Can Your Cholesterol Be Too Low? Challenging the Paleo View on Cholesterol

Wednesday Jan 14, 2015 | BY |
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Some people, when they follow a low-fat vegan diet or a RAW diet, come back with interesting blood test results, with cholesterol levels so low that their doctor is puzzled and even worried. They’ve just never seen any patient with levels that low.

I’m talking about levels way below 150 mg/dl. For example, as low as 120 mg/dl, and sometimes lower.

Are low cholesterol levels a good thing or a bad thing? Many paleo authors claim that low cholesterol leads to depression and other health problems. Yet, hunter gatherer, the healthiest cultures around the world, most mammals, and even human infants have low cholesterol levels. What’s going on here?

When I started looking at this a few years ago, I had an open mind and wanted to find out the truth. Were the vegans right? Were the paleo folks right? What would be the right approach when it comes to preventing heart disease, and consuming animal products?

I was prompted to get down to the bottom of this issue when my dad died of a heart attack, and my own cholesterol readings did not put me in the healthiest range according to the vegan doctors.

The “contrarian” thing to say would be that cholesterol has nothing to do with heart disease, and in fact prevents heart disease (such a claim is made by the Weston Price Foundation).

weston

But here’s the danger in this view…

What if they’re wrong?

TRUTH: Heart disease can be caused by a number of factors, but elevated LDL levels is the most important factor of all.

TRUTH: It’s almost impossible to develop atherosclerosis if one smokes, has hypertension, and doesn’t exercise… as long as LDL levels are under 80 mg/dl (some people say 70 mg/dl).

What’s Unique About LDL Cholesterol and Heart Disease

There are many causes to heart disease, but only one main factor that alone is sufficient to cause it. This factor is elevated LDL levels. Some quotes:

“There are many risk factors to cardiovascular disease but elevated cholesterol levels alone are enough to drive the disease.”1

“Among the many genetic and environmental risk factors that have been identified by epidemiological studies, elevated levels of serum cholesterol are probably unique in being sufficient to drive the development of atherosclerosis in humans and experimental animals, even in the absence of other known risk factors. In humans, the majority of serum cholesterol is carried by LDL particles.”2

“In contrast to feeding cholesterol and/or saturated fat, it is not possible to produce atherosclerotic plaques in herbivores by raising the blood pressure chronically, by blowing cigarette smoke in their faces for their entire lifetimes, or by somehow raising the blood glucose levels without simultaneously feeding them an atherogenic diet.”3

William C. Roberts.

You’ve just heard what scientists say on the topic. Let’s hear from the Weston Price Foundation on what apparently causes heart disease…

weston2

What Happens to People With Naturally High or Low Cholesterol

To try to make sense of this debate, let’s take a look at a unique piece of evidence.  Some people are affected by by a rare genetic disorder: they produce usually high or low cholesterol levels.

People with familial hypercholesterolemia have very high cholesterol levels and have to be treated with medications.

If you’re less lucky even (1 in a million chance), you can be affected by familial hypercholesterolemia in both chromosomes

On the other hand, another genetic anomaly is hypocholesterolemia, which is just the opposite: abnormally low levels of blood cholesterol.

What happens to those people?

People with familial hypercholesterolemia in both chromosomes can die of heart disease in their 20s, with no other risk factor involved.4

People withhypocholesterolemia tend to live longer than their peers because this defect protects them from heart disease.

How does the Weston Price Foundation explain this?

How Much Cholesterol do we Need?

cholesterol

The Weston Price Foundation talks about the importance of cholesterol. They are absolutely right: cholesterol, produced by our own bodies, is essential to health. But the question is… how much do we actually need?

What we need is in the range of 25-60 mg/dl for LDL, and total cholesterol of 110 to 150 mg. 6

FACTS: 

  • Other mammals without heart disease have LDL generally less than 80 mg/dl.
  • LDL level in newborn humans is around 30 mg/dl
  • Infants have total cholesterol levels of 50-90 mg. 10
  • In humans raised on a low-fat diet, LDL stays around 50 to 80 mg/dl.
  • LDL of 100 mg/dl and above is customary in rich societies with high intakes of animal foods.7

Official Recommendations (Mayo Clinic) for LDL Cholesterol:

  • Below 70 mg for people at very high risk of heart disease
  • Below 100 mg for people at risk of heart disease

People claim that cholesterol is necessary for the body to perform essential functions. That is true, but the amount we need is very low. Other mammals have LDL levels well below 42 mg/DL and do just fine.

What are Ideal Cholesterol Levels?

Ok, so now we know what’s the minimum amount of cholesterol we need. But what’s optimal? Let me give you the answer, and then I’ll show you the evidence.

Optimal for LDL seem to be 50 to 70 mg/dl. Lower is generally better and physiologically normal.

