Low Cholesterol Part 1: Stroke and Depression

It’s been so long since I wrote anything, some of you might have been wondering if I had died from low cholesterol. No, I am still here plugging away. But unlike Dr. Michael Greger, whose Latest in Clinical Nutrition: Volume 15 is now out on DVD, I have not been working at a speed that violates Einstein’s theory of relativity.

My post of August 28th, The Winter of Their Discontent, caused quite a firestorm of comments. (Whoops! – I mean it was correlated with a firestorm of comments.) Let’s just say that some people do not care for the suggestion that cholesterol levels could get too low.

I’ve spent much of my nutrition time over the last few weeks checking out links to studies that people posted in their comments, along with many others that I found along the way, and want to share what I have found. But first, I want to clarify a few things.

The question I am trying to answer is: at what point, if any, does total cholesterol become so low that it could impact things such as steroid hormone production or mood in some people? And as a corollary: Is low cholesterol possibly a culprit when it comes to the egg cravings some vegans get?

One thing I have never said, and am not suggesting, is that low LDL cholesterol levels don’t protect against atherosclerosis (or even mortality) and I’m not sure why people have jumped to the conclusion that I am implying this.

Unfortunately, I have not done a good job of documenting the anecdotal reports of vegans who have come to me with problems who also have very low cholesterol. One guy was passing out unless he ate cheese, and his cholesterol levels were about 100 mg/dl. My recollection is that adding plant saturated fat didn’t help him. A few other people have had loss of libido which improved upon adding coconut oil (I don’t know what their cholesterol levels were). Another person with cholesterol of 94 mg/dl was suffering from mild fatigue, headaches, and anxiety. Kristen, the ex-vegan featured in The Winter of Their Discontent, had an irregular menstrual cycle (among other things) and a cholesterol of 95 mg/dl. However, I also know vegans with cholesterol levels below 100 mg/dl who appear to be thriving.

So what do we know about low cholesterol?

Low Cholesterol and Hemorrhagic Stroke

During the 1990s, it became known that cholesterol was associated with mortality in a U-shaped curve. In other words, both high and low cholesterol levels were associated with higher mortality – though much more on the high cholesterol end. At the time, the thinking was that most of the association of higher mortality with low cholesterol was a merely a manifestation of early cancer, poor nutrition from depression, or liver disease and poor nutrition from alcoholism. The remaining cause of increased mortality was thought to be due to an increase in risk for hemorrhagic stroke (which is a much less prevalent form of stroke than the more typical ischemic stroke where a blood vessel to the brain is blocked).

The most recent, comprehensive review I found on low cholesterol and hemorrhagic stroke was a 2013 meta-analysis of prospective studies (1). Among 17 studies, they found that high total cholesterol was associated with a 31% decreased risk of hemorrhagic stroke (.69, 0.59–0.81), although publication bias was detected. The vast majority of these studies adjusted their results for blood pressure and alcohol intake, among other variables. Lower LDL, but not lower HDL, was also associated with an increased risk of stroke.

It should be noted that lowering one’s LDL decreases heart disease risk by so much that you are better off with a low LDL even if it does increase the risk for hemorrhagic stroke. It is also still possible that these studies had confounding variables that could not be fully adjusted.

The authors finish their paper by saying, “Our results remind clinicians to take this caution during intensive lipid-lowering therapy. Further studies are needed to investigate the underlying pathogenesis better, and identify subjects who would benefit most from lowering cholesterol without risk of hemorrhagic stroke.”

With few exceptions, the low cholesterol category was less than about 150 mg/dl; the average cholesterol in the lowest categories was rarely given. I have not taken the time to read each study and see if there is any way to detect trends as to whether the findings were different based on the different cholesterol levels being compared or the level or types of adjustments.

A reader pointed out a study from Korea (2), which was included in the 2013 meta-analysis (1), in which the risk of hemorrhagic stroke disappeared after adjusting for blood pressure.

There were 8,319 people in the lowest cholesterol category of 130 mg/dl or less (average cholesterol not given). The decreased risk of having a hemorrhagic stroke in the fully adjusted model (including blood pressure and alcohol consumption) for every 38.6 mg/dl (1 mmol/l) increase in total cholesterol was 9% (.91, .87-.95).

