How Low Should You Go for Ideal Cholesterol Levels?

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Having a so-called normal cholesterol in a society where it’s normal to drop dead of a heart attack isn’t necessarily a good thing.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Intro: LDL cholesterol is a prime factor for the #1 killer of men and women—heart disease. But how low should you go? Watch the video to find out.

Consistent evidence from a variety of sources unequivocally establishes that bad LDL cholesterol causes atherosclerotic cardiovascular disease, strokes, and heart attacks—our leading cause of death. This evidence base includes hundreds of studies involving millions of people. Cholesterol is the cause of atherosclerosis, the hardening of the arteries. The message is loud and clear. “It’s the Cholesterol, Stupid!” noted the editor of the American Journal of Cardiology, William Clifford Roberts, whose CV is more than 100 pages long, having published about 1,700 articles in peer-reviewed medical literature. Yes, there are at least 10 traditional risk factors for atherosclerosis. But, as Dr. Roberts noted, only one is required for the progression of the disease—elevated cholesterol.

“Phew!” you say, because you just got back from your doctor, and your cholesterol’s normal. Thank goodness. But wait . . .having a normal cholesterol in a society where it’s normal to drop dead of a heart attack isn’t necessarily a good thing. With heart disease, the #1 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 current laboratory standards, but optimal for human health.

Normal LDL cholesterol levels are associated with the hidden buildup 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 get a gold star and a lollipop. But if your doctor used ultrasound and CT scans to actually peek inside your body, overt atherosclerotic plaques would be detected in 38 percent of people with those kinds of “optimal” numbers. Maybe those ain’t so optimal after all.

Maybe we should define an LDL cholesterol level as optimal only when it no longer causes disease. What a concept! When more than a thousand men and women in their 40s were scanned, having an LDL level under 130—which most lab tests would consider a normal LDL—left them with atherosclerosis throughout their body. Atherosclerotic plaques were not found only with LDL down around 50 or 60, which just so happens to be the level most people had before we all started eating this way. The majority of the adult population of the world had LDLs of about 50 mg—so that’s the true normal. Present average values should not be regarded as “normal.” We don’t want to have a normal cholesterol based on a sick society; we want a cholesterol normal for the human species, which may be down around 30-70 mg/dl (which for those who live outside of the U.S. is an LDL of .8 to 1.8 millimoles per liter).

Although an LDL level of 50 to 70 mg/dl seems excessively low by modern American standards, it is precisely the normal range for individuals living the lifestyle and eating the diet for which we were genetically adapted over millions of years: a diet centered around whole plant foods. No wonder we have this killer epidemic of atherosclerosis, given the LDL level our bodies were designed for is less than half of what we we presently consider “normal.”

There is an inappropriate tendency in medicine to accept small changes in risk factors, but the goal is not to just decrease risk, but to prevent plaques, period. So, how low should you go? 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 do you go?’ is, arguably, a straightforward “As low as you can!” But yes, lower may indeed be better.

However, if you’re going to do it with drugs, then you have to balance that with the risk of drug side effects. The reason we don’t just drug everyone with statins, like put it in the water supply, is that although it would be great if everyone’s cholesterol was lower, there are the countervailing risks of the drugs. So, doctors aim to use statin drugs at the highest dose possible, achieving the largest LDL cholesterol reduction possible without increasing risk of the muscle damage the drugs may cause.

But when you’re using lifestyle changes to bring down your cholesterol,  all you get are the benefits. But can you get it low enough with diet alone? Ask some of the country’s top cholesterol experts what they shoot for, and odds are you’ll hear something like an LDL under 70 or so. Yeah, we should try to avoid the saturated and trans fats found in junk foods and meat, and the dietary cholesterol found mostly in eggs, but “It is unlikely anyone can achieve an LDL cholesterol level of 70 mg/dl with a low-saturated fat, low-cholesterol diet alone.”

Many doctors have this mistaken impression. An LDL of 70 isn’t only possible on a healthy enough diet—it may be normal. Those eating strictly plant-based diets can average an LDL that low. No wonder plant-based diets are the only dietary patterns ever proven to reverse coronary heart disease in a majority of patients.

