Five Reasons Why You Don’t Want Your Cholesterol Level To Get Too Low

Friday Sep 12 | BY |
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Heart Disease

Is cholesterol the enemy of heart health? Can our levels get too low?

It takes a gigantic shift in thinking to turn the idea of a bad molecule into a good one, but sometimes it’s worth the effort. In this case, you’re life might depend on it.

Could the supposed villain of cardiovascular disease become an ally in our times? Probably not, but as it turns out, high cholesterol alone is not the archenemy. It’s more complicated then just getting your cholesterol level down, and going too low may pose another set of problems.

As it often turns out, there’s more to the story. Let’s take a look at why you don’t want your cholesterol level to get too low.

Cholesterol 1

“Bad” Cholesterol

Eat less shrimp and skip the lobster. No more eggs. Shop for “fat free” chips. (Is there even such a thing?) From the 1970s to recently, all cholesterol was deemed bad, and too much was really bad for you. People avoided high cholesterol foods and statin drugs became an eight billion dollar business. As a nation, our average cholesterol level went down a little, but the incidence of fatal cardiovascular events went up.

As research statistics came in, doctors cheered the lower levels but were amazed at another statistic: at least 50 percent of people who experienced a heart attack had normal cholesterol levels. What was wrong with this picture?

We gradually learned that there are two kinds of cholesterol. LDL was considered the “bad” one, and HDL the “good” one. Now we know that there are many types of LDL and HDL cholesterol particles, and that inflammatory changes in blood vessels play a greater role in cardiovascular disease than just lipids. The simplistic notion of high cholesterol as the sole cause of our cardiovascular disease epidemic is an example of wrong thinking that misguided a generation of doctors and their patients. But besides inadequate science and wrong clinical thinking, people went off track with their diets.

Replacing Fat with Sugar

What was really wrong about all this was our idea about the benefits of a fat-free diet. Not only did eliminating fats lower an important energy source in our diet, but the American diet was very low on the right kind of fats and oils. Without enough omega-3 fatty acids, for example—fats mostly found in fish oil but also in many whole grains, seeds, and nuts—our risk for heart disease rocketed.

Most Americans replaced dietary fats with sugary foods. Now we realize that the liver doesn’t know what to do with all the extra sugar so converts it to LDL and triglycerides. The fat-free, high sugar diet was killing more people than ever.

Then, doctors thought it must be the “bad” LDL causing heart disease, and since statins lower LDL, they kept prescribing drugs. But their patients still had heart attacks even though their LDL levels went down. The answer was more and better statins.

Yet more than a dozen studies have shown that healthy people with no history of heart disease get zero cardiovascular benefit from taking statins, even though it might lower their LDL level on a blood test.

Cholesterol 2

Health consciousness Americans took matters in to their own hands and went after the LDL without drugs. They cut out meat and dairy products, and eliminated sugar and refined wheat products like white bread and pasta. Some went gluten-free. Many became vegetarians, and some even tried veganism and raw foods. Within months, their LDL levels dropped.

Doctor’s were figuring it out too. In Prevent and Reverse Heart Disease, Caldwell Esselstyn, M.D., of the Cleveland Clinic, wrote that you could drop your cholesterol and LDL levels within a few months with a vegan diet, and keep it down permanently by eating a plant-based diet. My personal and clinical experience confirms these results.

But what if your cholesterol level drops too much?

Life Essential Cholesterol

Cholesterol is not inherently bad. You need some, because it’s essential for life. Without enough cholesterol your body cannot fully function. In fact, it’s so important that some of the cholesterol your liver excretes is recycled by the small intestine. Every last drop counts.

Without cholesterol, your body cannot make many important hormones like testosterone and estrogen, and adrenal gland hormones. All animals use cholesterol as a structural component for cell membranes. It keeps cells fluid and easily mobile. Cholesterol supports chemical communication networks between cells. The liver uses it to make bile that help to digest food. It even has an antioxidant role in the body.

The brain is the most cholesterol-rich organ in the body. It requires enough cholesterol every day to function. A genetic condition called Smith-Lemli-Opitz Syndrome (SLOS) that causes very low cholesterol levels has also been linked to autism.