However, when they broke the cohort into two groups, those with high blood pressure and those with normal blood pressure, the effect did not hold for those with normal blood pressure. There was still a non-significant trend towards lower stroke in those with “medium” cholesterol levels as compared to the lowest category.

They broke the group up even further. Among those with high blood pressure, they stratified the results for gamma glutamyl transferase (GGT) which reflects alcohol consumption. At low concentrations of GGT, low cholesterol was not associated with a higher risk of hemorrhagic stroke among those with high blood pressure.

The researchers conclude, “In effect, low blood cholesterol may act as a marker of the health damaging effects of alcohol, rather than be a cause of hemorrhagic stroke.”

Based on the results from the 2013 meta-analysis, I’m not sure that this one study from Korea can be considered to put to rest the entire question of whether low cholesterol, in itself, can contribute to hemorrhagic stroke. Apparently the authors of the meta-analysis didn’t think so, but I’m actually inclined to think perhaps it does.

In any case, if you have low cholesterol (below 150 mg/dl) and have either high blood pressure or drink alcohol heavily, you should talk to a doctor about your risk for hemorrhagic stroke.

Low Cholesterol and Depression

The most recent, comprehensive report I found was a 2008 review from the journal, Psychiatry (3). They sum up their findings nicely in the introduction:

“A number of investigators have found a possible relationship between low serum cholesterol levels and mood disorders. In addition, low serum cholesterol levels have been associated with suicidal ideation [suicidal thoughts] and suicide attempts. While the pathophysiology of this association remains unknown, some researchers have postulated that there may be a relationship between altered lipid metabolism and changes in serotonin functioning. In addition, some researchers have found that the pharmacological treatment of depression results in increased serum cholesterol levels. While controversies and inconsistencies characterize this area of study, it appears reasonable to conclude the following: (a) alterations in lipid metabolism may be one of several risk factors for the subsequent development of depression and/or suicidal ideation/suicide attempts (i.e., a non-specific contributory variable) and/or (b) low serum cholesterol levels are an inconsistent but possible biological marker for the manifestation of these phenomena in some individuals.”

In other words, low cholesterol might cause depression and suicidal thoughts/attempts in some individuals. Could this be related to why some ex-vegans claim their mood became much improved upon going back to eating animal products?

More research is needed. Stay tuned for Part II (now available).

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References

1. Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013 Jul;44(7):1833-9. doi: 10.1161/STROKEAHA.113.001326. Epub 2013 May 23. | link

2. Ebrahim S, Sung J, Song YM, Ferrer RL, Lawlor DA, Davey Smith G. Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ. 2006 Jul 1;333(7557):22. Epub 2006 Jun 6. Erratum in: BMJ. 2006 Sep 2;333(7566):468. | link

3. Sansone RA. Cholesterol quandaries: relationship to depression and the suicidal experience. Psychiatry (Edgmont). 2008 Mar;5(3):22-34. | link

20 Responses to “Low Cholesterol Part 1: Stroke and Depression”

  1. Healthy Longevity Says:

    I previously reviewed the evidence of the association between blood cholesterol and hemorrhagic stroke and found evidence from data based on more than 90 prospective cohorts with 2.4 million participants and 8,000 cases of hemorrhagic stroke that blood pressure modifies the association between blood cholesterol and the risk of hemorrhagic stroke. These cohorts found that low cholesterol was only associated with an excess risk among those individuals with unfavorable blood pressure.

    The Prospective Studies Collaboration including 61 cohorts found that among participants with a baseline systolic blood pressure of less than 125 mmHg, lower blood cholesterol was actually associated with a significantly decreased risk of hemorrhagic stroke.

    http://healthylongevity.blogspot.com/2012/10/diet-blood-cholesterol-blood-pressure.html

    Despite these findings the authors of this 2013 meta-analysis paper appear to mention very little of a possible interaction of blood pressure and the association between blood cholesterol and hemorrhagic stroke. They however mentioned the following important but perhaps underappreciated limitation of the studies:
    “Another major concern was that our results might be confounded by comorbidity at baseline. Because patients who died from other diseases at earlier ages could not contribute to a later risk of ICH, a survival bias possibly existed. No study excluded the first 5 or 10 years of follow-up, and still showed an association for hemorrhagic stroke. This bias may explain the protection conferred by high TC against hemorrhagic stroke, by progressively decreasing the proportion of patients with atherothrombotic disease and subsequently increasing the proportion of other cerebral vessel diseases or conditions in the elderly, which cause hemorrhagic stroke with unknown relations with cholesterols.”

