My Interview with Dr. Mercola On Cholesterol, Vitamin K, Insulin, Blood Lipids, CT Scans, Calcification, and Heart Disease

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From a Christmas-celebrator to the rest of you, Merry Sixth Day of Christmas! I hope you're all enjoying whatever you might be celebrating during the season of expanding daylight and just plain enjoying life.

Dr. Mercola posted a video interview today that we had recorded a few weeks back, about cholesterol, vitamin K, insulin, blood lipids, CT scans, calcification, and heart disease. If you'd like to watch it, here it is!


If you'd like to read the article Dr. Mercola wrote about our interview, you can read it here:

Why Cholesterol is Essential for Optimal Health,

and the Six Most Important Risk Factors of Heart Disease 


And here's a table of contents so you can navigate your way through the interview if you'd like:
0:00:00 — Dr. Mercola introduces me
0:01:40 — Why cholesterol is good for you — my favorite topic!
— Why has cholesterol been so demonized?
—  Is it all about the money? And who's got all that cash?
— Stephanie Senneff and cholesterol sulfate
— Total-to-HDL-C ratio, a powerful predictor of heart disease, but not a cause.
— Total-to-HDL-C ratio as an inverse metabolic marker for LDL-C utilization
— Vitamin K2 (egg yolks and cheese!) protects against atherosclerosis by inhibiting blood vessel calcification and promoting cell survival (Mercola talks about his new, standardized K2-rich fermented veggies)
— Coronary calcium scores by CT scan
— Can atherosclerosis be reversed?
Small LDL particles — cause, or marker? Their redundancy with total-to-HDL-C ratio. Lack of standardization in testing, expensive.
— Insulin (and leptin) protects against atherosclerosis by promoting thyroid activity and possibly by directly supporting LDL receptor activity; insulin resistance is thus probably a major cause of low LDL utilization.
— Insulin resistance as a natural adaptation to energy overload.
It doesn't help to have maximal insulin sensitivity if you don't have any insulin; optimal insulin signaling probably requires some carbohydrate in the diet for most people.
Why measuring total, LDL, and HDL cholesterol can be valuable even if you can measure your waist-to-hip ratio for practically free at home (a couple case studies demonstrating its value relating to insulin resistance and low thyroid activity).
Stuff I'm working on, and goodbye!
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  1. This is my experience. I had issues with cholesterol so much that I even tried generic zetia as well. They did help, however, one person once told me about some foods that are more natural way to reduce my cholesterol. I was lazy to start exercising so I had to turn to healthier food. After 6 months my cholesterol was down to 4 which is great. And guess what, I actually ate about more than 70% of the food listed here, so I am definitely into lowering cholesterol that I even started my own blog about it but I am glad that many more people are writing about it. We need to help out each other. Great post man!

  2. One more question, please, Chris, from the previous writer: my doctor wants me to have a nuclear stress test. Given the scores in my note to you (above), do you think that this is necessary? This is a nerve-wracking test. Mary

  3. Hi Chris, This was so informative! I am a 76 year old female (so maybe, at my age, I shouldn't be worried about this!) , but my lip(a) has been at 90 for at least ten years. I had a calcium scan, and my score was at 140. My doctor has me on Crestor (40!), but it doesn't seem to budge my lip(a) score at all. I have been taking vit d and k2 and vit a. I know that you haven't determined yet just what those ratios should be, but can you suggest some ballpark figure? I am currently taking 2,00 units of vit d and 300 vit k…not sure what the vit a should be. Can you help me do the best I can in regard to this? My dad and brother had heart attacks at age 50; my mom lived to 98, so it is all kind of confusing. Thank you! Mary

  4. A blood test is that test requested by a doctor to be able to make the … tests; Blood enzyme tests; Blood tests to measure heart disease risk and … anemia, red blood cell dysfunction, or even vitamin deficiencies. …. Blood lipids are mainly cholesterol and fatty acids. ….. Does Fish Oil Help Artery Calcification?

  5. Hello –

    I have had a 23andme test and I have APO E5 GG marker as well as MRPS6. I am now wondering if I can influence the health outcomes with an adjusted diet. I am on a Paleo diet but I clearly wonder if I should lower dietary fats in light of the APO E5 marker. I can find litterature on APO E4 but not E5.

