Paleo, endurance racing and familial hypercholesterolemia

Answered on August 19, 2014
Created January 13, 2013 at 1:49 AM

I am a 52 year old woman. I have been strict paleo for six months while working with a naturopath, a personal trainer and a nutritionist. I started on Paleo because despite supposedly eating healthy and working out (I do sprint and olympic triathlons and century bike rides) for the past five years I was obese at 151 pounds (5 foot 2 1/2 inches) and my bloodwork for sugar and fat were off the wall. Since going paleo I dropped 25 pounds, lost 10% of my body fat comp (from 40 to 30) and got my blood sugar into normal range. But my lipid panel was still crazy. Last night I learned from the VAP cholesterol panel results that I am FH--familial hypercholesterol (my ldl-r was 172--should be under 100--I got it from my father who had his first heart attack at 52--my age now--and died of massive heart attack at 66--despite being an athlete and on statins) Sooo it means that I have to limit even my good fat eating along with the standard paleo protocol re carbs. The kicker is that I am about to start training for my first half ironman race--and now I am faced with both fat and sugar (the 2 sources of fuel) being a problem for me. Soooo, I am looking for any advice on how to "thread this needle"--how to train and fuel without compromising my sugar and fat blood levels. Given I'd like to continue my endurance racing, do you have any other guidance you could provide me. Thank you, Cindy Arnold Humiston

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6 Answers



on January 13, 2013
at 02:51 AM

Cindy - first, let me say wow, you go girl! The first thing that pops in my mind is Paleo Zone. A lot of people hate it, and I understand why. I am trying it right now, and have mixed feelings .. but it's def something to look into. Here is an article from years ago that gives you an intro. It's a lot lower fat and higher carb than regular paleo, and intended for athletes. Maybe it will be a starting place for you:



on January 13, 2013
at 02:44 AM

Have you had your thyroid checked? Sometimes low thyroid can be the cause of high cholesterol.


on March 21, 2013
at 11:54 AM

Don't know if you have already, but you could be interested in reading Loren Cordian's book: The Paleo Diet for Athletes, it discuses a lot on this topic.


on March 16, 2013
at 01:19 AM

Have you been tested to see if you have FH? Are you APOE 3/3, 3/4, etc?


"To summarize, what matters is the Apolipoprotein E (ApoE), a lipoprotein that carries cholesterol through the bloodstream. Dr. Goldstrich says you should know your ApoE status before deciding what type of diet to pursue. There are 3 kinds of ApoE: types 2, 3, and 4. And since we have 2 alleles, we can have combinations of 2-3, 3-3, 4-3, 4-4, so on.

For about 65% of the population, the ApoE status is 3-3. If you're 3-3, you can eat fat without unduly raising LDL. That is, those who seem to be thriving on the high-fat Paleo or low carb diets, judged only by their LDL, may have Apo E 3-3 alleles.

For the remaining 35% of the population, about 25% include type 4: e.g., 4-3, 3-4 or 4-4. These people's LDL may skyrocket on a fat-heavy diet, especially saturated fat. And the LDL increase may be in the form of Pattern B (the small, dense ones that are supposed to be dangerous). These people tend to thrive on a low-fat diet, as their LDL would be managed best by keeping saturated fat low. For example, eating coconut oil might increase their LDL significantly, while it would not affect the Apo E 3-3 type. Fish oil could also increase the LDL of these people, while supplement Quercetin could lower their HDL."



"LDL particle size is dependent on both genetic factors and environmental factors such as dietary fat composition. The apolipoprotein E (apoE) genotype is a major genetic determinant of LDL size. Thus, the aim of this work was to study whether the apoE genotype interacts with the quantity and quality of dietary fat, modifying LDL size in young healthy subjects. Healthy subjects (n = 84; 66 apoE 3/3, 8 apoE 4/3, 10 apoE 3/2) were subjected to 3 dietary periods, each lasting 4 wk. The first was an SFA-enriched diet (38% fat, 20% SFA), which was followed by a carbohydrate (CHO)-rich diet (30% fat, < 10% SFA, 55% carbohydrate) or a monounsaturated fatty acid (MUFA) olive oil–rich diet (38% fat, 22% MUFA) following a randomized crossover design. At the end of each diet period, LDL particle size and plasma levels of total cholesterol, LDL cholesterol (LDL-C), HDL-C, apoB, apoA-I, and triacylglycerols were determined. LDL particle size was significantly higher (P < 0.04) in subjects with the apoE 4/3 genotype compared with those with apoE 3/3 and apoE 3/2 in the basal state. LDL size was smaller (P < 0.02) after the CHO diet than after the MUFA or SFA diets. After the CHO diet, a significant increase in LDL particle size (P < 0.035) was noted with respect to the MUFA diet in apoE 4/3 subjects, whereas a significant decrease was observed in the apoE 3/3 individuals (P < 0.043). In conclusion, a Mediterranean diet, high in MUFA-fat increases LDL particle size compared with a CHO diet, and this effect is dependent of apoE genotypes."


on January 15, 2013
at 02:03 AM

THank you to all 3 of you--I really appreciate your taking the time to provide me with info. I have had my thyroid checked and it's normal. I appreciate the info on the Zone diet--I read the article and going to discuss it with my nutritionist tomorrow. And I am at this moment listening to Jimmy Moore's show!


on January 13, 2013
at 09:24 AM

Hi Cindy, check out the latest interviews on Jimmy Moore's Living la Viva Low Cho show as he interviews a Dr Thomas Dayspring who talks about FH and you might hear something relevant. Particularly about other tests which might provide more info. Low CHO and low fat... Not good! http://www.thelivinlowcarbshow.com/shownotes/page/2/

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