  2. Valerie Lewis Says:

    When I was a young woman in the early 60′s, my father who was an internal medicine specialist was interested in all the burgeoning discussion about cholesterol causing heart disease. He stated categorically that this was nonsense….that the body produces cholesterol, and that it is essential for health. He went on to say that if cholesterol levels get too high, that is not what causes heart disease…that something else was creating a problem, e.g. inflammation, so that the body produces more cholesterol. Ditto if cholesterol gets too low. He said it is like saying that too many white blood cells causes infection. Or that it is all those firemen that caused the house to burn down. I have yet to hear a decent refutation of what he said. The body is a complex and inter-related system, and surely all this reductionism about cholesterol being a causal agent is like the blind men and the elephant? Where diet is concerned, surely it contributes to the picture- e.g. eating mostly meat means eating little fiber, and over consuming certain enzymes etc. which in turn might lead to the body trying to protect itself in various ways, some of which end up being measured and seen as a ’cause’ for ill health. What are your thoughts on this?

  3. Ilana Says:

    Is it possible that the link for depression is with omega 3, not cholesterol? (Since that is a known link and they are both fats?)

  4. Healthy Longevity Says:

    In regards to depression, a mendelian randomization study found that individuals who inherit genetic variants that lower LDL do not display increased depressive symptoms, casting doubt on a causal association.
    http://www.ncbi.nlm.nih.gov/pubmed/18990452/

    A recent review of clinical trials found that cholesterol lowering statins are associated with improvements in mood scores. Furthermore, several clinical trials have found that vegetarian diets, also known to lower serum cholesterol have favorable effects on measures of mood and stress. These interventions may have improved mood via mechanisms unrelated to blood cholesterol, but nevertheless cast doubt on the suggestion that low cholesterol has a significant unfavorable effect on depressive symptoms.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568015/
    http://www.nutritionj.com/content/11/1/9
    http://www.ncbi.nlm.nih.gov/pubmed?term=8205407
    http://www.ncbi.nlm.nih.gov/pubmed/3783150

    An analysis of 18 mammalians species showed a mean LDL concentration of 42 mg/dl, and these animals appear to be doing just fine. People with hypobetalipoproteinemia who have lifetime LDL concentrations of <15 mg/dl show perfectly normal growth and development and actually appear to live longer.
    http://circ.ahajournals.org/content/118/6/672.long

    Michael S. Brown and Joseph L. Goldstein who were awarded a Nobel Prize for their research on the metabolism of LDL cholesterol demonstrated that a LDL cholesterol concentration of 25 mg/dl is sufficient to nourish body cells work cholesterol.
    http://www.nobelprize.org/nobel_prizes/medicine/laureates/1985/brown-goldstein-lecture.pdf

    @Valerie,
    The body produces body fat and some body fat is required for normal bodily function, but this does not necessarily mean that being obese is healthy. The same can be said for high blood pressure, blood sugar and blood cholesterol. Your statements are typical examples cholesterol skeptic propaganda that do not hold up to scientific scrutiny.

  5. Dan Says:

    Couldn’t help myself. Really feel like chiming in on what is a very important topic.

    I am concerned about the advice to supplement with saturated fats such as coconut oil in people with low cholesterol on a vegan diet who are failing to thrive. Here is the problem:

    1) It assumes that the low cholesterol is driving the symptoms of failure-to-thrive – e.g. menstrual irregularities (no menses), severe fatigue/exhaustion, depression. As we know, one of the cardinal symptoms of depression is anorexia – or greatly reduced food intake. This alone – a very hypocaloric diet – would drive down cholesterol and a host of other biochemical markers of health (e.g. ferritin, hemoglobin, prealbumin, 1,25-OH-vitamin D, etc). Why is cholesterol being singled out here for special treatment?

    2) We know that free-living hunter-gatherer cultures, such as those still living in the Amazon, have very low cholesterol levels – presumably they have been living on the same diet for tens of thousands of years. Are they committing suicide or dropping dead from hemorrhagic strokes? Same thing with the Kitivar horticulturalists in Papua New Guinea.