  6. Chris, thank you for your contribution to understanding cholesterol. I did not see though that you ever addressed high cholesterol (though all ratios are within a normal range) issue in a person with no weight problems and no risk factors.I also always have high bilirubin and "low normal" WBC. Everything else is normal. Other than low blood volume (allegedly), nothing has been found, but my health is deteriorating. The official diagnosis -an autonomic nervous system dysfunction. My acupuncturist's diagnosis – blood deficiency, liver wind. I have to find the cause. I had to quit great job, have no medical insurance, have no one to help me financially.I do believe high bilirubin and cholesterol have something to do with deterioration of my health. If there anything in your posts I missed, please point me.Female, 42. Thank you

    1. Anonymous.
      I had higher than normal range bilirubin, high cholesterol and no overweight ( at least in obvious and visible way 5'10"-185 lb.). My doctor informed me that raised bilirubin is associated with gallstones, so she referred me to do ultrasound of gallbladder and liver. And I am very happy I did that, because they didn't find any gallstones, but they've found fatty liver. I still have to confirm this diagnosis with the specialist, because I have a limited trust in family doctors knowledge and assessment.
      I read Chris' blogs now and I listen his podcasts, and eat egg yolks like crazy. I am also thinking to get more liver, betaine and folate into my diet. Thanks, Chris.
      Chris! If someone with cardiovascular issues or suspected CVD would like to check relevant to that condition genes. What genes he should test for?

  7. Can you point me to a dr. in the Chicago area who knows this research and can help me address metabolic syndrome?

    Also, are you soliciting human subjects for your new research yet?

  8. Dear Chris,

    Thanks for all your informative articles. I practice oriental medicine and wholefood nutrition in Boulder, Colorado and do some lecturing for Standard Process. I have two questions.

    First, does Vitamin K2 get destroyed by cooking? Is it better to eat the K2 food sources in a raw form?

    Secondly, according to Royal Lee and Pottinger, cooked food destroys amino acids since they are heat labile. How does cooking bone broth not destroy the amino acid content since bone broth is viewed as a excellent source of gelatin?


    Larry Welsh

  9. Chris – I will contact the lab The site is very generic and does not provide any specifics as to what they specifically test for.

    Also, I have heard some of your podcast interviews where you specifically discussed TRG/HDL ratios to measure oxidative stress and insulin resistance. Can you direct me to those sites?

    Thanks Dr Jeff

    1. Dr. Jeff,

      You spit in a tube and they test you for everything.

      You're probably thinking of my interviews with Chris Kresser and maybe my most recent one with Jimmy Moore, and my very recent one with Dr. Mercola. On the right-hand side click on the tag "podcasts" and you should be able to find all of them.

      Take care,

    1. Thanks Dr. Gerber. It would seem 23andMe, which might still be $99, would be a lot more cost-effective since they test for >500,000 polymorphisms and I'm sure you can get all the same information plus somewhere between a thousand to a million times more for a lower cost. I can see it might be confusing to someone who just wants one or two tests. I'm not familiar with other labs, so thanks for listing that one.


  10. Great interview Chris!
    I'm trying to find information on low cholesterol, how low is too low, what factors may contribute to that and what one can do about it, especially that some studies show associations with low cholesterol and shorter life span, cancer, etc…

  11. It is amazing how strongly rooted the idea of cholesterol as public enemy #1 is. People are so emotional about it. If you talk to any chiropractor , they will tell you that people on cholesterol lowering meds tend to have a lot more tension in their body and they tend to have more back pain. I realize this is merely correlation and not necessarily causation but it is hard to ignore. This fight seems insurmountable though. Big pharma has a choke hold. Keep it up Chris.

  12. My LDL was 200 after a year of paleo eating that already included above 200g of carbs and lots of liver (copper) and brasilian nuts (selenium) – all PHD recommendations. I mainly attributed that to eating lots of butter and coconut oil. 6 month after I significantly reduced that (while still used as cooking oil) my LDL is down to 100. I assume some of the paleo folks are in the 14% of pupulation with Apo E4 gene and respond to saturated fat with sky high cholesterol numbers.

