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.

1. Jukema JW, Bruschke AV, van Boven AJ, et al. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS).Circulation 1995;91(10):2528-2540.
2. Shirani J, Yousefi J, Roberts WC. Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol 1995;75(2):151-156.
3. Joseph A, Ackerman D, Talley JD, et al. Manifestations of coronary atherosclerosis in young trauma victims--an autopsy study. J Am Coll Cardiol 1993;22(2):459-467.
4. SJ Sharp, SJ Pocock. Time trends in serum cholesterol before cancer death. Epidemiology 8: (MAR 1997):132-136. M Zureik, D Courbon, P Ducimetiere. Decline in serum total cholesterol and the risk of death from cancer. Epidemiology 8: 2 (MAR 1997):137-143.

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Comments (23) Read through and enter the discussion with the form at the end
JDavidson - April 8, 2006 3:05 PM

I am trying to find the lowest recorded total cholesterol level. Can you help? My friend says that his total is 69? Is that possible?

Brandon - May 3, 2007 9:48 AM

I had my cholesterol tested and I had a total level of "122". After 8 months of becoming "vegan", I got tested again, and my total level was "85". I can only imagine it will continue to go lower the longer I practice veganism.

Jennifer - May 18, 2007 2:40 PM

I've been a vegetarian for 18 years and a vegan for the last 7 years. My total cholesterol was 90 when I was checked about a year and a half ago. I feel so much better on a plant-based diet. It doesn't feel restrictive at all once you figure out what you can eat. In fact, I've found it to be quite liberating. It is easier nowadays with the increasing popularity of vegetarian and soy products. It's an adjustment from the standard American diet, but it is well worth the effort (and becomes effortless over time). Why don't you give it an honest try and recheck your numbers. I find it's helpful to view the diet change positively (as an opportunity vs. a chore, for example). There are all sorts of books and websites dedicated to plant-based diets. I've found some good information and helpful tips on following a plant-based diet on the website Physicians Committee for Responsible Medicine. You might want to browse around there. Good luck!!

Mike - June 14, 2007 1:25 AM

I got mine checked after having blood work done for a medication I am on. My cholesterol level turned out to be 102. The weird thing is that I am in no way a vegan. I eat meat everyday, and a lot of it.

peter gorton - August 27, 2007 4:52 AM

what is the lowest cholestrol ever recoreded, and is 2.8 a sensible cholestrol.

ed verghese - October 4, 2007 10:12 PM

what is the lowest cholostrol level one can have, below 70

Meredith - April 19, 2008 12:10 AM

Wow, that's a relief to read. I just got my cholesterol results back. My overall cholesterol is 98, with HDL (good) cholesterol 71 and LDL (bad) cholesterol 14. I've been looking everywhere for something about cholesterol this low but had only found the depression/cancer stuff.

Brian - May 9, 2008 2:12 PM

I just got finished reading this article ( which appears to directly contradict Dr. Joel Fuhrman statements above. I don't think at any point in this article they're advocating any kind of diet. It is simply saying the study conducted in Japan showed that the combination of low cholesterol and high blood pressure created a greater threat of death from cerebral hemorrhage presumably due to the fact that cholesterol plays a vital role in maintaining cell membranes and a lack of cholesterol could lead to weak artery walls prone to rupture, especially when under high pressure. Can someone comment on the validity of these findings?

nikki - May 13, 2008 1:18 AM

I'm right there with Meredith. I just got the results from my physical and wasn't really surprised with LDL=52 and HDL=47 b/c my mom has really low cholesterol too. But when I told someone who has a total level of 146 they said mine was too low. I've been doing research and fully believe that it is because I eat mostly organic, very little meat and 6-9 servings of fruit and veggies everyday. I also take Nordic Natural fish oil. Does anyone know where one can find the levels of cholesterol in a study related to amount of fish eaten?

Sara Pulis - May 14, 2008 8:25 PM

One might mention that much of cholesterol levels seem to be genetically linked, as well. My husband and I are both vegan and each eat the same things the other does, but my cholesterol is 139 where his is 216. (To be fair, I do get much more exercise than he does, but that oughtn't totally account for such a vast difference.) I have also read about the study which Brian referenced above; how common is it to have both high blood pressure and high cholesterol, anyway? I've never met anybody with that duo.