    3) Most trial data that I have seen, including those summarized in the latest Cochrane review on fat-reduced diets, suggests that a reduction in saturated fat reduces the risk of cardiovascular events. The converse is that increasing saturated fat would increase the risk of cardiovascular events – which is what observational studies also suggest.

    4) Postprandial lipids are more strongly tied to cardiovascular risk than fasting lipids. Were the vegan cases in question measuring postprandial lipids? An increase in postprandial triglyceride levels increased the risk of cardiovascular events by more than 3-fold in the ‘Sugar and Cream’ study from Homberg, in non-diabetic patients. What effect does ingesting coconut oil have on acute cholesterol and triglyceride surges postprandially?

    5) If people improve on this regimen, could it be a placebo effect? Coconut oil has distinctive flavor characteristics, it has unique physicochemical properties (such as melting at low temperatures), it has to be purchased by the person in a health food store upon the dietician or naturopath’s recommendation. All of this is setting up for a strong placebo effect, whereby the person will believe in the powers of coconut oil to remedy their fatigue, etc. With respect to menstrual cycles, are they making other changes to their diet, or eating more protein or more food in general? It is well known that anorexia and severe exercise suppress menses.

    Given that non-human mammalian species have an average cholesterol level of around 43 mg/dl, are we unique in needing higher levels as seen in western cultures (and those that have rapidly industrialized)? Can’t we get by with levels of 90-100 mg/dl? I believe neonates have extremely low cholesterol values – around 50 mg/dl – and yet proceed to have normal brain development and sexual characteristics (even the vegan ones!).

    The standard response is that certain individuals may fail to thrive with diet-induced hypocholesterolemia. But then we need to see evidence that organ failure is directly linked to the low cholesterol values and treating it improves organ function, cognition, etc. The usual standard for testing that would be an RCT. As you know. Not a case report or two.

    I have seen many patients with cholesterol levels of 40 mg/dl or less who are thriving. Doesn’t rule out that there may be some people who would be harmed by such levels, but it would be nice to have some proof of such, free of reverse causality and confounding by systemic diseases, poor nutrition, etc.

  6. Jack Norris RD Says:

    Healthy,

    > “Because patients who died from other diseases at earlier ages could not contribute to a later risk of ICH, a survival bias possibly existed. No study excluded the first 5 or 10 years of follow-up, and still showed an association for hemorrhagic stroke.”

    Good point. As I implied in my post, I consider it very possible that low cholesterol does not cause hemorrhagic stroke.

    The Korean paper made it appear that even elevated blood pressure had no role to play in hemorrhagic stroke, only alcoholism.

  7. Jack Norris RD Says:

    Llana,

    > Is it possible that the link for depression is with omega 3, not cholesterol? (Since that is a known link and they are both fats?)

    The connection between omega-3s and depression is also open to question, and generally omega-3s are inversely associated with cholesterol levels, not positively. But, in very low-fat diets, there is possibly going to be low cholesterol levels and low DHA. So, you might be right.

  8. Jack Norris RD Says:

    Valerie,

    Not being an actual expert in the area, my thoughts are that the mechanisms by which high cholesterol levels result in heart disease are fairly well established. I don’t follow the research on inflammation and heart disease closely, but I recently saw a report that implicated cholesterol as being more important than inflammation. I can’t remember where, unfortunately.

  9. Jack Norris RD Says:

    Dan,

    > Why is cholesterol being singled out here for special treatment?

    Well, for one thing, many sex hormones are cholesterol-based, as is vitamin D (that you mentioned).

    > Are they committing suicide or dropping dead from hemorrhagic strokes?

    As I pointed out in my post, the evidence is that low cholesterol doesn’t cause hemorrhagic stroke in otherwise healthy people. You make it sound like I’m suggesting otherwise.

    > Postprandial lipids are more strongly tied to cardiovascular risk than fasting lipids. Were the vegan cases in question measuring postprandial lipids?

    I would seriously doubt it, but so what?

    > I have seen many patients with cholesterol levels of 40 mg/dl or less who are thriving.

    Really? Do you mean LDL or total cholesterol? If you mean total cholesterol, then that is something to take note of. How long have they had cholesterol levels that low? And didn’t you just recently tell me you have a patient who lowered their cholesterol levels significantly only to find their atherosclerosis get significantly worse?

