Doctor's Note

Interested in more on cholesterol? Check out these videos:
Cholesterol Crystals May Tear Though Our Artery Lining
Optimal Cholesterol Level
Switching from Beef to Chicken & Fish May Not Lower Cholesterol

And check out my other videos on cholesterol

For more context, see my associated blog post: Stool Size and Breast Cancer Risk.

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  • Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other videos on cholesterol. Also, there are 1,449 other subjects covered in the rest of my videos–please feel free to explore them as well!

    • Toxins

      Dr. Greger, I came across a question asked by my uncle that I did not have the answer too. He said that if cholesterol is too low, then we cannot have proper excretion of hormones and our normal hormone levels will be low. Is there truth to this? If not, what are the studies that dispel this idea.

  • Gio

    This shows that women are better off with high cholesterol:

    • Toxins

      Hello Gio,

      Interesting article, nonetheless, if your suggesting meat is a health food you are mistaken. An analysis of the micro nutrient load shows a rather poor nutrient profile. To focus on one aspect of meat that may be beneficial is not a sensible approach, as one must look at the big picture. Do the pros outweigh the cons? The answer is a resounding no.

    • DrMike

      Yeah, and in that study anyone with a total cholesterol below 200 was considered “low”, and that made up less than @20% of the test subjects.  That “200” or anything close to it still WAY too high, and is not a good current standard for cholesterol, as people with 175 total drop dead from lard clogged arteries all the time.

      • Simon

        so 80’s, people drop dead from oxidised cholesterol, mediated by too much omega 6 plant oil in the diet, and from weak artery walls caused by glycation and calcification, google vitamin K2

        why do our bodies produce saturated animal fat and cholesterol? if stearic acid in cacao is healthy why would stearic acid in lard harm us, plants and animals produce the most saturated fat that will melt at their body temperatures, to reduce oxidative stress.

  • jdevries

    Help! My doctor is so concerned about my low cholesterol levels (24 LDL, 32 HDL, 89 Total), that he wants me to get a liver biopsy because he’s certain something is wrong. I’ve been vegan about 3 years, and a year ago LDL was around 50. I think the drop from 50 to 24 is what he’s concerned about. I know about 9 months ago I started restricting my calories to around 1500 to lose weight, and I’m pretty sure I let my protein intake drop to about 30-40g/day, which is too low (should be 80g; I’m 6’5″, 200 lbs). Can too low of protein intake lead to very low LDL numbers? Should my doctor take a chill pill? Thanks!

    • Toxins

      1500 per day?! Arent you hungry a lot? Most whole foods plant based advocates allow all the food you want as long as it fits under the criteria of low fat whole foods plant based. Our calorie needs satisfy our protein needs so if your going hungry, then your depriving yourself needlessly.

      Perhaps you can show your doctor this study?
      Also, if you eat whole foods plant based, our white cell count in the blood is lower when we are not sick. This is a sign of health but the doctors misinterpret this as cancer because, well, they probably haven’t seen any truly “healthy” person.

      • jdevries

        Was I hungry? Yes, but I was also tired of lugging around an extra 50+ pounds (I weighed 260 last January)! I also didn’t count fruits and veggies against the 1500 calories, i.e. I would eat as much of those as I wanted, without counting their calories.

        I guess my real question was whether a too-restrictive protein intake can lead to lowered cholesterol numbers (by which I really mean if I get my protein intake back up to what it’s supposed to be will the cholesterol numbers come back up a bit?).

      • Hanna

        This is interesting, the white blood cell count being low can be a sign of health. What do you consider too low?
        I also have read and been told that low white blood cell counts often go higher once B12 levels increase.

      • dogulas

        Hey, it’s funny you mention white blood cell count being low for WFPB eaters. I also have a very low cholesterol profile Anyway, my white blood cell count was lower than the recommended range: The doctor thought I might have had a virus or something at the time even though I felt fine. I have yet to get a follow-up test, but I will soon. But where have you heard/read about WBC being lower for WFPB? I know you wrote this 3 years ago…

        • Toxins

          I believe that I got the idea from Dr. Fuhrman who made the claim. My standards for evidence are much higher now then they were in 2011 (when the comment was made). I have gone through a steep learning curve. I found the article that mentioned this.

