I entirely agree with your assessment. As a biomedical scientist I measured thousands of serum cholesterol levels, and the low levels were very often in very sick people, often elderly and malnourished. I'm reminded of those claiming that excess acidity is the cause of all illness, whereas the truth is that acidosis, like a very low cholesterol, is the RESULT of illness, not the CAUSE.
I'm so delighted that you posted this. I've been so confused by people talking about acidifying and alkalinizing foods. The only good grain is millet. Etc. This has made no sense to me. I get it now, because of your clarity. Thank you.
You are more optimistic than me. We've got an anti science kook running for President in the USA who's polling in double figures and getting applauded by people like Musk, Maher, an ex Twitter CEO, ..etc
It is frightening that it is so easy to restore your faith. He used association of other U-curve graphs to disprove the association in an other u-curve graph. & had one half-baked argument that the reason why lower cholesterol has a high hazard is because people with disease have lower cholesterol by coincidence of being sick. So unfortunate that they have this really great and healthy cholesterol score, but still are dying from cancer and such. When dismissing the U-curve. What should the graph look like then? linear? Would you argue that it is best to have 0 cholesterol?
@@Joop3000 I think you miss the point, if certain diseases naturally drop your cholesterol then this becomes a symptom and the lower cholesterol shouldn’t be read as a cause. To have the correct correlation then those cofounders would need to be filtered out for it to be truly representative of whether or not the cholesterol level of a certain individual represents their risk of getting sick and not related to them already being sick
@@888jucu That is exactly what I got out of it. So, let me ask you then, if we ''filter'' (I don't think this is realistic and based in logic and evidence, but just for the sake of argument) those confounding factors out, what do we end up with then? A linear line going back to 0 cholesterol which is healthiest?
@@Joop3000 I don’t believe zero is realistic nor advisable for the general populace but probably a number significantly less than 230. That said for people with real advanced ASCVD then lowering cholesterol either with lifestyle, drugs or both has proven to be the best for their immediate health outcomes. For the general population what is the best cholesterol target seems to still be of some debate but high cholesterol certainly is well documented to be problematic regardless what certain carnivore advocates may preach. True carnivores in nature do not develop ASCVD so humans being “omnivore” means we are not fully developed to handle large quantities of saturated fats as can been seen by the fact our species develops ASCVD the more we are exposed to saturated fat be it through direct diet or internally produced by “excessive” carb intake etc
Similar issue with a recent paper on weight loss being associated with increased mortality where the confounding of disease driven weight loss was so obvious and yet it still hit the headlines that “weight loss can kill you“. Reverse causality. Another good video, Gil. Keep up the good work.
To be fair weight loss is often unhealthy. What people should be focusing on is fat loss and a scale is a poor way of measuring that. People start reducing calories, hydration and protein which results in an unsustainable loss of weight that includes lean mass and reduced basal metabolic rate.
It is not the logic that gets us in trouble, it is the low probability premises. Doing the expensive research and data analysis for accurate premises is the hard work.
Thanks for this! I remember when I first got my cholesterol taken. It was at a company heath screening. A couple friends had slightly high readings. Mine? In the low 130s. When everyone commented the nurse there immediately jumped in an made a comment that cholesterol can be too low. I blew it off at the time because I was in my twenties. Fast forward to today when I’m 56, I’m still getting low readings. As a vegan it dropped again to 126 which is my lowest and has happened a couple years ago as well. When was this a problem for me? Well, prior to adopting a vegan diet, I was on a low carb diet called GAPS. After that, I experimented with Keto. In BOTH of those communities I started hearing how I needed to raise my cholesterol because of research about low cholesterol. A functional medicine practitioner talked to me about the same thing. My efforts yielded a total of 162. I am thankful that I found a channel where someone actually discusses the actual studies (and posts them!). Thanks again!
I just found this channel and wondered if he has shared this fact with the audience yet; Did you know that Cholesterol is a required precursor to essential hormones: estrogen, testosterone and vitamin D?
@@birdgirl1516 Yes, it is. But today's adults (and many children) have cholesterol levels that are far beyond that necessary for basic bodily functions. No healthy person needs to worry about 'having enough' cholesterol.
Thank you for what you do. There’s so much misinformation about nutrition floating around on RU-vid. It’s a shame cause people are trying to better their health but getting misinformed by non experts or outright grifters. We need more professionals to do this kind of thing. 👍
Thank you for another straightforward explanation that even a high school dropout could understand. If I had only seen these graphs w/o your explanation, I probably would've thought "oh, I guess they found new evidence." Keep the good work going, a lot of us depend on you.
