Millet is probably the most goitrogenic food out there. This is a problem because when some people go gluten free, the replace it with gluten.
• Masterjohn’s solution is to eat all these foods in moderation and try to add in some sea food.
• Kresser says that in his clinical experience, people with elevated LDL and some symptoms of hypothyroidism, despite being euthyroid with normal T4, T3, and TSH levels, that using a higher dose of iodine, in the range of 2.5 – 6 mg, and sometimes up to 12.5 mg can have a dramatic effect on total cholesterol and LDL.He cautions that it’s important to start iodine supplementation very slowly from a low dose, because if you jump immediately to 6.5 mg or 12 mg, it can provoke or exacerbate an autoimmune thyroid response, especially if there isn’t enough selenium in the diet.
• Kresser recommends starting at 250 mcg for 7-10 days, and then increasing it to 500 mcg for the next 7-10 days, and so on.Selenium should also be added because studies have shown that it can protect against the potentially negative effects of iodine supplementation.
• 250 mcg of selenium should be sufficient
• Kresser Recommends Life Extension Super Selenium Complex because it has four different forms of selenium.

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Thyroid and cholesterol:

• A number of studies have shown that carbohydrate restriction or calorie restriction can decrease thyroid function and show a decrease in free T3 and an increase in reverse T3 (like me!)
• There is evidence that insulin cooperates with TSH to increase production of the enzymes and proteins involved in making thyroid hormone, and contributes to the enzymes that activate thyroid hormone from T4 into T3, the active form.
• When we have insulin operating in its optimal conditions, then insulin is acting as a messenger telling the body that it’s in a state of abundance.
• In the absence of insulin, the conversion from T4 to T3 is prevented, and this is the effect carbohydrates exert here.
• The best way to detect this is to look for a decreased ratio of T3 to reverse T3 (like in me!!).
• From clinical studies, this seems to be the most likely marker to look for to see if this is what’s happening, to see if this is why cholesterol has gone up.
• If you find that the T3 or reverse T3 are out of whack, the best way to address this is to try increasing carbohydrate intake.
• Kresser says he sees this a lot in his practice, people who go low-carb paleo, and develop classic hypothyroid symptoms. Their hair falls out, hands and feet are cold, and other symptoms of a lowered metabolism.
• These symptoms abate when they add carbs back in. The trouble is that in some of these patients, their blood sugars go up, they gain weight, and they develop metabolic issues associated with metabolic syndrome.
• So in these patients, he needs to address the other mechanisms that cause carb intolerance, like gut issues, SIBO, or other metabolic issues.
• Masterjohn adds in that if you have increased liberation of free fatty acids, beyond what you’re able to utilize, there is some evidence that the free fatty acids will accumulate in the nucleus of the cell at a high enough concentration to inhibit thyroid binding to its receptor, and this can cause hypothyroid symptoms, including the high cholesterol. And this can occur in the absence of abnormalities of T3 or RT3 changes in the blood.
• So if you develop classic hypothyroid symptoms with high cholesterol and low sex hormones, this can indicate that you might need more carbohydrates.

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Thyroid supplementation in the Arctic

Masterjohn shares something he learned from Weston Price’s book, Nutrition and Physical Degeneration

• Among the Indians living in the Arctic circle, a large percentage of babies were born in June. This was because adults liberally ate the thyroid glands of male moose that came down from the high mountain areas for mating season. During these times, moose thyroids were greatly enlarged.
• When moose were about to reproduce, they naturally went into a hyperthyroid state where their thyroids were enlarged, and these people would harvest the thyroid glands so they could be in an optimal metabolic state to reproduce. As a result most children were born 9 months before moose mating season.
• Masterjohn suspects that because these people lived inland, they didn’t have a lot of iodine in their diet, and they certainly didn’t have access to a lot of carbohydrate, they adapted by supplementing with moose thyroid hormone. This allowed them to increase their fertility by converting cholesterol to sex hormones.