          “Consistent with these data, those who follow a Nutritarian diet often
          have lower than average white blood cell counts, reflecting appropriate
          levels of systemic inflammation and immune system activation. Lower WBC
          counts are reflective of excellent health and associated with longer
          lifespan.5 As such, those whose healthful eating habits cause WBC counts drop below the normal range should not be alarmed. ”

          Here is the study he used to cite it.

          I have to request full access before I can see past the abstract though. I cannot give you a definitive answer to your question.

          • dogulas

            Interesting. Yeah, my university doesn’t even have access to the full article either. It usually can access these types of publications.
            I guess, according the Dr. Fuhrman, I might just be so healthy that I need fewer white blood cells. Huh. Either that or I have cancer or I had an asymptomatic virus at the time of the test. I feel great, I’m athletic, I have energy all day, and I am thin. I guess I might be okay. Thanks.

          • Toxins

            I can request publications via my university interlibrary loan and get any publication out there. You might have this feature at yours as well. It takes a few days to electronically arrive though.

    • Can you tell me how you’re doing now, 3 years later? I have been WFPB vegan for almost 3 years now and have a cholesterol of 100 mg/dl.

  • DrDons

    Hi Jdevries, Lower cholesterol levels in your blood is a marker for good health unless associated with starvation. Your liver produces cholesterol naturally to meet your bodies needs. A small number of folks have livers that make alot of cholesterol. Beyond your livers production of cholesterol the amount is raised by how much cholesterol you eat(only in animal products) and how much saturated fat you eat(it is converted to cholesterol and is found in animal and plant products). Just a note to say there is alot of saturated fat in the tropical oils. Your cholesterol is also reduced by the amount of fiber you consume(helps pull bile and cholesterol out of your body). The amount of protein in your diet is not a factor in what your cholesterol numbers are unless your protein intake is associated with the above factors. So I wouldn’t try to get your cholesterol numbers up. I would be happy that they are low. You raise the issue of protein requirements. Our body needs 9 essential amino acids(the building blocks of protein). If you are consuming adequate calories you will get enough essential amino acids to meet your requirements. Clinical studies at this time point to consumption of animal protein to adversely effect our kidney function and decrease calcium content in our bones. Animal and epidemiological studies support animal protein as an initiator and promoter of the growth of certain cancer cells. So the consumption of plant based protein seems to be the best recommendation at this point. I would encourage you to read the two articles on protein by Dr. John McDougall. The articles are in his December 2003 and April 2007 newsletters which you can read free on his website. They provide the best concise summary of this complex issue that I have seen.

    • Toxins

      DrDons, I am trying to find a scientific paper stating we do not need dietary cholesterol and that our liver produces all that we need. My uncle seems to think that we need dietary cholesterol for hormone production. Can you clear this up for me and provide me with any scientific literature if you can?

      • Michael Greger M.D.

        You can check out the official Institute of Medicine monograph: “Given the capability of all tissues to synthesize sufficient cholesterol for their metabolic and structural needs, there is no evidence for a biological requirement for dietary cholesterol.”

        • Toxins

          Thanks Dr. Greger. This is exactly what I was looking for.

  • kmcf

    To resurrect this, what do you think of the newer release from the American College of Cardiology?

    • Toxins

       Low LDL may be a marker for cancer in certain scenarios but LDL cholesterol is not cancer protective. These are simply relationships seen with cancer patients. Furthermore, we have no dietary need for cholesterol as recognized by the national academies of science and the FDA.

    • Mike Quinoa

      Are they not referring to omnivores who would be expected to naturally have higher LDL levels? A person on a purely plant-based diet would be expected to naturally have lower LDL levels.

  • N_

    I’ve heard many people say that the body creates less cholesterol when intake is high, so the cholesterol level will balance out.

    • Mike Quinoa

      Doesn’t seem to be. If you read the book “Engine 2” by Rip Esselstyn, there were some formerly-omnivorous firefighters who adopted a purely plant-based diet who had very significant drops in cholesterol.

  • Julie V Savoy

    A naturopathic doctor I have been speaking with told me the following. Can you tell me if it is correct or not please and thank you. I like to have the right information.

    “if your liver is producing enough cholesterol then you do not need to worry about cholesterol. However, I have treated vegans who have developed symptoms that I would attribute to low cholesterol levels. We are just starting to understand how the body carries cholesterol to and from cells in the form of LDL, VDL, and HDL particles. Cholesterol is used by the body to help aid in cell integrity and cell signaling. Cholesterol is also used to make steroid hormones such as, DHEA, Cortisol, testosterone, estrogen and other sex hormones. A low BMI and low fat vegan diet may, over-time, lead to extremely low cholesterol levels. There may be vegan ways to raise cholesterol which might include offering liver support and increasing consumption of healthy fats that the body can use to make cholesterol.”