  13. Chris, this statement, and then what you went on to say about it in the interview, confuses me:
    "optimal insulin signaling probably requires some carbohydrate in the diet for most people." Even on a low carb diet, people will ingest carbs in the form of glycogen from meat for example. Excess protein also converts to carbs. It seems to me that, when we only eat what is necessary for the brain, insulin is not needed. Why would there be a need to have more glucose than the brain needs to raise insulin? Raising insulin is at the root of many diseases from what I understand. Can you direct me to more information on this, and on the relationship between insulin and cholesterol? Thank you.

    1. Hi Maria,

      There is hardly any glycogen in meat so it just isn't a very substantial or meaningful amount of carbohydrate. Although protein can be converted to glucose, that occurs under conditions where insulin is suppressed. It's the exact opposite of eating glucose, from an endocrinological perspective. Production of thyroid hormone and activation of T4 to T3 is dependent partly on the insulin-to-glucagon ratio. In order to raise that ratio, you must eat carbohydrate. Protein will stimulate insulin, but it won't raise that ratio much because it also stimulates glucagon. So, severe carbohydrate restriction will likely lower thyroid activity in most people, which will lower turnover of LDL (and also decrease the expression of vitamin K-dependent proteins that protect against heart disease). I've written a little on this on my blog, so you might want to search the heart disease tag, but mainly I've talked about it on my podcasts with Chris Kresser on cholesterol, so I'd suggest listening to those.

      Hope that helps,

  14. Chris – I enjoyed the interview immensely, thanks. From your comments, I take it that you believe that a certain amount of dietary carbs is probably a good thing, because it allows insulin to work properly. Would that be a correct assumption? A few years back, I switched to a very low-carb diet for a while, to lose weight and improve my overall health (and it worked). Since then, I have settled on a diet that includes a few more carbs (rice and potatoes, in particular), and my new weight has remained very stable, and I feel great. I tend to eat a diet similar to what Paul Jaminet recommends now, and it seems to be working for me.

  15. Chris…I love your balanced approach and I thought your interview with Dr. Mercola was very informative. I have high HDL of 115 and LDL of 140, trigs at 49. According to my NMR, which my nontraditional lipidoligist recommended, I have the genetic marker of high Lp(a) Mass and LP(a)cholesterol and even though my particle numbers are not bad…they feel they should be lower because of these markers. I also had some slight insulin resistance. She wants me to use Metformin for a while to see if we can reduce the insulin resistance and Niaspan to reduce the particle numbers to under 700 and try to increase the HDL further. She is also recommending a carotid scan to see if my HDL is protecting me. I had been following a Paleo diet but recently switched to PHD and although I have lost no weight on the scale I have noticed a reduction in visceral belly fat…my jeans fit looser. Julie

  16. From Mercola's article on your interview:

    "To further reinforce the importance of cholesterol, I want to remind you of the work of Dr. Stephanie Seneff, who also works with the Weston A. Price Foundation. One of her theories is that cholesterol combines with sulfur to form cholesterol sulfate, and that this cholesterol sulfate helps thin your blood by serving as a reservoir for the electron donations you receive when walking barefoot on the earth (also called grounding). She believes that, via this blood-thinning mechanism, cholesterol sulfate may provide natural protection against heart disease. In fact, she goes so far as to hypothesize that heart disease is likely the result of cholesterol deficiency — which of course is the complete opposite of the conventional view."

    Are you comfortable being even indirectly associated with this "hypothesis".

    1. Hi Anonymous,

      I don't really know what "being even indirectly associated with" means and I don't see how it could carry much meaning given that Dr. Mercola directly asked me about it in the interview and I answered him, but I'm comfortable with the answer I gave him.


  17. Hi Chris, great video! I've been on a hunter-gatherer diet for over a year and finally got blood tests and my doctor wants to talk immediately! Cholesterol=350, HDL=57 (Total-HDL ratio = 6.1), Triglycerides=62. Any thoughts?

    1. I'm the subject of Paul Jaminet's post referenced above by PeterC. My total cholesterol peaked at 461 in June 2010, after following a very low carb paleo diet. Thereafter I started following Paul's recommendations and my total cholesterol started dropping. When Paul posted, it had dropped to the low 300's. Last month it was 210 (HDL was 74).

