Advertisement
U.S. markets closed
  • S&P 500

    5,069.76
    -8.42 (-0.17%)
     
  • Dow 30

    38,949.02
    -23.39 (-0.06%)
     
  • Nasdaq

    15,947.74
    -87.56 (-0.55%)
     
  • Russell 2000

    2,040.31
    -15.80 (-0.77%)
     
  • Crude Oil

    78.17
    -0.37 (-0.47%)
     
  • Gold

    2,043.10
    +0.40 (+0.02%)
     
  • Silver

    22.66
    +0.02 (+0.11%)
     
  • EUR/USD

    1.0842
    -0.0006 (-0.05%)
     
  • 10-Yr Bond

    4.2740
    -0.0410 (-0.95%)
     
  • GBP/USD

    1.2661
    -0.0025 (-0.20%)
     
  • USD/JPY

    150.6150
    +0.1350 (+0.09%)
     
  • Bitcoin USD

    62,414.40
    +5,306.65 (+9.29%)
     
  • CMC Crypto 200

    885.54
    0.00 (0.00%)
     
  • FTSE 100

    7,624.98
    -58.04 (-0.76%)
     
  • Nikkei 225

    39,208.03
    -31.49 (-0.08%)
     

A normal cholesterol level can still be deadly, warns healthy aging expert Dr. Michael Greger

Scientific consensus panels going back decades established—“beyond a reasonable doubt”—that lowering LDL cholesterol reduces the risk of heart attacks. Consistent evidence “unequivocally” establishes that LDL causes our number one killer, heart disease. This evidence base includes hundreds of studies involving literally millions of people. In other words, “[i]t’s the cholesterol, stupid,” quipped American Journal of Cardiology editor in chief William Clifford Roberts. His CV is more than a hundred pages long, and he’s published about 1,700 articles in the peer-reviewed medical literature. Yes, there are at least ten traditional risk factors for atherosclerosis, but, as Dr. Roberts notes, only one is required for the progression of the disease: elevated cholesterol. All of the other factors, such as smoking, high blood pressure, diabetes, inactivity, and obesity, merely exacerbate the damage caused by high cholesterol.

Phew! you say, because your bloodwork just came back and your doctor said your cholesterol is “normal.” But, hold on. Having a normal cholesterol level in a society where it’s normal to drop dead of a heart attack isn’t necessarily something to celebrate. With heart disease the top killer of men and women, we definitely don’t want to have normal cholesterol levels. We want to have optimal levels—and not “optimal” by arbitrary laboratory standards, but optimal for human health.

Normal LDL cholesterol levels are associated with the build-up of atherosclerotic plaques in our arteries even in those with so-called optimal risk factors by current standards: blood pressure under 120/80, normal blood sugars, and total cholesterol under 200. If you went to your doctor with those kinds of numbers, you’d probably get a gold star and a lollipop, or at least a pat on the back. But, when ultrasound and CT scans were used to actually peek inside the bodies of patients boasting those numbers, overt atherosclerotic plaques were detected in 38 percent. Maybe those digits ain’t so optimal after all.

Perhaps we should define an LDL cholesterol level as optimal only when it no longer causes disease. (What a concept!) How would we go about figuring that out?

When more than 1,000 men and women in their forties were scanned, most of those with “normal” LDL levels under 130 had frank atherosclerosis. No atherosclerotic plaques were found only when LDL was down around 50 or 60, which just so happens to be the level most people had before our diets changed to what they are today. The majority of the global adult population had LDLs around 50 mg/dL. So, average values today are regarded as normal based on a sick society. What we want is a cholesterol level that is normal for the human species, which is considered to be around 30 to 70 mg/dL (or 0.8 to 1.8 millimoles per liter).

Although an LDL level in this range might seem excessively low by modern American standards, it is precisely the normal range for individuals living the lifestyle and eating the diet for which our ancient ancestors were genetically adapted over millions of years: a diet centered around whole plant foods. Given that the LDL level our body was designed for is less than half of what is presently considered as “normal,” it’s no wonder we are awash in a pandemic of atherosclerotic heart disease.

Why is there a tendency in medicine to accept small changes in risk factors when the goal shouldn’t be just decreasing risk, but preventing plaques from forming in the first place? In that case, how low should we go?

One noted professor of vascular biochemistry noted: “In light of the latest evidence from trials exploring the benefits and risks of profound LDL cholesterol-lowering, the answer to the question How low should we go? is, arguably, a straightforward As low as you can!” How we get there, though, matters. Low may indeed be better, but if we’re lowering our LDL with drugs, then we need to balance the benefit with the risk of pharmaceutical side effects.

There’s a reason we don’t try to drug everyone with statins by putting them in the water. Yes, it would be great if everyone’s cholesterol was lower, but the drugs themselves have countervailing risks. So, doctors aim to use statins at the highest dose possible to achieve the largest LDL cholesterol reduction possible without increasing the risk of muscle damage the drugs may cause. Statins also increase the risk of developing type 2 diabetes. However, when you use healthy lifestyle changes to bring down cholesterol, all you get are the benefits—including a significant drop in diabetes risk. But, can you get your LDL low enough with only your diet?

Ask some of the country’s top cholesterol experts what levels they shoot for, and odds are you’d hear something like an LDL under 70 or so. Just cutting down on the saturated and trans fats found in meat, dairy, and junk, as well as reducing intake of the dietary cholesterol found mostly in eggs, is unlikely to get most people to the target. However, those eating completely plant-based diets can average an LDL that low. It’s no wonder plant-based diets are the only dietary patterns ever proven to reverse the progression of coronary heart disease.