And the side effects? You get to feel better too! Several randomized clinical trials have demonstrated that more plant-based dietary patterns significantly improve psychological well-being and quality of life: less depression, less anxiety, better emotional well-being, better physical well-being, and better general health.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Intro: LDL cholesterol is a prime factor for the #1 killer of men and women—heart disease. But how low should you go? Watch the video to find out.

Consistent evidence from a variety of sources unequivocally establishes that bad LDL cholesterol causes atherosclerotic cardiovascular disease, strokes, and heart attacks—our leading cause of death. This evidence base includes hundreds of studies involving millions of people. Cholesterol is the cause of atherosclerosis, the hardening of the arteries. The message is loud and clear. “It’s the Cholesterol, Stupid!” noted the editor of the American Journal of Cardiology, William Clifford Roberts, whose CV is more than 100 pages long, having published about 1,700 articles in peer-reviewed medical literature. Yes, there are at least 10 traditional risk factors for atherosclerosis. But, as Dr. Roberts noted, only one is required for the progression of the disease—elevated cholesterol.

“Phew!” you say, because you just got back from your doctor, and your cholesterol’s normal. Thank goodness. But wait . . .having a normal cholesterol in a society where it’s normal to drop dead of a heart attack isn’t necessarily a good thing. With heart disease, the #1 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 current laboratory standards, but optimal for human health.

Normal LDL cholesterol levels are associated with the hidden buildup 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 get a gold star and a lollipop. But if your doctor used ultrasound and CT scans to actually peek inside your body, overt atherosclerotic plaques would be detected in 38 percent of people with those kinds of “optimal” numbers. Maybe those ain’t so optimal after all.

Maybe we should define an LDL cholesterol level as optimal only when it no longer causes disease. What a concept! When more than a thousand men and women in their 40s were scanned, having an LDL level under 130—which most lab tests would consider a normal LDL—left them with atherosclerosis throughout their body. Atherosclerotic plaques were not found only with LDL down around 50 or 60, which just so happens to be the level most people had before we all started eating this way. The majority of the adult population of the world had LDLs of about 50 mg—so that’s the true normal. Present average values should not be regarded as “normal.” We don’t want to have a normal cholesterol based on a sick society; we want a cholesterol normal for the human species, which may be down around 30-70 mg/dl (which for those who live outside of the U.S. is an LDL of .8 to 1.8 millimoles per liter).

Although an LDL level of 50 to 70 mg/dl seems excessively low by modern American standards, it is precisely the normal range for individuals living the lifestyle and eating the diet for which we were genetically adapted over millions of years: a diet centered around whole plant foods. No wonder we have this killer epidemic of atherosclerosis, given the LDL level our bodies were designed for is less than half of what we we presently consider “normal.”

There is an inappropriate tendency in medicine to accept small changes in risk factors, but the goal is not to just decrease risk, but to prevent plaques, period. So, how low should you go? 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 do you go?’ is, arguably, a straightforward “As low as you can!” But yes, lower may indeed be better.

However, if you’re going to do it with drugs, then you have to balance that with the risk of drug side effects. The reason we don’t just drug everyone with statins, like put it in the water supply, is that although it would be great if everyone’s cholesterol was lower, there are the countervailing risks of the drugs. So, doctors aim to use statin drugs at the highest dose possible, achieving the largest LDL cholesterol reduction possible without increasing risk of the muscle damage the drugs may cause.

But when you’re using lifestyle changes to bring down your cholesterol,  all you get are the benefits. But can you get it low enough with diet alone? Ask some of the country’s top cholesterol experts what they shoot for, and odds are you’ll hear something like an LDL under 70 or so. Yeah, we should try to avoid the saturated and trans fats found in junk foods and meat, and the dietary cholesterol found mostly in eggs, but “It is unlikely anyone can achieve an LDL cholesterol level of 70 mg/dl with a low-saturated fat, low-cholesterol diet alone.”

Many doctors have this mistaken impression. An LDL of 70 isn’t only possible on a healthy enough diet—it may be normal. Those eating strictly plant-based diets can average an LDL that low. No wonder plant-based diets are the only dietary patterns ever proven to reverse coronary heart disease in a majority of patients.

And the side effects? You get to feel better too! Several randomized clinical trials have demonstrated that more plant-based dietary patterns significantly improve psychological well-being and quality of life: less depression, less anxiety, better emotional well-being, better physical well-being, and better general health.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avo Media

Doctor's Note

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