FACT:  Loren Cordain, promoter of the paleo diet, says that optimal levels of LDL should be between 50 and 80 mg/dl. (I found an interesting study he co-authored that I will reference below.)

FACT:  Hunter-gatherers have low cholesterol, generally about 70 to 140 mgl/dl (35-70 mgl of LDL).

FACT: Wild primates have total cholesterol levels below 120 mg/dl

chart

“Cholesterol is an essential component of the cell membrane and an obligate precursor for bile acid, steroid hormone, and vitamin D synthesis. (…) Although individuals with serious chronic illnesses, such as cancer, often develop depressed LDL levels as a result of malnutrition, epidemiological studies show that people with naturally low LDL levels are associated with improved longevity.” 15

Why do Hunter-Gatherers Have Low Cholesterol Levels?

It’s a bit of a paradox that societies with a relatively high intake of animal products have low cholesterol levels, while people following a paleo diet nowadays have a high cholesterol level.

It seems to be that parasites could eat up excess cholesterol, and parasitic infections are common in those societies. 17

Even malaria (parasites) lowers cholesterol.

Also, a number of diseases cause cholesterol to be lower. So, that’s why people have lower cholesterol at the end of their lives.

Sometimes, this is why low cholesterol levels are associated with some diseases. The low cholesterol is a consequence of the disease… not likely a cause! 

For the hunter-gatherer societies, other explanations include food scarcity and genetic adaptation.

Conclusions

weston-unwise

I tried to keep this article short and to the point, but it still took me dozens of hours to research! I started out with an open mind. My conclusions are simple:

If you’re at a high risk for heart disease, you should aim at LDL levels of 80 mg/dl or less.

If you exercise and do all of the right things, then youroverall risk of heart disease is lower, because some of these things will prevent the disease (in part).

But I still think looking at LDL levels or total cholesterol is a good idea. About 25% of heart attacks occur in people in the cholesterol range considered “normal…”

Finally, I can only conclude that the Weston Price Foundation is leading a misinformation campaign with their ideas on cholesterol, among other things…

—-

1 SOURCE: (Arteriosclerosis, Thrombosis and Vascular Biology. 1987:7:612-619 – “Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake”)

2, 3 SOURCE: (Cell, Vol. 104, 503-516, February 23, 2001 Christopher K. Glass and Joseph L. Witztum Specialized Center of Research on Molecular Medicine and Atherosclerosis Other source: book called “Nutritional and Metabolic Bases of Cardiovascular Disease”)

4 Source: (Familial hyperalaphalipoproteinamia J Lab Clin Med, 1976, Dc,88(6)-941-57)

5 Source: (The Johns Hopkins Textbook of Dyslipidemia) – Peter O. Kwiterovich, Jr., MD)

6, 7 Source: (“A Receptor-Mediated Pathway for Cholesterol Homeostasis” – Nobel Lecture, 9 December, 1985 by Michael S. Brown and Joseph L Goldstein)

8, 9 SOURCE: (“Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia” – Circulation, 2008; 118:672-677)

10 SOURCE: (Serum Cholesterol Concentration in New-Born African and European Infants and Their Mothers) – American Journal of Clinical Nutrition, Vl 4, No. 8, 1962)

11-16 SOURCE: (James H O’Keefe, MD*; Loren Cordain, PhD†; William H Harris, PhD*; Richard M Moe, MD, PhD*; Robert Vogel, MD‡ J Am Coll Cardiol. 2004;43(11):2142-2146. doi:10.1016/j.jacc.2004.03.046 http://content.onlinejacc.org/article.aspx?articleid=1135650)

17 SOURCE: (“Role of cholesterol in parasitic infections” – Lipids in health and disease 2005,4:10)

Note: thanks to PlantPositive for inspiring this article.

Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.

Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.

17 COMMENTS ON THIS POST

Comments are closed for this post.

  1. Diane Fowler says:

    I’m really disappointed in your article. You seem to be using the terms ‘cholesterol’ and ‘lipoprotein’ as if they are the same, when your research should have shown you they are not. Cholesterol is the carrier for lipoproteins of all types, and it is the type of lipoprotein that affects risk factors. You are focusing on the bus when you should be concentrating on the passengers in the bus.
    You also have not even mentioned the different densities of lipoprotein, and the ratios between high, low and very low lipoprotein. These are important.
    You seem to have interchangeably used ‘LDL’ and ‘total cholesterol’ .
    As a result have not shed one scrap of real light on a very complex topic.

    • Diane, I’m sorry you didn’t like the article. Of course the topic is big enough for an entire book. I used total cholesterol and LDL depending on the area of research. My point was simply that: LDL levels do matter. Although other theories may explain this complex disease, LDL levels are still the best way to evaluate risks of heart disease.