Sara Pulis - May 15, 2008 2:01 AM

Sorry, correction to the above comment: "how common is it to have both high blood pressure and LOW cholesterol, anyway?" The other makes no sense.

Bill - August 7, 2008 9:20 AM

Brian, you're right to question the blanket statements made in this article. Even the National Cholesterol Education Program says people at high risk of heart attack should have a total cholesterol of 140-150 and LDL at 70, while there's some research showing that LDL levels between 60-70 are not only safe but may even reverse coronary artery disease.

As for that China study Fuhrman touts, there's a huge problem: many of those Chinese farmers have chronic hepatitis, which not only lowers cholesterol (since it's made in the liver, which hepatitis attacks) but can lead to liver failure and liver cancer. In this case, the people with low cholesterol didn't die of heart disease because they were already dead from liver disease. Meanwhile, those who didn't have chronic hepatitis had higher cholesterol because they had healthy livers, and so they lived long enough to die of heart disease in their old age.

Cholesterol is absolutely vital to life; without it you'd die: besides being crucial to the strength of cell walls, it is what the body uses to make progesterone, estrogen, testosterone, steroid hormones; it's important for metabolizing fat-soluble vitamins like A, D, E, and K. You can indeed have too-low levels of cholesterol, and some of the levels in the comments here are clearly way too low.

It works this way: Triglycerides, a major fatty acid source of energy for cells, are carried around the body by Very Low-Density Lipoproteins (VLDL); VLDL are precursors of LDL. VLDL and LDL are protein shells that are the transporters essential for bringing cholesterol to the cells - and you need cholesterol to live. HDL is the protein shell that carts away unneeded cholesterol back to the liver for excretion.

So you need both LDL and HDL and you need to keep them in balance. Your total cholesterol should be less than 5 times your HDL, which should be at least 40. A good rule of thumb is to keep your LDL below 100 but above 60. Your total cholesterol is HDL+LDL+VLDL - if you look at your scores you'll see that adding HDL + LDL doesn't equal your total cholesterol. You calculate VLDL by multiplying your triglycerides by 20%.

A low-fat/low-cholesterol diet does not really protect against heart disease; it may even promote it. It doesn't mean you rush out and stock up on butter and red meat; the latter especially is problematic for, among other things, the colon. But you don't have to avoid them altogether.

Instead, the single greatest protection against heart disease is to moderate your carb intake - the liver makes triglycerides out of unused carbs (the kind you eat for dessert and munch on while watching TV - in other words, you eat them and go to bed, you don't use them for energy). Thus too many carbs raises your triglycerides, which are the major component of VLDL; too much VLDL raises your LDL. Americans eat far too many simple carbohydrates and don't exercise enough to burn them off.

If you want to lower your LDL because it's over 100, one major way is to cut back on sugar and simple carbs like corn, potatoes, pasta, white bread - do that and you may not even need medications. Niacin (not niacinamide) also lowers LDL while raising HDL. Statins should be a last resort because although there's ample proof they protect against heart disease, it's not at all clear they do it by lowering cholesterol - people with normal cholesterol aren't supposed to be at risk for heart disease, but statins protect even them. It's likely that statins work in other ways - for one thing, they have an anti-inflammatory effect, and inflammation of artery walls is implicated in heart attack. Aspirin is also anti-inflammatory while also an anti-coagulant that prevents blood clots from forming at the site of inflammation.

Obviously, this is all a lot more complex than Fuhrman would have you believe. Anyone who says, as he does, that his knowledge is definitive needs to raise his own level of skepticism of conventional wisdom.

ED - October 30, 2008 4:20 AM

I strongly suggest to all to disregard most of Bill's statements and suggest you read the China Study which has the most comprehensive research by world experts supporting a plant based whole foods diet for life which as a physician, I highly recommend. Bill may have good intentions but is seriously misinformed.