    2. Thanks guys for the reference and comments. I will talk to my doctor about testing my blood levels of:

      Testosterone, Free T3, Copper, Iron, Choline, Vitamin C, Iodine, Selenium

      I already eat chicken liver once a week. Larry, what else did you change?

    3. Ken,

      Paul hypothesized that my problem was a nutrient deficiency (plus eating too few carbs). This may well be the case. Although I sometimes ate liver, I didn't do so on a regular basis. Furthermore, as I became more paleo, I had eliminated nuts in order to lower my omega-6 intake. Before my cholesterol started going up I had been eating a cup of nuts a day — mainly almonds and walnuts. Although these nuts are high in omega-6, they are also high in many nutrients. I hadn't replaced these nutrients with any other source. At the time, Paul was recommending taking a multi-vitamin, which I started doing. (His current advice, however, is to not take a multivitamin.)

      Since then, I have concluded that the main source of my problem was probably my thyroid. When my cholesterol was very high, my free T3 was below range. Now it is within range, although still at the low end. Also my temperature now is nearly 1.5 degrees F higher than when my cholesterol was high, which also points to my thyroid.

      Besides starting to eat more carbs, I started taking iodine, slowly increasing the dose until I reached 12.5mg. I took selenium for a while, but now I depend upon food for selenium. (I currently take daily D3, K2, magnesium, C, and iodine — and once a week some B vitamins.)

    4. Hi Larry,

      Sounds like you've had absolutely fantastic success. Did you change everything all at once? It seems tough to tease out all the changes you made, but it's possible just eating more carbs could have done the trick. Not a bad idea to cover the nutrient bases though. A well-rounded nutrient-dense diet is indicated for everything, including prevention!


    5. Hi Ken,

      I think you've already gotten good advice from the commenters and I second your proposal to have those tests run. You may want to throw in basal body temperature. Is this a new thing, or has your cholesterol always been this high? Have you changed diet or lifestyle in between measurements?


    6. Hi Chris,

      I first started eating more carbs, but only saw improvement after I started taking some supplements. Of course, it is impossible to know whether it was the supplements that made a difference or eating more carbs started a healing process that had a long time course.

      I should add that my lipids improved over a two year period and the improvements were fairly gradual. During that time my diet became more nutrient-dense. For example, at the beginning of 2012 I started eating gelatin regularly, and in the summer I started eating bone broth regularly.

    7. Hey Larry, Chris, thanks for the comments. A few follow-ups:

      1. What types of carbs would you recommend (for example fruits)?

      2. It definitely seems diet related, because my last lipid panel in 2008 — before I changed to low carb (and lost 40 pounds) — showed Total-C=182, Triglyceride=41, HDL=56, LDL=118

      3. If I wanted to test one variable at a time, how long do you think I should try each nutrient before a new blood test? 2 weeks? 1 month? Also, I wonder about the variability – i.e. maybe I need multiple tests for each variable?

      4. Larry, as far as the supplements you take, other than iodine for which you mentioned an amount, what amount do you take for the others? I'll talk to my doctor about amounts as well.

      5. Chris, what should I be looking for in the basal body temperature reading? From Larry's post, it sounds like if it goes up that's good?

      6. Chris, what are your thoughts about the research that Triglycerides/HDL is a better ratio than Total-C or LDL-C to HDL? See "High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease" — My ratio is very good

      7. Larry, how do you eat gelatin?

    8. Hi Ken,

      Have you gotten any benefits out of restricting carbohydrate intake? If so, what are they?

      1. Anything that agrees with you, preferably things that are unrefined and nutrient-dense (as opposed to things made with white flour and white sugar).

      3. Keeping in mind that a proper self-experiment is difficult to do, and often it makes sense to go the easier route of tweaking things and settling on whatever seems to work without really knowing definitively what does and doesn't work, please see this post I wrote about how to conduct a proper self-experiment:

      5. I don't have materials on me right now that address this, but I think what you want to do is put a thermometer in your armpit when you wake up, without getting up or doing or drinking or eating anything, and keep it there for ten minutes, and repeating this on several occasions. It should be between 97.8 and 98.2 degrees. Keep in mind for recommending this to others that additional complications factor in for menstruating women.

