Can Cholesterol Be Too Low?

Typically, those individuals promoting the myth that low cholesterol levels are dangerous and the topsy-turvey "science" that saturated fat and high cholesterol are not bad, but good, are those individuals and health advisors advocating diets high in animal products, such as the Atkins devotees. Unfortunately, this advice is not merely incorrect; it is dead wrong for hundreds of individuals who heed such dangerous advice and die of heart attacks every day.

When it comes to coronary artery disease, there may be no such thing as lowering total blood cholesterol levels too far. Another recent study, published in the journal Circulation, found that the arteries in male patients with a total cholesterol level as low as 155 mg/dl benefited significantly from cholesterol-lowering medication as well.1 Both regression of atherosclerosis and a dramatic reduction in heart attacks were seen in the group treated.

While some research in the past has raised questions about the safety of very low cholesterol levels, no danger has been proven in larger, more dependable investigations. The new reports, documenting the effectiveness in saving lives with more substantial cholesterol lowering, fuels an ongoing debate about how aggressively to treat heart disease patients whose cholesterol levels are better than average and whether aggressive cholesterol lowering is valuable even in young healthy adults without signs of heart disease.

In the past, it was thought to be good enough to have a cholesterol level better than average. Until recently, doctors advised their patients to strive for a total cholesterol lower than 200 mg/dl. Eventually, this advice was found to be lacking and now we know that it is not very good to be average in a population that ubiquitously develops atherosclerosis. On autopsy, almost all American adults demonstrate significant coronary artery disease (2) and even 78% of young trauma victims who died before the age of 35 demonstrated significant atherosclerosis on autopsy.3 If you eat American food, you will inevitably develop American diseases. It is rare that someone can escape from the biological laws of cause and effect.

Clearly, if we attempt to rival the low cholesterol of populations that eat mostly natural plant foods and do not have heart disease, we are always looking at total cholesterols below 150 mg/dl. The average cholesterol level in rural China, as documented in the massive China Cornell Project, was 127 mg/dl. Heart attacks were rare, and both cancer and heart disease rates plummeted as cholesterol levels fell, which reflected very low animal product consumption. The lowest occurrence of heart disease and cancer occurred in the group that consumed plant-based diets with less than two servings of animal products per week.

There was some controversy years ago about striving for lower, protective cholesterol levels after some studies in the eighties noted that depression, suicide, hemorrhagic stroke, cancer, and death from other causes, were higher in some groups with very low cholesterol groups. Larger, recent investigations studying larger populations did not confirm these questionable findings.

When investigators looked more carefully at the individual characteristics of the studied populations they were able to explain the earlier findings. This issue is complicated because these studies evaluated individuals who were eating the modern American diet, rich in saturated fat and other components of animal products that raise cholesterol, and low in plant derived anti-oxidants, phytochemicals, and essential fatty acids that improve cholesterol ratios. Those who demonstrated very low (ideal) cholesterol levels, while following the traditional, modern, cholesterol-promoting diet, may actually have a compromised health status or undetected chronic disease.

For instance, we know cancer causes less cholesterol production in the liver. Low cholesterol may be associated with cancer, but does not cause it. Researchers showed that cholesterol starts to fall up to 8 years prior to a person dying of cancer, and that those with the greatest drop in cholesterol in a 4 year period without dietary improvements to lower cholesterol were those most likely to develop cancer.4 The low cholesterol did not cause the cancer; the cancer caused the low cholesterol. Those who work to lower cholesterol by avoiding saturated fats, eating a high nutrient diet with lots of raw vegetables, cooked green vegetables, and beans do not have a pathological condition causing their low cholesterol. They earned it.

This is why in rural China where the diets are nearly vegetarian, the average cholesterol levels are low and you see lower cancer rates, not higher. Those with the lowest cholesterol in the China study actually had the lowest cancer rates as well. Obviously, there is a difference between one who has a low cholesterol because his dietary style earns it, and one whose cholesterol seems unjustifiably low on a modern heart-disease-promoting diet that almost everyone in the west eats.

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A Life Plan for The New Year

In spite of the more than $110 million consumers spend every day on diets and "reducing" programs (more than $40 billion per year), Americans are the most obese people in history. To be considered obese, more than one-third of a person's body must be made up of fat. A whopping 34 percent of all Americans are obese, and the problem is getting worse, not better.

Unfortunately, most weight-loss plans either don't work or offer minor, usually temporary, benefits. There are plenty of "rules and counting" diets, diet drugs, high-protein programs, canned shakes, and other fads that might enable you to lose some weight for a period of time. The problem is that you can't stay on these programs forever. What's worse, many are dangerous.

To achieve the results in preventing and reversing disease, and attaining permanent body weight, we must be concerned with the nutritional quality of our diet.

Based on an exhaustive look at research data from around the world over the past fifteen years, my recommendation is that your diet should contain over 90 percent of calories from unrefined plant foods. This high percentage of nutrient-dense plant foods in the diet allows us to predict freedom from cancer, heart attacks, diabetes, and excess body weight. Fruits, vegetables, and beans must be the base of your food pyramid; otherwise you will be in a heap of trouble down the road.

Most people lose weight and then stop losing when they have reached their ideal weight. You are not the judge of your ideal weight; your body is. As almost everyone is overweight, many people think they are too thin when they have reached their best weight. I have many patients who, after following my plan to reverse diabetes or heart disease, report, "Everyone tells me I look too thin now." I then measure their periumbilical fat and check their percentage of body fat, and usually show them they are still not thin enough.

