High Cholesterol and Heart Disease

High Cholesterol, Heart Disease, and Paleo Diets

Most of us have been taught that dietary cholesterol and saturated fat intake are the leading causes of heart disease. However, unless you are a “hyper-responder,” dietary cholesterol and saturated fat intake do not significantly affect blood levels of cholesterol or heart disease risk. The latest research suggests that metabolic problems like insulin resistance and inflammation play a larger role than serum cholesterol levels or dietary fat intake in our risk of developing this disease.

If you’ve been diagnosed with heart disease, or your doctor has told you that you’re at higher risk of developing heart disease, then a nutrient-dense, anti-inflammatory Paleo-diet is an excellent starting place. It includes all of the necessary micronutrients in their most bioavailable form, emphasizes an optimal balance of fats, eliminates highly processed and refined foods, and reduces other food toxins that interfere with nutrient absorption.

However, within the basic Paleo approach, there’s tremendous room for individual variation, depending on existing health conditions, among many other factors. If you have an abnormal lipid profile and are at increased risk of heart disease, your specific approach to a Paleo heart-healthy diet will depend on the root cause of your condition:

• If you have markers of insulin resistance, such as high triglycerides, low HDL, high blood sugar, and are overweight, you should follow a low-carbohydrate version of the Paleo diet.
• If you do not have markers of insulin resistance, and simply have high total cholesterol, you should follow a “Mediterranean” Paleo diet. 

Low-Carb Paleo Guidelines

Decrease your carbohydrate intake to less than 15% of total calories per day (roughly less than 100 grams on a 2,500 calorie diet and less than 75 grams on a 2,000 calorie diet). A low-carb diet can sometimes cause an initial increase in LDL cholesterol, but this effect is usually transient and lasts about three to six months. Low-carb diets are effective for weight loss in people with insulin resistance. They also increase HDL (i.e., “good”) cholesterol, reduce triglycerides, and improve other metabolic markers.

Here’s a snapshot of what a day’s worth of food might look like with a low-carb Paleo diet:
• Breakfast: Three scrambled eggs, bacon, raw sauerkraut, coffee with heavy cream
• Lunch: Chicken salad with fresh tomatoes, avocado, goat cheese, olive oil, and vinegar
• Dinner: Rib-eye steak with steamed broccoli and sweet potato

You may also consider intermittent fasting, which has been shown to improve blood sugar control. Intermittent fasting involves alternating between periods of eating and periods of fasting. There are many ways to do it, but here are the two most effective and convenient methods:
Compress your food intake between 12 pm and 8 pm. This means you would skip breakfast and eat all of your meals within that eight-hour window each day.
Perform a longer fast once a week or twice a month. In this case, you would fast for 24 hours.

Low-Carb Paleo Guidelines

Mediterranean Paleo Guidelines

While low-carb diets are the best choice for most people with insulin resistance, they may not be the best choice for those with high total and LDL cholesterol but normal metabolic function. In these cases, a “Mediterranean” Paleo diet may be a better choice. This means:

Eat more carbohydrates
Aim for at least 25 to 30% of total calories from carbohydrates (in the form of fruit, starchy tubers, and perhaps full-fat dairy, white rice, or properly prepared grains, or pseudo-grains if you tolerate them).

Reduce your intake of saturated fat.
Focus more on monounsaturated fats like avocados, olives, nuts, and long-chain omega-3 fats such as EPA and DHA found in cold-water fish and shellfish.

Reduce your intake of added fat.
It’s fine to eat fat if it naturally occurs in food, but try not to add extra to your food. For example, if you have a sweet potato, just add a small amount of coconut oil rather than several chunks of butter.

Favor leaner cuts
Eat red meat, chicken, turkey, and fish over fattier beef and lamb cuts.

General Heart-Healthy Diet Guideline

General Heart-Healthy Diet Guideline

Regardless of whether you have insulin resistance—if you’re at greater risk for heart disease, you should follow these guidelines:

Eat Cold-Water, Fatty Fish & Shellfish
These fish are excellent sources of omega-3 fatty acids, which are beneficial for heart health. They have been shown to decrease heart disease risk by reducing inflammation and positively changing gene expression. Focus on eating fish with high levels of EPA and DHA such as salmon, mackerel, herring, sardines, anchovies, and bass, as well as shellfish like oysters, clams, and mussels. Aim for 12 to 16 ounces per week for best results.

Focus on Monounsaturated Fats
Monounsaturated fats reduce LDL, triglycerides, and inflammation, increase HDL (good cholesterol), and lower blood pressure. Focus on olives, olive oil, avocados, and macadamia nuts. Aim for a handful of macadamia nuts, ¼ to ½ of an avocado, and 1 tablespoon of olive oil daily.

Increase Your Antioxidant and Polyphenol Intake
Antioxidants help reduce oxidative damage, while polyphenols have many benefits, including increasing insulin sensitivity, lowering blood pressure, and lowering oxidized LDL cholesterol. To increase your intake of antioxidants and polyphenols—eat the rainbow! Fruits and vegetables are great sources of antioxidants and polyphenols but don’t miss out on meats, organ meats, eggs, and dairy, which contain important antioxidants not found in plant foods, like CoQ10.

Eat Nuts
Nuts have been shown to reduce an array of cardiovascular risk factors such as BMI, waist circumference, and systolic blood pressure. Tree nuts are the most beneficial and include almonds, Brazil nuts, cashews, chestnuts, filberts/hazelnuts, macadamia nuts, coconut, pecans, pine nuts (pignoli nuts), pistachios, and walnuts. It’s very easy to overeat these!—so watch your intake. Aim for a handful of nuts several times a week.

Eat Fermented Foods and Soluble Fiber
Fermented foods help reduce lipid levels, increase antioxidant potential, lower blood pressure, and decrease inflammatory molecules. Fermented foods include sauerkraut, kimchi, beet kvass, kombucha, kefir, and more. Aim for one to two tablespoons of fermented vegetables with each meal, plus a half-cup of kombucha or kvass and a half-cup of yogurt or kefir per day.


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