What is the Ideal Cholesterol Level?
By Joel Fuhrman, M.D. www.drfuhrman.com
Results Of Ongoing Current Research Are Driving The Recommended Level Lower and Lower.
The ideal cholesterol level would be one that prevents the formation of cholesterol deposits and actually promotes the reversal of the cholesterol plaques that could be present.
In recent years, Americans have received constantly changing advice about what constitutes a “normal” cholesterol level. The American Heart Association has changed their recommendations multiple times during the last ten years, gradually lowering the level they consider to be a risk indicator for heart disease. In the past, drug therapy was recommended only for those with an LDL cholesterol above 160. Today, the level is much lower.
Most recently, the National Cholesterol Education Program has updated their Adult Treatment Panel (ATP) III guidelines, based on evidence derived from recent statin trials and published them in the July 12, 2004 issue of Circulation. The updated recommendations, which are endorsed by The National Heart, Lung, and Blood Institute, the American College of Cardiology, and the American Heart Association, suggest that more intensive cholesterol treatment is an option for people at high risk for myocardial infarction (MI) and cardiovascular death.
“The lower the better for high-risk people,” Scott Grundy, M.D., Ph.D., representative for the American Heart Association, said in a news release. “That’s the message on lowdensity lipoprotein (LDL) cholesterol from recent clinical trials.”
The last set of guidelines in 2001 encouraged physicians to treat high risk individuals with an LDL cholesterol greater than 130 with a goal to bring their LDL cholesterol below 100.The newest guidelines encourage treatment with medication for all heart patients whose LDL is above 100, with a goal to bring their LDL below 70.
These latest recommendations occurred as a result of drug trials that illustrated fewer cardiac events and fewer deaths in heart patients whose cholesterols were driven to those very low levels with drugs. The reason they only recommend these aggressive numbers for highrisk patients, and not all people, is that achieving these low levels has to be balanced against the cost and side effects of treatment that often requires high doses of medication or combination therapy with a variety of medications.
The Rest Of The Story
So are these authorities correct? Is an LDL cholesterol below 70 ideal, or are they taking this cholesterol lowering advice too far, just to push medication and doctoring?
First of all, keep in mind that a person’s cholesterol level is not the only factor that permits the development of atherosclerosis. Atherosclerosis is a complex process involving a myriad of risk factors, including low antioxidant intake, excess caloric consumption, and lack of adequate exercise. In order to maximally preclude the possibility of heart disease, we have to do more than merely lower cholesterol with drugs. The toxic standard American diet (which has spread to other countries) has enabled heart disease to emerge as the number one killer of the human species, yet this problem is never seen in wild animals. Evidence from early human civilizations also has shown no evidence of heart disease or atherosclerosis, even in people in their seventh and eighth decades of life.
Wild animals, as well as early humans, all demonstrate total cholesterol levels between 90 and 150, and LDL cholesterol between 50 and 75. High cholesterol is strictly a modern phenomenon, the result of our toxic food environment.
The mean cholesterol level of modern Westernized humans is about twice the values seen in infants, wild animals, and primitive populations eating wild, natural food. (See chart.) Healthy infants run LDL cholesterol levels in the 30 to 70 range, about the same as healthy primates in the wild and other wild animals.
Recent interventional trials on cholesterol lowering in modern countries found that the further we push the LDL cholesterol down, the larger the degree of regression of coronary artery disease observed. 2,3 In other words, dropping the LDL cholesterol to 80 showed dramatic reversal of disease that was not seen when LDL cholesterol was lowered to 110. In fact, moderate LDL lowering to 110 allowed for continued progression of disease for most people.4
If we combine the data from all of these modern trials,we find that the level of LDL reduction at which the cardiac event rate can be predicted to approach zero is in the 50 to 70 range, the same range we see in wild animals and early humans.
Furthermore, the effect of dramatic LDL reduction was so profound at preventing heart attacks at this lower range that we can theorize that LDL cholesterol is a required catalyst in the atherosclerosis process, whereby extremely low LDL may prevent coronary heart events regardless of other risk factors. Reversal and protection may be available for the majority with a cholesterol of 110 or lower if they were eating a truly heart-healthy diet; however, without a great diet, more cholesterol lowering clearly is needed.
My observations of those following my nutritional guidelines for a vegetable-based, high-nutrient- density diet over a long term (10 years or more) has illustrated that people routinely achieve the numbers seen only in childhood and in wild animals.
The bottom line is that the vast majority of our population develops hardening of the arteries, and the entire so-called “normal” range of LDL levels in modern society is pathologic. Truly healthy LDL cholesterols are certainly below 80. The modern target of 100 mg/dl for LDL is a great goal considering how far above that our population is at present, but if you have heart disease and truly want to maximally reverse your condition and protect your life, a better goal would be an LDL cholesterol below 70.
This is not driving cholesterol too low; it merely is bringing it down to the levels seen in all healthy animals (and humans) with no signs of atherosclerosis. Of course, you must keep in mind it is impossible to drive the cholesterol that low with conventional dieting. The studies referenced above relied on cholesterol- lowering drugs.
The only way to achieve lipid levels that low without drugs is to use the vegetable-based dietary approach described in my books, Eat To Live and Cholesterol Protection For Life. No other dietary approach has been demonstrated to drop cholesterol levels as powerfully as drugs. By using nutritional excellence with the judicious use of natural cholesterol-lowering supplements, we can reap full benefits and remove the risk of heart disease, without the dangers of cholesterol-lowering medications.
Nutritional Excellence Versus Medication
A crucial piece of evidence to consider is that most studies documenting the benefits of cholesterol- lowering drugs for heart patients do not document a statistically significant increase in life span for those who did not have heart disease. For example, in the PROSPER study, the 22 fewer deaths for vascular disease in the pravastatin group were offset by an increase of 24 deaths from cancer.5 Unlike the drug approach, when you lower your cholesterol naturally, you get a dramatic reduction in both heart attack and cancer mortality. This is why my nutritional recommendations for cholesterol lowering are the only choice for intelligent individuals. All people should be aware that we can eliminate cardiac risk and dramatically lower cholesterol without needing to resort to medications with risky side effects. Unfortunately, this information is still hidden from the public.
When you first maximize your cholesterol levels with high green vegetable intake and other nutrient- rich foods, you remedy other factors that promote disease causation and receive an even more dramatic reduction of heart problems and other diseases normally associated with aging in modern societies. Not only will you avoid heart disease, you also will prevent stroke, diabetes, dementia, macular degeneration, arthritis, osteoporosis, cancer, and other typical degenerative diseases.
1. O’Keffe JH, Cordain L, Harris WH, et al. Optimal low-density lipoprotein is 50 to 70 mg/dl. Lower is better and physiologically normal. J Am Coll Cardiol 2004;43(11):2142- 2146.
2. Smilde TJ, van Wissen S, Wollersheim H, et al. Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolemia (ASAP): a prospective, randomized, double-blinded trial. Lancet 2001;357:577-581.
3. Taylor AJ, Kent SM, Flaherty PJ, et al. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation 2002; 106:2055-2060.
4. Nissen S, Tuzcu EM, Schenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression coronary atherosclerosis: a randomized controlled trial. JAMA 2004;291:1071-1080.
5. Sacks FM, Tonkin AM, Shepherd J, et al. Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors. The Prospective Pravastatin Pooling Project. Circulation 2000;102:1893-1900.