      6. Well that is a single small study that doesn't look prospectively at incidence and mortality, so it is interesting but not terribly useful. As pointed out in the link that Larry provided, there is a massive amount of prospective data that shows that, in the general population, total-to-HDL-C is an independent predictor and TG is not. As I've explained elsewhere, I think high TG is an indicator of insulin resistance and high total-to-HDL-C is an indicator of poor LDL turnover. The predictive value of TG is not independent, in my opinion, because insulin resistance leads to poor LDL turnover, so the information in the high TG is redundant with the information in the high total-to-HDL-C. The converse of this is not true because other things besides insulin resistance contribute to poor LDL turnover. That is my working interpretation of the data for now.


    9. Thanks Chris for the replies. The primary benefits for the carb restriction has been 40 pound weight loss, but I haven't tested adding unrefined and nutrient dense carbs, so maybe it was other things that I cut out that caused the weight loss.

      I see your point on #6. It certainly makes sense to me that I should try to lower my Total-C/HDL ratio, but I'm just finding the various recommendations on all the nutrients overwhelming. And I'm not sure my doctor is going to be very helpful (we'll see, appointment in a few weeks).

    10. Also, one last thing is that there was another anomaly in my blood work. I'm not sure if it's related at all, but it was mild liver enzyme elevation (ALT=73).

    11. Hi Ken,

      So the carbs you cut out were primarily refined carbs?

      I would experiment with adding carbs back in a way that doesn't cause you to regain the weight. I would focus on that more than the micronutrients for now, but just try to eat a nutrient-dense diet in general rather than getting wrapped up in the minutiae.

      Keep in mind that your weight loss may be causing transient changes in your blood lipids, and it will take a while to see how they stabilize.

      Mild liver enzyme elevation is probably nothing. Keep an eye on the ALT, get it measured several more times. If it returns to normal, don't worry about it. If it stays elevated for a long time, it could indicate a problem. Keep in mind its a gluconeogenic enzyme, so it could just be increased because you are engaging in more gluconeogenesis. These enzymes are not specific to damage.


    12. Hey Chris, To be honest, I never really paid much attention to my diet before I started to gain weight (about 5 years ago in my mid-20s), and that occurred without any noticeable change in diet, exercise, etc. So I don't really remember everything I ate, but it was certainly a lot of packaged goods which I'm sure had a lot of sugar in them, and a lot of packaged sandwiches. I avoided sugary drinks though.

      I've been on my low carb/high fat diet for about 1 and a half years now. My weight stabilized at 165 pounds (I'm 6 foot) about 1 year ago (and by the way, this is the weight I used to be at for many years before 5 years ago).

      Are you aware of a list of nutrient dense carbs? Or could you just throw out some examples? I'm not sure exactly what that means. For example, what do you eat as far as that?


    13. Hi Ken,

      I mean unprocessed foods like fruits, potatoes and other tubers, or properly prepared whole grains (soaked, soured, etc). I tend to eat potatoes, bananas, and French Meadows European-Style Sourdough Rye for starches, and an assortment of fruits, but there's no reason to stick to any of my choices. Overripe bananas are particularly digestible and nutritious.


    14. Hi, I just wanted to follow up on this thread. After the diet changes recommended on this thread, I got my LDL down from 292 to 134 and my LDL/HDL ratio is back to 2.39 (down from 5.12). Chris, Larry, thank you, you may have literally saved me a few years of my life! My doctor was very surprised. Go internet!

      Here are the things I changed in my diet:

      1. Daily, I took a multivitamin: "Up&up adults' multivitamin/multimineral dietary supplement"
      2. Daily, I took a supplement of Vitamin K (90 mcg) (In addition to 30mcg in the multivitamin)
      3. Daily, I took a supplement of Vitamin C (500 mg) (In addition to 60mg in the multivitamin)
      4. I added a handful of strawberries, blueberries, raspberries, blackberries, and tomatoes to my breakfast every morning.
      5. About 2-3 times a week, instead of chicken breast or tuna or shrimp, instead I had a banana, orange or avocado for lunch.
      6. I added 1 potato and 1 sweet potato to my daily steamed vegetables at dinner.

      (My "base" diet is still: Breakfast=3 eggs, 2 sausages, 3 pieces of bacon, 1 slice of cheese, Lunch=Chicken Breast or Shrimp or Tuna, Dinner=Meat or Fish or Liver plus one plate of 11 vegetables.)

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