Can Your Cholesterol be Too Low?

Heart Health

Dr. Gabe Mirkin

Some studies show that people who live the longest have total blood cholesterol levels between 211 and 250, which is considered too high by many doctors. Almost everyone agrees that having total blood cholesterol levels above 250 is likely to shorten your life and markedly increases your chances of suffering a heart attack, unless you have a high HDL (which is usually good). Other studies also show that people with very low cholesterol are at increased risk for cancer of the stomach, esophagus, liver and colon, but it looks like the incubating cancers cause the low cholesterol, rather than a low cholesterol causing the cancers.

Having a very low cholesterol could mean that you are not eating enough food. The following are harmful eating habits that cause disease and shorten life: eating too much food, calories, fat, saturated fat, partially hydrogenated fat; and not eating enough vegetables and whole grains, beans and other seeds. Not eating enough vegetables and seeds may be the most harmful because that deprives you of their essential vitamins, minerals, phytochemicals and omega-3 fatty acids. So when you read that having very low cholesterol may be as dangerous as having a very high cholesterol, realize that a very low cholesterol may be associated with not getting enough nutrients, or because your body is not absorbing essential nutrients from the food that you eat.

A study in the British medical journal, Lancet (August 4, 2001), showed that elderly men who have low blood cholesterol levels die earlier than those with higher levels. This does not mean that having a high cholesterol prolongs your life. It means that having a high cholesterol when you are under age 70 puts you at high risk for a heart attack, but having a high cholesterol when you are older may mean that you are getting all the nutrients that you need, and having a low cholesterol when you are over 70 may mean that a person is not eating or absorbing adequate amounts of essential nutrients.

In this study, thirty-five hundred Japanese-Americans living in Hawaii were followed for 35 years. Those with cholesterol levels below 150 died earlier than those with levels of 232. We usually disregard studies like this because we know that a drop in cholesterol with aging often means that a person has a hidden cancer or some other serious disease that interferes with his nutrition, but this study is different. It shows that having a continuously low cholesterol is associated with an early death. The authors also showed that men and women with the lowest cholesterol levels also had the weakest grip strength and had other measures of frailty. That means to me that they are missing something from their diet or exercise programs. Many scientists now explain that we may be putting too much emphasis on cholesterol as a predictor of disease in older people, because diseases that interfere with absorption of nutrients cause heart attacks and cancers and shorten your life.

I believe that everyone should eat plenty of fruits, vegetables, whole grains, beans, seeds and nuts; limit meat, poultry and whole milk dairy products; avoid foods that contain partially hydrogenated oils; don't be obese and try to exercise at least five times a week. If you do all of these things and your cholesterol is very low, ask your doctor to check for malabsorption problems.

Since long-term infections of any sort can lower cholesterol, it may be that people who have chronic infections have lower cholesterol and the chronic infection shorten their lives, not the lowered cholesterol. The safest cholesterol appears to be between 165 and 250. However, doctors no longer predict your chances of suffering a heart attack by how high your total cholesterol is. The current guidelines recommend that everyone should have a blood level of the bad LDL cholesterol below 100. If you live in Canada, divide the American number by 40. That means that Canadians must have their bad LDL cholesterol levels below 2.5. If you have had a heart attack, you should try to get your bad LDL cholesterol below 70 (Canadian value below 1.75).

How to interpret cholesterol numbers

1) YM Song, J Sung, JS Kim. Which cholesterol level is related to the lowest mortality in a population with low mean cholesterol level: A 6.4-year follow-up study of 482,472 Korean men. American Journal of Epidemiology, 2000, Vol 151, Iss 8, pp 739-747. Address: Song YM, Sung Kyun Kwan Univ, Samsung Med Ctr, Dept Family Med, Sch Med, 50 Ilweondong, Seoul 135230, SOUTH KOREA.

2) DR Jacobs, C Iribarren. Invited commentary: Low cholesterol and nonatherosclerotic disease risk: A persistently perplexing question. American Journal of Epidemiology, 2000, Vol 151, Iss 8, pp 748-751 Address Jacobs DR, Univ Minnesota, Div Epidemiol, Minneapolis,MN 55455 USA

Checked 3/9/19