Normal Cholesterol

“Normal” blood cholesterol levels in Australia are not normal or supportive of good health. These “normal” levels result in an enormous burden of heart disease and a population in which almost everyone has artery disease by age 65. The national goal of less than 5.5 mmol/l is well up into the zone in which artery disease develops. The medical profession knows this and the official safe level for cholesterol following a heart attack is less than 3.8 approximately (the target being LDL<1.8). So, we have the situation where you can be reassured by your doctor that your cholesterol level of 5 is OK, suffer a heart attack later that day, and be told the next morning that your cholesterol needs to be less than 4 to prevent further heart attacks (which they think can only be achieved with statins). A whole foods plant based diet can lower your cholesterol to a safe level without the inconvenience of having to have a heart attack first.

Humans have a similar cholesterol metabolism to herbivores. This is an observation rather than an argument for or against eating meat. It is easy to experimentally induce artery disease in herbivores: you just replace some of their usual fibrous unprocessed plant foods with some saturated fat and cholesterol.

It is well established that there are multiple risk factors for heart (artery) disease including obesity, inactivity, family history and diabetes to name just a few. Blood cholesterol often gets buried among these, even in education aimed at doctors. Statistical analyses often underestimate the contribution of high cholesterol to heart disease because they choose a cut off point for normal vs high cholesterol that is way above the safe level of less than 4. Therefore all of the heart disease that occurs in those with cholesterol levels of 4.0 to 5.5 (or sometimes even higher) are considered to have been caused by risk factors other than high cholesterol. It has recently been proposed by leading cardiovascular expert Prof Roberts (see Eliminating the #1 Cause of Death ) that there is only one risk factor for heart disease – high blood cholesterol. The other risk factors only come into effect when cholesterol is elevated above 3.8.

A lean fit person with ”normal” cholesterol can still develop heart disease, and conversely, heart disease rarely occurs in people with very low cholesterol levels even if they are not very fit. There is individual variation in just how much blood cholesterol your arteries can tolerate before becoming diseased and blocked, and there is variation in how much fatty food it takes to raise your blood cholesterol to dangerous levels. This is where genetics and other lifestyle and dietary factors can swing the outcome. Fortunately nearly all of us can overcome the genetic factors with a whole foods plant based diet and avoid heart disease altogether. A recent large multi-country study found that known modifiable risk factors accounted for 90% of heart attacks (Yusuf et al 2004).

A normal, safe, cholesterol level is difficult to define precisely but may be as low as 3.8mmol/l. Unrealistic without medication? No, this level is normal in populations where the diet is predominantly plant based and consequently heart disease is uncommon. It is interesting that the individual spread of cholesterol levels in Australia overlaps so little with the range of cholesterol levels found in low risk populations. An interesting observation of The China Study was that the incidence of heart disease (between different provinces) increases as cholesterol levels increase from 4.0 to 4.5, levels that have been regarded as in the safe range in Australia. Even within developed countries, very low cholesterol levels are protective – Framingham Heart Study director, William Castelli, MD, reported that in 35 years of the Framingham study, no subject with a cholesterol level under 150 (3.85 in our units) ever suffered a heart attack (Esselstyn 2007,p.30)

The current medical focus solely on fasting cholesterol may be misguided. It ignores what happens in our arteries for hours after each meal (see Endothelium and atherosclerosis). It’s like assessing diabetes by only measuring fasting blood glucose and ignoring very high levels that may follow high fat meals.

NOTE: cholesterol is measured in different units in USA. Multiply cholesterol by 40 (39 to be precise) to translate into their units. 150 in USA units (mg/dl) = 3.8 in Australian units (mmol/l), or use a cholesterol conversion website (see below).

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