This is a good explanation and a reminder that correlation is not the same as causation. My 84 YO father died 3 months ago and we had just seen his lung doctor 4 days earlier. His weight was the lowest it had ever been as an adult and his blood pressure was also very low and his cholesterol thanks to taking vytorin was around 150 and frankly, better than mine. An uneducated person (ie. people who listen to "Bro" podcasts) might then conclude that low cholesterol, losing weight, and having low BP is unhealthy but in his case, when he WAS "healthy", he had very high blood pressure. He was in denial about it and I didn't find out about it until 15 years ago when he cut his finger and it would not stop bleeding and the urgent care center saw that his BP was 215 and they had to put him on an IV med to bring it down before letting us leave. After that, I became active in his care and got him a primary care doctor who managed his BP, cholesterol but the damage was done as 6 years later he needed a stent put in and 6 years after that, he had heart failure that thanks in part due to all the COVID lockdowns and in part due to the cardiologist not being aggressive with the water pills and/or wanting to do a valve replacement surgery, he had so much fluid build up in his lungs that by the time they admitted him to the hospital, the damage was done to his lungs and so at that point, surgery was completely off the table and he pretty much had to suffer for 2 1/2 years with home oxygen and being homebound and mostly just getting comfort care which led to him losing weight and his heart getting weaker. If I had a time machine, I would have made sure he got to his doctor sooner.
Great video! You see the same sort of curve for level of alcohol use and mortality, where it appears that people who don't drink at all have higher mortality. However, when you control for why a significant proportion of those people aren't drinking (due to health problems), the relationship becomes linear, with healthy people who don't drink having the lowest risk of mortality.
Interesting point in your video is that if your cholesterol is lower than expected, while you never tried to actively lower it,.... it means you probably have a disease you may not even be aware of. I know some people like that, though they are aware of the diseases. But their doctors tell them it's great. They don't tell them that their cholesterol is low because of their other diseases.
Many people for genetic reasons have low cholesterol and that is a healthy marker. It's when your cholesterol declines over time without a reason that it is cause for concern.
Great video with lots of easy to understand information. You have a really great ability at explaining a complicated subject, and making it easy to understand.
Excellently presented and very interesting! All I can do is repeat the famous words of Dr. John McDougall that "People Love to hear good things about their bad habits", and the internet hugely rewards those claims with tons of hits. Keep doing what you are doing!
McDougall?? rofl, A diet of white rice, fruit, fruit juice and table sugar -- cures diabetes, heart disease, arthritis, obesity, and just about everything, is the claim of Mcdougall
Thank you so much for empowering your audience and letting us decide on what to do based on the science. It's such a refreshing change from RU-vidrs that use click bait, criticise a persons character that they don't agree with and let their emotions get involved in their efforts to ultimately deliver an otherwise well intentioned message. Great work and thank you again.
From what I’ve learned cholesterol is extremely nuanced. There are many factors involved. lots to know and I’m still learning to help make the best decisions along with my doctor but it’s a team effort.
I've watched this video three times and read a lot of the comments, and I"m still not persuaded that optimums on cholesterol aren't actually the high levels. Remove the people with cancers and other non-cardiovascular diseases, and we should see a linear effect, with those at relatively high levels still near the optimum. The comparison to the BMI, BP, and HbA1c are not persuasive as two of them are not quadratic, and the other shows a tiny risk change across a wide range of BMIs.
This video would be helped by showing graphs from some of the better, double-blind studies that factor out the people with illness and show the curves where they "should" be. I'm skeptical without seeing those graphs. No dog in this fight, just want to actually see the better evidence.
I can't point to the exact video, but I think he shows one where he puts dot plots of all the studies on a graph and it shows pretty clearly the affect of LDL cholesterol on mortality. If you have time to check out some of his older videos on cholesterol, you will run into it.
The links to the studies are all in the description. The Korean cholestrol study is exceptionally thorough and HUGE. Read the details of it and see. (first link I believe)
For those that are worried about high cholesterol, it might be good to get a CAC score to see if there's any blockages. There is also Life Line screening that will do the same thing if you don't want to go to the doctors to get a referral for CAC. I will be doing the Life Line screening since I have high cholesterol.
A CAC score won't tell you about blockages caused by soft plaque. It will only reveal old, calcified plaque. Your arteries can be nearly fully clogged with a low CAC score.
CAC only detects calcium. Not all of the build up will be calcified, may work in very old people or people who have been developing cholesterol build-up from a young age and gave it years to calcify
Oh my goodness thank you so much for making this video. The dangerous messaging out there is getting out of hand. We need actual doctors like you to set the record straight.
Thank you! I'm so glad I found you, because you are able to explain to lay people. And you illustrate how important it is to be discerning about nutrition/health info that comes out, and not just swallow everyone/everything blindly. I appreciate you!