Joshua - November 7, 2008 2:09 PM

I have had a total cholesterol of 43 or lower for the past 3 years. Last year it was at 39. I had to redo the test 3 times because they didnt think the results were right. If anyone has a lower total chlesterol or has heard of anyone lower I would love to hear that I am not the only one with unusually low choleterol. Every doctor I have talked to says that it is the lowest they have ever seen. I look forward to hearing back from everyone.


Alexander L - November 19, 2008 2:12 AM

josh, i got mine checked a few months ago and it was 43 as well. i know that it runs in my family. we have very low cholesterol and very very high iron. the doctors have tested me my brothers and my dad however and have said that it is not a problem.

Thaya - October 7, 2009 8:28 PM

how do you convert cholesterol reading from mmol/Litre to the sort of numbers used in USA?

In Australia, the standard range permitted for total cholestrol is 3.9mmol/L to 5.5mmol/L

As for Glucose the factor is exactly 18

The Standard Australian reading for fasting Glucose is 3.6 to 6 mmol/L
This converts to 65 to 108 in the USA

Karen Krantz - December 15, 2009 4:51 AM

I have a horrible diet, and eat lots deep fried foods. Also, fried chicken with potatoes and gravy, eggs and sausage, no fish, and lots of butter. I don't eat a lot of red meat, but did up to a year ago. Since that time my cholesterol has gone up slightly, from 93 to 108. My HDL is 76, LDL is 25, and triglycerides is 36. Low cholesterol runs in my family. One brother's total cholesterol was 75 when he had a triple heart bypass at age 47. My sister, who has totals like mine, and I both carry a lot of extra weight around our abdomens. She is a type II diabetic, I am pre-diabetic. I suffer from joint destroying osteoporosis, and have been diagnosed with low dhea, vitamin B12 and D3, have problems sleeping, and have absolutely no energy! I have asked my physician to refer me to an endocrinologist as I am so tired of being tired. I am 58 years old and retired from a very stressful job last December, before that I lost my Mother-in-law that September, my father had his colon and rectum removed that October due to cancer, my mother needs a lot of emotional support from me, and I am in charge of my father-in-law's medical needs-which include parkinsons's disease and he recently broke his hip and is recouperating from that. What do you think I should do to feel better?

Bekah - March 3, 2010 10:31 AM

Incase anyone would was wondering - this is from the Mayo Clinic about having too low of Cholesterol.

Here's the part that you should know about:

"Some research suggests that low levels of low-density lipoprotein (LDL), or "bad," cholesterol may be associated with an increased risk of certain types of cancer. Other studies associate a low total cholesterol level with depression and anxiety, perhaps because low cholesterol may reduce levels of the brain chemical serotonin. And pregnant women who have low total cholesterol may be more likely to give birth prematurely and have babies who have low birth weights."

Cholesterol level: Can it be too low?Can your cholesterol level be too low?


from Thomas Behrenbeck, M.D.

A high blood cholesterol level increases your risk of coronary artery disease. Lower cholesterol is usually better — but not always.

Some research suggests that low levels of low-density lipoprotein (LDL), or "bad," cholesterol may be associated with an increased risk of certain types of cancer. Other studies associate a low total cholesterol level with depression and anxiety, perhaps because low cholesterol may reduce levels of the brain chemical serotonin. And pregnant women who have low total cholesterol may be more likely to give birth prematurely and have babies who have low birth weights.

Although the upper limits for total cholesterol and LDL cholesterol have been clearly established, the lower limits depend on the individual.

Ideally, keep your total cholesterol below 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L), and your LDL cholesterol below 100 mg/dL (2.6 mmol/L) — or below 70 mg/dL (1.8 mmol/L) if you're at very high risk of heart disease. An adult who eats a low-fat, low-cholesterol diet may have an LDL cholesterol level between 40 and 50 mg/dL (1.0 and 1.3 mmol/L) and a total cholesterol level of 100 mg/dL (2.6 mmol/L).

It's also important to remember that high-density lipoprotein (HDL), or "good," cholesterol counts, too. A low HDL level increases the risk of heart disease. For women, a low HDL level coupled with excess weight after menopause may increase the risk of breast cancer as well. To help prevent heart disease, aim for an HDL level of 60 mg/dL (1.5 mmol/L) or higher.

If you're concerned about your cholesterol level, consult your doctor. He or she can determine the cholesterol range most appropriate for you.