    > If people improve on this regimen, could it be a placebo effect?

    Yes.

    > The converse is that increasing saturated fat would increase the risk of cardiovascular events – which is what observational studies also suggest.

    If a low total cholesterol level (via low LDL) reduces heart disease by 88% as in the PCSK9 Genetic Variant study, with total cholesterol levels of 172 mg/dl, then one would extrapolate to assume that a total cholesterol level of 100 mg/dl or less would reduce it by even more than 88%. Would adding some coconut oil to increase cholesterol levels a bit really increase the risk of early death enough to worry about? I’m guessing most people are more worried about their menstrual cycle and libido being normal, than increasing their lifespan by some tiny amount. Given that these ex-vegans typically go crazy eating saturated fat and cholesterol when they fail to thrive, I don’t think I’m going to be too worried about the harmful effects of their trying some coconut oil before giving up veganism for a paleo diet.

  10. Andreas Says:

    All this smells like a severe deficiency of sunshine and a domesticated contagious disease called lazyness where individuals waste countless hours in the sitting position, hence blocking blood flow. Add junk food to the lazyness disease and we have obesity, which further lowers blood pressure. Add technology addiction to the lazyness disease and we have dysregulation of neurotransmitters like dopamine and serotonin; lower dopamine levels lowers blood pressure further. Add a calcitriol/retinoids deficiency to the lazyness disease and we have lower neurotransmitters levels. Hence depression; a psychological disease that eventually leads to the lazyness disease.

    See if you can spot the backwardness of the above paragraph. ;)

  11. Dan Says:

    Jack,

    My point about postprandial lipids is that normally we are not in the fasting state. Fasting lipid measurement typically requires up to 14 hours of fasting. Thus our physiology is more likely to comprise multiple meals and postprandial lipid concentrations every day. The people who are telling you they have very low cholesterol and symptoms, or posting such on the web, may actually have normal postprandial lipid concentrations, thus we may be falsely implicating low cholesterol after a 12-14 hour fast as the cause of their symptoms. Since normally we manufacture about 80% of our total cholesterol pool, none of this should really matter anyway. Those people with extremely low cholesterol concentrations on diet or drugs appear, at least in observational studies and post-hoc analyses of large randomized trials (JUPITER, METEOR, ASTEROID) to have the lowest rates of cardiovascular events and death. Wouldn’t that normally track with quality of life? (one would think)

    Two tablespoons of coconut oil doesn’t sound like a lot on a daily or even weekly basis, but since the person will be supplementing with this for decades (unless they go back to non-veganism), I would be concerned about what their postprandial trigs and cholesterol are doing to their arteries. As mentioned, in the Homburg sugar and cream study, postprandial triglyceride spikes increased the risk of cardiovascular events by 3-4-fold in non-diabetics, and this has been seen in a number of other large cohort studies (one of which was published in JAMA a couple years ago). Wouldn’t coconut oil produce a chylomicron surge? (it was certainly a big part of the Atkins diet that led to my own severe hypercholesterolemia)

    The patient I mentioned actually had severe derangement of his trigs/HDL on an Esselstyn diet – metabolic syndrome – which I think more than counteracted his low diet-induced LDL levels. He was eating enormous quantities of fruit which drove his metabolic syndrome.

    If two tablespoons of coconut oil dramatically improve symptoms of failure-to-thrive, then couldn’t the issue be that they are not consuming enough fat in their diet? Why not add more MUFA/PUFA instead? Suggesting more olive oil is at least evidence-based, from the PREDIMED and Lyon Heart Trial. This would also test whether cholesterol was the culprit, as MUFA is lipid-neutral and PUFA (especially omega-6) is hypocholesterolemic.

    As mentioned, I have seen many patients on very high dose statins plus/minus other hypocholesterolemic agents with ultra low cholesterol levels who are thriving. Largely I have been looking at their LDL cholesterols, which are often under 40 mg/dL. But their totals are not far behind, as they tend to have low HDL levels as well. Admittedly, anecdotes like this don’t prove anything, since they lack control groups, randomization (to prevent selection bias), and placebos (blinding)….

  12. Jack Norris RD Says:

    Dan,

    > My point about postprandial lipids is that normally we are not in the fasting state.