  2. Chris says:

    Hey Fred, the average Americans total cholesterol is 200.
    Curious where the 940 figure in your chart came from?

  3. mary kay says:

    I don’t understand the “Total Cholesterol” numbers: Avg American: 940 ??????

    Can you explain this? I’m an American –can this be somehow in the metric system? Might be a dumb question, but I’m serious. Mine is always in the “low normal” range around 165 – 170…..

    Thanks for researching all of this. My doctor looked at the LDL. What you didn’t mention was that there are a couple types of LDL as well…..

  4. mary kay says:

    Oh…one other thing: I remember an article by Kevin where he was told his cholesterol was too low…I can’t remember what it was, but I do remember it was less than 170 and that at that time, he had the testosterone of a 70 year-old…..

  5. Deborah says:

    My husband was diagnosed with celiac disease three years ago as a consequence of our daughter’s diagnosis. For years doctors have been congratulating him for his low weight and low cholesterol levels. Low cholesterol is a symptom of celiac disease as the area of the small intestine most damaged by gluten is where many nutrients including B12 are uptaken.

  6. Jackie says:

    The LDL particle size and number are the important things, not merely just LDL. Also, what about the French people in France, who eat more saturated fat and cholesterol but have less heart disease? Have you looked at Chris Masterjohn’s work? He’s one of the world’s leading expert on cholesterol. I would encourage you to have an open mind and read a lot of his valuable work. http://blog.cholesterol-and-health.com/
    and also http://www.cholesterol-and-health.com/Vegetarianism.html
    http://chriskresser.com/chris-masterjohn-on-cholesterol-and-heart-disease-part-3

  7. Nina says:

    I do believe this issue is more than a little confusing and I would like to get to the truth as much as the next American. I have to refute your claim that hypocholesterolemia is “protective” since a friend of mine with that condition died of a massive heart attack at the ripe age of 31. I have also read about studies showing longer life spans for women after menopause with slightly elevated (above 200) cholesterol levels. Didn’t the Framingham study, the largest and longest study on heart disease to date, also show that? Maybe the scary elevated levels have more to do with stress. If stress depresses adrenals, and adrenals need cholesterol to help with steroid hormone production, it could signal to the body the need for higher levels. That sounds very American to me!

  8. Sally says:

    Ok, so here are my thoughts and story around this issue. I am a healthy 58 yr old female.. Baby boomer. Irish (celtic) maternal grandparents who came from a beef/dairy (raw ) eating country but probably not alot of food…Father’s parents Canadian (English/Nova Scotia) paternal grandmother died young from heart disease/angina (but note, she also smoked and ate alot of starch/sweets etc).. No heart disease in Mothers family at all..My 3 oldest relatives on Mothers side (her sister and 2 brothers) alive, healthy and NO heart disease or other problems. ( 88, 87 & 86!!).No meds for HBP etc…And the drum roll please…….EXTREMELY LOW CHOLESTEROL!!! I imagine that is where I get my current # (last checked 10 years ago @ 109 total cholesterol)…The first time I ever had it checked the machine couldn’t record it because it could not record #’s under 100!!!! I had just come off of a week of binging eating tons of chocolate (my kids Halloween candy)…so the part of this article that talks about genetics etc. makes sense to me.. You know the saying ” One man’s meat is another man’s poison”!!! I believe there is alot of truth to that saying. Also the natural temperament of my mothers family is VERY chill..My mother once said of me, “That one doesn’t have a nerve in her body”.. As a former Colon Hydrotherapist, and a Massage Therapist of 24 years, I have noticed a pattern between peoples personalities and temperaments and types of illness for sure. Examples would be the highly stressed quick to anger types for sure being a sure bet for earlier than hoped for heart attacks, strokes etc.. Then there is my Dad, who outlived my Irish Mom, high cholesterol, HBP (only after his 1st Dr’s appt @ 67 yrs old..after entrance into Navy @ 16!!) He drank, laughed alot, ate meat potatoes, LOTS of candy, and very bad family history..I’m convinced his easy going loving very NON COMPETITIVE nature (laughed ALOT), not gay, but NOT a macho tough guy…a real lover if there ever was one..was the key to his longevity..He said a few years before he died “Sally, If I’d have know I would have lived this long I would have taken better care of myself”. So truly, being in tune with one’s body, trying to eat never to fullness and living each day to the fullest as happy and peacefilled as possible will (imho) do more for ones health and longevity than all this focus (I’ve been the guiltiest of this for years///water fasting..food fanatic etc) on stats etc..Just my take in the moment..

  9. Rebecca Cody says:

    I think hunter-gatherers have lower cholesterol because they eat more of what they gather than what they hunt.