Many health authorities and diet advisors recommend only small changes; they are afraid that if the change is too radical, dieters will give the whole thing up and gain nothing. I strongly disagree. My work over the past ten years has shown that those who have jumped in with full effort the first six weeks have been the individuals most likely to stick with the plan and achieve results, month after month. Those who try to get into it gradually are the ones most likely to revert back their former way of eating. Under the gradual approach, they "yo-yo" back and forth between their old bad behaviors and good ones. Change is hard. Why not do more and glean the results you have always been after quickly and permanently? Be realistic and flexible; changing your behavior is the key to success.

When you adopt the Eat to Live program as a longevity plan, a slim weight will be a by-product of your new commitment to excellent health.

Energy Through the Roof. Asthma Gone.

DiseaseProof recently sent out e-mail requests for success stories. (E-mail us yours!) One of the first to respond was Michael from the Bahamas:

Started reading your book (Eat to Live), 12 November 2005. Strarted the diet (new way of eating - 6 week plan) 2 December 2005. Weighed 266lbs. To date, 28th December, down to 248lbs (lost 18 lbs). Two more weeks to go. Energy through the roof. Asthma gone.

Restless Weight

Restless over your inability to lose weight? Laurie Barclay, MD and Désirée Lie, MD, MSEd report that getting sufficient sleep may help reduce weight gain. A study published in the Dec. 7 issue of the Annals of Internal Medicine explains:

Short sleep duration in young, healthy men is associated with decreased leptin levels, increased ghrelin levels, and increased hunger and appetite. Additional studies should examine the possible role of chronic sleep curtailment as a previously unrecognized risk factor for obesity.

If the findings prove to be reproducible and generalizable, and the hormonal changes of leptin and ghrelin due to sleep curtailment cause changes in food intake over time, we might add sleep duration to the environmental factors that are prevalent in our society and that contribute to weight gain and obesity.

Government: Half of 55 to 64 Year Olds Have High Blood Pressure

The AP's Mike Stobbe passes along some good news: the government just announced that life expectancy in the U.S. has hit an all-time high of 77.6 years. But, he writes, there are some worrying trends on the horizon:

Half of Americans in the 55-to-64 age group — including the oldest of the baby boomers — have high blood pressure, and two in five are obese. That means they are in worse shape in some respects than Americans born a decade earlier were when they were that age.

In his book Eat to Live Dr. Fuhrman has this to say about high blood pressure.

Studies have shown controlling sodium intake and weight loss to be effective in reducing blood pressure, even in the elderly.1 How can you implement these interventions into you lifestyle? It's simple. Eat many more fruits, vegetables, and legumes; eat less of everything else; and engage in a moderate amount of exercise. High blood pressure is relatively simple to control.

I encourage my patients to do what it takes to normalize their blood pressure so they do not require medication. Prescribing medications for high blood pressure has the effect of a permission slip. Medication has a minimal effect in reducing heart attack occurrence in patients with high blood pressure because it does not remove the underlying problem (atherosclerosis), it just treats the symptom. Patients given medication now falsely believe they are protected, and they continue to follow the same disease-causing lifestyle that caused the problem to begin with, until the inevitable occurs--their first heart attack or stroke. Maybe, if high blood pressure medications were never invented, doctors would have been forced to teach healthful living and nutritional disease causation to their patients. It is possible that many more lives could have been saved.
Dr. Fuhrman tells the story of a patient who followed his advice.
Though it took a full two years, Rhonda Wilson dropped her weight from 194 to a slim 119. She was able to come off blood pressure medication as a result of her newfound commitment to a healthful lifestyle. When she first came to me, she was on two medications to control her high blood pressure. These two medications were not sufficient, as her blood pressure was still excessively high. Rhonda did not see normal blood pressure readings for a long time and was not able to stop her blood pressure medication until she became relatively thin. Her story illustrates a common dilemma. It is not unusual for some people to lose some weight, yet still have high blood pressure. Some individuals develop high blood pressure and diabetes even from a small amount of excess body fat. For these individuals, it is even more important to maintain an ideal weight.

UPDATE: You can read the whole government report here.

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The Skinny on Dieting--UPDATED

Adapted from Dr. Fuhrman's book Eat to Live.

You may already know that the conventional "solution" to being overweight--low-calorie dieting--doesn't work. But you may not know why. It is for this simple yet much overlooked reason: for the vast majority of people, being overweight is not caused by how much they eat but what they eat. The idea that people get heavy because they consume a high volume of food is a myth. Eating large amounts of the right food is your key to success and is what makes this plan workable for the rest of your life. What makes many people overweight is not that they eat so much more but that they get a higher percentage of their calories from refined fat and refined carbohydrates, or mostly low-nutrient foods. Plus, this low-nutrient diet establishes a favorable cellular environment for disease (like cancer, heart disease, and dementia) to flourish.

As long as you are eating so many low-nutrient foods, it is impossible to lose weight healthfully. In fact, this vicious combination of sedentary lifestyle and eating typical "American" food should make normal people overweight. It is perfectly normal to become a "food-addict," eating more calories when the body requires, when your intake of micronutrients is so low. This low nutrient intake leads to cellular toxicity creating an internal environment when cravings, and ill-feeling ensue if the body is not continually overfed. It is similar to the way a heroin or nicotine addict, who needs their regular fix, or withdrawal will begin and they will feel too uncomfortable. The standard (low phytonutient) diet leads to discomfort (headaches, weakness, abdominal spasm and fluttering, mental confusion and more) the minute your stomach empties for a few hours.

Eat To Live is the only dietary style that recognizes "toxic hunger" as the cause of obesity and that the nutrient-per-calorie density of foods must be considered when trying to fuel the body for health. Because eating more high-nutrient foods and recipes end toxic hunger, they put an end to dieting forever.