  • Stevie T.

    I’m assuming you mean that cholesterol can’t be too low……as long as it is not caused by statin usage. Due to a coronary “event” in May resulting in 4 stents being placed, I was put on Lipitor. I told both my cardiologist and internist that I was concerned about statins because I am almost totally vegan. When my lipid levels were re-checked, my LDL came in at 43 (doctor’s target was at or below 70) my total cholesterol was 90 and my HDL 29. My cardiologist promptly had me cut my 80mg Lipitor tablets in half and I’ve been taking 40mg since….to be rechecked in 3 months. Please comment on this.

    • Joe

      I don’t know why the Doctor has you on statins when you are so low. Maybe the statins made them lower? The review will be interesting. I think it’s standard procedure for heart patients because Cholesterol is believed to be the cause. But I don’t think that story is so clear. I think there are other causes and contributing factors, like low vitamin C and lysine. (and possibly proline). Philip Day, in his book health wars, describes heart disease as a ‘slow motion scurvy’ caused by nutritional deficiencies of the 2 amino acids above + vitamin C – which cause damage to the arteries, which is then repaired by cholesterol (which then builds up eventually blocking arteries) (I’m pretty sure it was lysine and proline – you’d have to check).

      I am only a layman in such terms, but Day really makes a good case for further examination. Have you had your lysine levels checked? What kind of diet do you eat? Do you go for whole foods or is it more grain based?

      Also, perhaps its the LDL /HDL ratio that is the problem, and not total cholesterol.

  • Thinkabouddit

    I just came across this article and thought it was relevant to this discussion. I also wonder if it’s true.

    Can total cholesterol be too low?

    As a psychiatrist, I have been quite aware, for more than 40 years, of the serious mental illness dangers associated with low cholesterol. Recent research has shown that there is a much higher association of depression, suicidability, and anxiety with cholesterols less than 159. Several cohort studies on nondepressed subjects have assessed the relationship between plasma cholesterol and depression. A direct relationship was found between low cholesterol and rates of high depression. It became clear among patients with major depression that there was a strong causative association with low cholesterol.

    Gabriel Cousens, MD
    “There Is a Cure for Diabetes”

    • Mike Quinoa

      ” Recent research has shown that there is a much higher association of depression, suicidability, and anxiety with cholesterols less than 159.”

      What kind of diet are these subjects eating? A person on a plant-based diet would naturally, and healthfully, have lower cholesterol levels. The rural Chinese have a TC of about 127. Does this predispose these largely plant-eaters to depression?

      • Thinkabouddit

        I’ve been on a plant based diet for over 40 years. My TC is around 140. I’ve always had some depression and anxiety, but there were so many reasons other than TC. What does Dr. Greger say about Cousins’s article?

  • Derrek

    Dr. Greger, where’s the study for this? I’d like to see it. Also, any other sources of selenium if vegan diet besides brazil nuts? People suggested eating 1 per day.

  • Justin

    My total was 68, ldl was 43, and hdl was 19? Should I be worried? How do I raise my hdl? I eat tons and veggies and exercise a lot.

  • M4TT

    I’ve switched to a whole foods plant based diet for the last 3 months with great results. I’ve lost 25 lbs and was able to lower my LDL from 5.42 mmol/l to 3.26 mmol/l (210 to 126 mg/dl). What I’d like to know is whether or not I can hope/expect it to keep dropping as time goes on? I’m sold on the benefits of eating this way regardless but would like to see things continue to improve.

    • Thea

      M4TT: Congratulations on the progress you have made so far!
      As to your question: I don’t think there is a guarantee, but you have a good chance of continuing your improvement. There are lots of people on this forum who report that they continue to drop weight until they hit their healthy weight. Some people report that they hit plateaus, but are able to eventually get past those plateaus: with some combinations of strategies such as waiting it out, getting rid of “back sliding” (sneaking in the unhealthy foods), and tweaking the diet further to continue to eat lower calorie density.

      Some people report that they hit a plateau and are unable to get past it. But perhaps tweaking their diet to be further down the calorie density scale would help. I can’t know either way.

      Good luck. I hope things keep going in a good direction for you.