    A couple of years ago I read a book written by a woman who grew up with a hunter-gatherer tribe that was one of the last known at the time (1950s) in Africa. Her parents were anthropologists, so they lived with these people for many years. She commented that, while they loved the meat the men brought home, and had a feast when hunting was successful, their daily diet largely consisted of leaves, berries, seeds, fruits and roots the women gathered and dug. Meat was a treat – party food – not daily fare. Sorry I can’t remember the name of the book!

  10. Shotofhealth says:

    Thanks again for an interesting article Frederic. I have a question on the natural elevation of cholesterol as we age. Apparently for women it is quite normal, especially with approaching menopause?

    Also, what about other factors which should be read in conjunction with the cholesterol profile? Homocysteine, HSCRP and VLDL? I’ve also read widely on this subject and came to the conclusion that it is far too simplistic to just look at cholesterol in isolation as a factor involved in cardiovascular disease.

    • Thanks for your comments! I would like to see some research regarding cholesterol levels with AGE in Hunter-Gatherers, animals or long-lived cultures. Sadly the research only shows a total cholesterol profile for the average individual in those groups.

      I think it’s just about keeping things in perspective. There are many causes to CHD and many contributing factors. The purpose of this article was simply to challenge the paleo view of some diet authors who say LDL levels don’t matter…

      • Shotofhealth says:

        I agree with you that the Paleo argument that LDL doesn’t matter is far too simplistic as well. Have you heard of Prof Tim Noakes in South Africa (which is where I am)? He’s hotly pursuing the “Banting” diet which is essentially an extreme Paleo which they are calling Low Carb/High Fat. It’s incredible how many people are jumping on this crazy bandwagon! It’s because it’s easy and people can ‘cheat’ and eat as much meat and fat as they like (well, they think they can).

        One thing that many people here don’t realise is that Noakes is a diabetic on GLUCOPHAGE and cannot control his blood sugars! He took up this diet over two years ago when he was pre-diabetic in order to avoid full-blown diabetes, which he now has. I have loads of information on this if you are interested. It’s yet another example of how people (sheeple) follow the leader without any notion of who the leader really is.

        South Africans are noted for their high consumption of red meat (most notably in the Afrikaaner nation, not so much the African tribes) so it’s like music to their ears. Many Afrikaaners (which are the caucasian group originally from the Netherlands/Holland) have familial hypercholesterolemia and there is no doubt that this creates a foundation for heart disease. So for them, their cholesterol profile is extremely significant and important. But I firmly believe that this subject requires a totally unbiased analysis in order to reach a sensible conclusion. Too many people are defending their own territories, which is why I enjoyed your article because I do not believe you are so staunch in one set of beliefs. Personally I eat mainly a raw, plant-based diet with lots of fruit and vegetables with a little fish now and again. Although I don’t eat meat anymore (for five years now), I don’t hassle others not to eat meat. I just say that they must source meat that is free-range with no anti-biotics, growth hormones etc.

  11. Hi Frederick, very interesting article. I appreciate your thorough research and your willingness to directly address the damaging and scientifically-unfounded claims of organizations like the WAPF.

    As far as cholesterol being too low? Well, all I can say is that from personal experience, I know that it can be an issue for people. It happened to me and it was one of the most difficult experiences of my life. I wrote about it here if you’re interested in reading: Facing Failing Health As A Vegan

    I definitely think this is something that the vegan, paleo, and entire wellness community needs to continue looking into. Thanks for keeping us honest!

    cheers,
    ~Sayward

  12. Joe says:

    Nice article – and it’s nice to see that the Paleo / WAPF perspective is being challenged.

    Not that we are looking for a winner here, but I think they are often careless about cholesterol in order to justify a high animal foods diet. When the objective is defined, it’s easy to make the boot fit.

    Of course, we all know cholesterol is essential – but I get worried when groups like that go around saying it literally has no bearing on heart disease, and levels of 300 + are fine. The majority if research says otherwise.

    It is very fashionable to say that butter is back on the menu, but when someone has levels of 200 or 300 I would have to say that even if cholesterol is not the bad guy, those high levels indicate some serious damage going on inside the body somewhere, which cholesterol is patching up.

    And perhaps that is my final point: I don’t believe cholesterol is the bad guy – is the great rebuilder – but I do believe it is a good indicator of internal damage for this reason. Like the firefighters at the scene of a fire – not the cause, but definitely a cause for concern if there are lots of them running round a burning bulding!

  13. Joe says:

    In response to whether Cholesterol can be too low: I think it has to depend on why it is too low.

    – It could be because you are healthy and efficient, and are producing all the hormones and cell material you need from a small amount.

    – Or – it could be that you really need more, but your body doesn’t have the building blocks to produce more.

    In both cases, the actual number could be the same – but in the second case, the person could be quite ill, while the first could be perfectly healthy.

    It is worth noting also that cancer cells consume a lot of cholesterol. It is quite clear that in this case, a low value would not be so desirable!

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