Five Main Functions of Cholesterol:

  1. Builds and maintains cell membranes
  2. Makes up bile acids that help digestion
  3. Used to build steroid hormones like estrogen and testosterone
  4. Necessary for the structure and integrity of the brain
  5. Helps make vitamin D
When Cholesterol Goes Too Low

Low cholesterol is associated with hyperthyroidism, adrenal insufficiency, liver disease, malabsorption, autism, and some cancers. Doctors know that extremely low cholesterol is a sign of severe deterioration of health. From my clinical experience, if my patients’ cholesterol levels go too low, their hormone levels drop, thinking gets fuzzy, and they’re tired all the time. What’s too low?

Total cholesterol levels above 200 mg/dL are associated with increased risk for cardiovascular disease. In my clinical experience, patients with levels between 145 and 165 have very low risk of heart disease, and those as low as 135 to 145, have no incidence. Going lower does not further reduce your risk—how can you get better than zero risk?

LDL levels above 100 are associated with increased risk for cardiovascular disease. Desirable LDL cholesterol levels are between 70 and 80. This is an approximate number. There are individual variations, and some people without cardiovascular disease have much higher LDL levels. However, recent research and my clinical experience inform us that people with levels in approximately the 70 – 80 range are unlikely to have cardiovascular disease. Would even lower be better?

Heart disease remains the number-one killer of American men and women. But, this is very odd, because in traditional cultures heart disease is so rare that instead of number one on the death list, it’s at the bottom. Even in America, at the beginning of the twentieth century, heart attacks were uncommon.

Medical anthropologists found that our hunter-gatherer ancestors likely had LDL levels between 50 to 70 mg/dL. Indigenous groups like the Maasai and Inuit also have low LDL levels. Heart attacks among these people are non-existent. What would a paleo range work for modern people?

Strict vegetarians can also have LDL levels in this range. Some of my raw food vegan patients have LDL levels as low as 35 and total cholesterol levels below 100.

It’s hard to know what is too low, but if your LDL is below 65 mg/dL, your body may not function optimally. You probably won’t have symptoms, or those that you experience might get associated with other conditions like chronic fatigue syndrome. If your LDL levels are lower than 35 mg/dL, your brain might not fully function. Your energy could drop, you may feel depressed, and your behavior could be altered because low cholesterol has been associated with reduced serotonin activity in the brain. You may not be able to use sunlight to make vitamin D. Your body will not be able to make enough steroid hormones, including adrenal hormones.

The Dangers of Too Low Cholesterol and LDL:

  • Low vitamin D
  • Fatigue
  • Reduced libido
  • Mood changes
  • Memory loss
  • Increased risk for neurodegenerative disease
The Goldilocks Zone

Is there a total cholesterol and LDL number that is just right? Since so many factors are involved in health, searching for a perfect number for lipid levels might prove futile. However, you might discover your own personal “Goldilocks Zone”—a range for cholesterol and LDL that is just right for you.

It’s time we seized a new vision about cholesterol because of it’s life giving—and, life take away—value. Remember, cholesterol is life’s friend, not the enemy.

Dr. J. E. Williams


Dr. Williams is a pioneer in integrative and functional medicine, the author of six books, and a practicing clinician with over 100,000 patient visits. His areas of interest include longevity and viral immunity. Formerly from San Diego, he now resides in Sarasota, Florida and practices at the Florida Integrative Medical Center. He teaches at NOVA Southeastern University and Emperor’s College of Oriental Medicine.

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  1. June Hanson says:

    Your Cardio patient thanks you, for straightening out my mind on correct numbers. In 2009 had heart attack, normal cholesterol, due to inflammation in coronary arteries., No damage, terrible angina. That is, until I met you. followed your program of eating healthy veggies, protein, supplements, balancing stress, exercise, good therapy, that I, amaze, other doctors, I am wondering, if high HDL counteracts a little high total or LDL? How can a perfect food as an egg from from a free range chicken, be so unhealthy? Unless, you smear it with greasy bacon! Fix it with healthy veggies, topped with salsa on sprouted corn tortilla, you have a great breakfast, fit for a king.


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