Excerpted from HOW NOT TO AGE: The Scientific Approach to Getting Healthier as You Get Older by Michael Greger. Copyright © 2023 by Michael Greger. Reprinted with permission from Flatiron Books. All rights reserved.

How Not to Age: The Scientific Approach to Getting Healthier as You Get Older 9781250796332_FC-(1)
How Not to Age: The Scientific Approach to Getting Healthier as You Get Older 9781250796332_FC-(1)

Sources:

  • Steinberg D, Blumenthal S, Carleton RA, et al. Lowering blood cholesterol to prevent heart disease: NIH Consensus Development Conference statement. Nutr Rev. 1985;43(9):283-91.

  • Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-72.

  • Roberts WC. It’s the cholesterol, stupid! Am J Cardiol. 2010;106(9):1364-6.

  • Roberts WC. William Clifford Roberts, MD curriculum vitae. http://www.iscvdp.org/docs/WCRoberts-CV.pdf. Accessed May 13, 2022.

  • Roberts WC. Quantitative extent of atherosclerotic plaque in the major epicardial coronary arteries in patients with fatal coronary heart disease, in coronary endarterectomy specimens, in aorta-coronary saphenous venous conduits, and means to prevent the plaques: a review after studying the coronary arteries for 50 years. Am J Cardiol. 2018;121(11):1413-35.

  • Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-72.

  • Fernández-Friera L, Fuster V, López-Melgar B, et al. Normal LDL-cholesterol levels are associated with subclinical atherosclerosis in the absence of risk factors. J Am Coll Cardiol. 2017;70(24):2979-91.

  • Nambi V, Bhatt DL. Primary prevention of atherosclerosis: time to take a selfie? J Am Coll Cardiol. 2017;70(24):2992-4.

  • Hochholzer W, Giugliano RP. Lipid lowering goals: back to nature? Ther Adv Cardiovasc Dis. 2010;4(3):185-91.

  • Fernández-Friera L, Fuster V, López-Melgar B, et al. Normal LDL-cholesterol levels are associated with subclinical atherosclerosis in the absence of risk factors. J Am Coll Cardiol. 2017;70(24):2979-91.

  • Gitin A, Pfeffer MA, Hennekens CH. Editorial commentary: the lower the LDL the better but how and how much? Trends Cardiovasc Med. 2018;28(5):355-6.

  • Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ. 2002;324(7353):1570-6.

  • Hochholzer W, Giugliano RP. Lipid lowering goals: back to nature? Ther Adv Cardiovasc Dis. 2010;4(3):185-91.

  • O’Keefe JH, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dL: lower is better and physiologically normal. J Am Coll Cardiol. 2004;43(11):2142-6.

  • Anderson JW, Konz EC, Jenkins DJ. Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr. 2000;19(5):578-90.

  • Hochholzer W, Giugliano RP. Lipid lowering goals: back to nature? Ther Adv Cardiovasc Dis. 2010;4(3):185-91.

  • Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ. 2002;324(7353):1570-6.

  • Roberts WC. Quantitative extent of atherosclerotic plaque in the major epicardial coronary arteries in patients with fatal coronary heart disease, in coronary endarterectomy specimens, in aorta-coronary saphenous venous conduits, and means to prevent the plaques: a review after studying the coronary arteries for 50 years. Am J Cardiol. 2018;121(11):1413-35.

  • Packard CJ. LDL cholesterol: How low to go? Trends Cardiovasc Med. 2018;28(5):348-54.

  • Packard CJ. LDL cholesterol: How low to go? Trends Cardiovasc Med. 2018;28(5):348-54.

  • Nambi V, Bhatt DL. Primary prevention of atherosclerosis: time to take a selfie? J Am Coll Cardiol. 2017;70(24):2992-4.

  • Hong KN, Fuster V, Rosenson RS, Rosendorff C, Bhatt DL. How low to go with glucose, cholesterol, and blood pressure in primary prevention of CVD. J Am Coll Cardiol. 2017;70(17):2171-85.

  • Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-81.

  • Guber K, Pemmasani G, Malik A, Aronow WS, Yandrapalli S, Frishman WH. Statins and higher diabetes mellitus risk: incidence, proposed mechanisms, and clinical implications. Cardiol Rev. 2021;29(6):314-22.

  • Hong KN, Fuster V, Rosenson RS, Rosendorff C, Bhatt DL. How low to go with glucose, cholesterol, and blood pressure in primary prevention of CVD. J Am Coll Cardiol. 2017;70(17):2171-85.

  • Glenn AJ, Li J, Lo K, et al. The Portfolio Diet and incident type 2 diabetes: findings from the Women’s Health Initiative prospective cohort study. Diabetes Care. 2023;46(1):28-37.

  • Sliding scale for LDL: how low should you go? The target for the safest amount of “bad” cholesterol continues to drift downward. Harv Heart Lett. 2011;21(12):5.

  • How low should your cholesterol go? Even lower may be better. For those at highest risk, very low cholesterol levels may help prevent a second heart attack or stroke. Health News. 2004;10(10):6.

  • De Biase SG, Fernandes SFC, Gianini RJ, Duarte JLG. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol. 2007;88(1):35-9.

  • Kahleova H, Levin S, Barnard ND. Vegetarian dietary patterns and cardiovascular disease. Prog Cardiovasc Dis. 2018;61(1):54-61.

This story was originally featured on Fortune.com

Advertisement