Clint Kimball - June 21, 2010 11:51 AM

I too have low cholesterol - my last check was 69. I eat as much meat products as the average American, and am reasonably healthy. 5'10" 180 lbs and can run a mile in under 7 mins.

The only sense I've gotten from it all is that, since 75% of cholesterol is made in the liver (only 1/4 comes from what you eat), there must be something wrong with my liver. But, since there's no vital purpose in cholesterol (it only makes testoserone and cortisol - neither of which is vital), I don't see any problem. There hasn't been sufficient research done on people like me (us), so that's all I can say. I do know that I don't have cancer, aids, tumors, or even a common cold. I just qualified for the super-premium rate for my life insurance (1 in 40 men my age do).

The only worry factor is that my grandpa and uncle both died in their mid-70's of liver failure, and both had low cholesterol. They also both drank a lot in earlier years, which was probably a greater contributing factor.

So I take my men's vitamin suppliment, fish oil pills, try to stay active, tell my wife I love her, and if the cholesterol is having any negative effects on my body or emotions it's definitely not showing.

Alan - August 30, 2010 3:17 PM

I too just got my figures back and was told by my doctor that he'd never seen such a low LDL of 33. Then i went to the internet and found the warnings bill mentioned. I also found the counter arguements. Like some of you, I've always had low cholesterol, which seems to excite doctors for some reason. I've gone on an almost vegan diet and my total cholesterol is 93.

I'll stick with my diet since I feel fine. I do wonder if my liver is working well - but my liver enzymes are better on the new diet as well, so it seems OK.

David Stokes - November 29, 2010 11:36 AM

Like Clint I have fairly low cholesterol (2.4 mmol/L = 93.6 mg/dL), eat as much meat as the average Brit, fish occasionally, fruit & veg not nearly enough as they say. I have never drunk alcohol (well not since a teenager) and never smoked. I have ideal BMI. Exercise pretty average for a 42 year old. Had an angiogram, CT scan and MRI scan, my arteries are in good condition (apart from the fact that one of them goes where it shouldn't).
Maybe cholesterol isn't as dependant on diet as the veggies claim !!

Anonymous - November 18, 2011 12:47 AM

While genetics do play a significant role in low cholesterol and lipoprotein levels, both genetics and the environment contribute to this multifactorial phenomenon. For example, many dietary plant sterols and stanols (like in Benecol) can inhibit cholesterol absorption and lower plasma cholsterol. Exercise can increase HDL levels, which may take some of the cholesterol from the body and transport it to the liver where it can be excreted as bile salts. About 5% of those bile salts are usually excreted leading to loss of some cholesterol from the body. As for the function of cholesterol, it contributes to the strength of cellular membranes. Furthermore, cholesterol is an important precursor not only for steroids, but also for vitamin D and bile acids. Bile acids help to emulsify the products of fat digestion, which aids in absorption of fat-soluble vitamins.

Anyways, I wish more people were concerned with low cholesterol levels instead of high cholesterol levels. Personally, I'm satisfied with my levels. Last time I was tested, I had about 26 mg/dl triglycerides (test was repeated several times), 34 mg/dl LDL, and 49 mg/dl HDL. While I may want to exercise for longer periods of time to increase adrenaline to increase HDL levels, I feel great and have no other health concerns.

Sara - January 28, 2012 9:38 PM

I found this article and the comments all very interesting. I have to say though that I do not believe that cholesterol is based on diet alone, although most veggies I meet would like to believe that it is. I eat based on the primal blueprint. About 70% of my daily calories come from proteins and fats - most of those animal based. I recently received a concerned call from my doctor that my cholesterol is dangerously low. I have scheduled a follow up with her. I have an autoimmune thyroid disease and low cholesterol in my case can be linked to hyperthyroidism or onset of thyroid failure. There can be lots of reasons why someone may fall outside of what are considered the normal ranges, and I would assume some not dangerous at all and based more on genetics. However I would still encourage anyone outside of what is considered to be normal healthy ranges to be checked out thoroughly by a doctor before assuming that it is nothing serious. Wouldn't you hate to wake up in the ER and find out that you were wrong?

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