    If we are using fasting lipids as a marker for having too high of a cholesterol level, then I don’t see why we can’t also use them as a marker for too low of a cholesterol level (other things being equal).

    > He was eating enormous quantities of fruit which drove his metabolic syndrome.

    Got it, thanks.

    > If two tablespoons of coconut oil dramatically improve symptoms of failure-to-thrive, then couldn’t the issue be that they are not consuming enough fat in their diet?

    I said “teaspoons”, not “tablespoons”. I would not recommend 2 tablespoons per day. To answer your question, yes, it could be, and trying a MUFA should probably be the first step as you suggest. Thanks for pointing that out.

  13. Andreas Says:

    Dan,

    “The patient I mentioned actually had severe derangement of his trigs/HDL on an Esselstyn diet – metabolic syndrome – which I think more than counteracted his low diet-induced LDL levels. He was eating enormous quantities of fruit which drove his metabolic syndrome.”

    Please post this patient’s weight and height before the Esselstyn diet. An obese individual that already has metabolic syndrome cannot blame a recent switch of diet on fruit. Please tell us the WHOLE story.

    Its like a patient that discovers a B12 deficiency a couple months after switching to a plant based diet. This patient was borderline B12 deficient on a meat diet.

  14. Amanda Says:

    I don’t totally understand the implications of all this. Is it something vegans, who don’t otherwise restrict their diets, should worry about? I mean, is the cholesterol deficiency usually caused by a low-fat or whole foods diet, or is it something that can happen to specific vegans based on their biology?

  15. Jack Norris RD Says:

    Amanda,

    1. If you don’t have low cholesterol, say below 110 mg/dl, then there are no implications at all.
    2. If you do have low cholesterol and high blood pressure of heavy alcohol drinking, talk to your doctor.
    3. If you are vegan and depressed and have very low cholesterol, try eating more fat. Perhaps start with olive oil.

  16. m Says:

    I want to stay vegan,I’ve been vegan 5yrs,been good with b12 the thought of irreperable brain damage is pretty motivating!After reading various articles etc.. and hearing from various nutritional psychiatrists such as Robert-Hedaya that meat is essential for mental health I feel distressed and conflicted. I looked on your website but only saw1 article you had on german vegetarians and mental disorders,1 on cholesterol…Humans have a different digestive system to canines like dogs,so are we really meant to eat meat? I used to take True Hope’s EmpowerPlus (non-vegan) that helped me stay out of the hospital but I can’t get it shipped to my country anymore or afford it.I don’t know what to do,if I go to a nutritional psychiatrist they will most likely tell me to eat meat.I’ve switched to vegan solgar female multi but its not as good as Empower I get mood swings about every hour,mini episodes of mania (unrealistic optimst,loss of rationality…)then a built up sleep debt followed by a cold.I’m adressing possible candida issues but that takes a loooong time since I get pretty bad die-off interfering with daily living (extreme fatigue,severe muscle pain) and vegan diets are high in carbs.I’m going to try getting a b12 shot from a doctor even though my blood levels are most likely “normal” blood tests never showed anything wrong when I was hospitalised.I do eat some coconut oil & olive oil,canola oil 1tsp/day for salad dressings at the same time as a probiotic every day.Can I live a healthy Life and continue being vegan?

  17. Jack Norris RD Says:

    m,

    Have you been tested for vitamin D or iron deficiency?

  18. m Says:

    Thanks you for your quick reply.
    Yes I have and also for inflammation,hormone levels,nutrients :glucose,B and U leucocites,hemoglobin,trombocytes ,U-nitrite,potassium,natrium,creatine,P-albumin,calcium,magnesium,P-Fosphate,P-ALAT,pancreatic amylase,P-ASAT,S-Tyroxin ,I will get checked again soon but I doubt there will be much change

  19. Taylor Says:

    I have very low cholesterol, am practically vegan, and have depression. The meds gave me an almost immediate fix which was palpably physical. If it is a placebo effect, it’s one hell of a placebo effect. How do you increase your cholesterol safely? I’m going to experiment to see if it makes a difference.

  20. Jack Norris RD Says:

    Taylor,

    People have had success raising cholesterol levels by adding more oil to their diets. Coconut oil seems particularly effective probably due to being high in saturated fat.

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