Highly active 56yo, 6ft, 158 lbs. BP is 109/72, resting HR, 54. My 14 day avg. glucose is 83mg/ml and total Chol 557, Trigs 104, HDL 52, LDL 461. Should I be concerned about my high cholesterol or LDL?
You should ask your primary care provider. Mine is half that but my primary care provider told me that it wasn't worrisome because my BP was excellent. But if it had been over 500 I'm not sure what he would've said. Just ask them on your next visit.
it is based of population medians. Meaning, what is average in the population. Doesn't even mean it is healthy. Especially if the average person is unhealthy, like the US
Look at the level of cholesterol and mental illness and suicide. Under 160 seems to be a problem on this side. Despite these reasonable suppositions, many studies over decades have (for the most part) consistently linked low total serum cholesterol with suicide, violence, and depression. Total cholesterol levels below 160, and especially below 130, correlate with a higher risk of mental problems.
The curves would seem to suggest that cholesterol of 240 is just fine... as long as it's not an upward trend. And BMI of 28 is just fine, even if it's considered overweight. And systolic blood pressure of 140 is just fine. And even that an A1C of 7 is just fine! And that the danger is when these values trend upward over time, which unfortunately they tend to do, into the frank danger zones. I appreciate Dr. Gil's point that the lower end values correspond with chronic disease, and that's different from "higher is healthier;" yet it does seem to me that if strictly following the data, a *little* bit higher is actually, truly healthier! Also, some of these things are not like the others. I've got low (healthy range) blood pressure, 21 BMI, low (healthy range) blood glucose from my low carb, high fat way of eating. I don't have inflammation problems, aches and pains, energy deficits like so many other 50 year olds do, and I'm simply not concerned about my cholesterol. I've got a low resting pulse rate, even, when I tested it at the pharmacy kiosk along with my blood pressure recently. I searched it up and it suggested it could be because a person is old, or an elite athlete. I'm not quite either, so who knows! I feel great and I don't think worrying is going to improve my health OR my disposition.
I have high total cholesterol and LDL but high HDL and very low triglycerides after switching to a low carb diet. My PC angiogram shows no plagues at all in my arteries and I am a senior. What does that tell you?
Thanks for making this. A friend of mine recently sent me an article arguing that people with high cholesterol live longer 🤦🏻♂️. I read the article and it referred to the u-curve and the study was specifically looking at people over 60 which I think would skew these numbers even more. I shared the link to this video with him 💕
Great explanation, thanks! I've seen people saying on social media that you need to eat plenty of dietary cholesterol to maintain high testosterone levels, even recommending pure butter for gains. Others say pretty much the opposite, that fatty foods are associated with lower testosterone. Could you please clarify?
All sexual hormones in both male and female are made from cholesterol, taken it from food is essential for a normal level. Just look at statistics on the age women get to menopause, 30 years ago it was 50+, today when we eat a lot less cholesterol together with other factors of course, many women see signs of menopause at early '40. It's that just a coincidence?
People love good news about their bad habits. Probably the most generally accurate statement I've heard in the health space. I imagine it could be credited for the "cholesterol skeptic" movement.
In a recent interview with Simon Hill - Walter Willet claimed that aggressive lowering of cholesterol may increase risk of hemorrhagic stroke (according to Mendelian Randomisation data) I’ve never heard this claim before - could you make a video exploring this claim?
I had the same thought, had meant to put it up on Simon Hills video as a query but had forgotten. Would be great to understand this with a bit more context.
@@helenryan2848 I personally haven’t heard much from Mulhotra outside of his cholesterol denialism claims. There’s a great article by Dr Alan Flanagan of Sigma Nutrition explaining the errors in his arguments - look up: *Sigma Nutrition - Low Cholesterol & Increased Mortality Risk?: Clarifying the Confusion*
Googling, I see an article from late 2020 in the Journal of Diabetes Investigation about it. As the article put it: "...all meta‐analyses have shown a net benefit of lowering LDL‐C with statins in reducing atherosclerotic cardiovascular disease (including ischemic stroke), which far outweighs the small risk of hemorrhagic strokes."
If you have untreated hyperlipidemia, you can have all of those markers (total cholesterol, LDL-C, triglyceride) dropping to nice levels during an acute infection, things like tooth infection, kidney infection etc.
"I wanted to take a moment to express my appreciation for this fantastic RU-vid channel and the informative content that it provides. This topic is incredibly insightful and well-presented. Thank you for taking the time to share this valuable information with your viewers."
I saw this mentioned recently by a couple of other youtube "doctors" as a reason why you don't need to worry about cholesterol ... glad you made this video to clear that up, thank you!
I admit i was sucked in by dr berg and his chiropractic cronies for a while too, until the likes of gil, brad stanfield, and lately physionic, brought me back from the dark side. Watching dr berg et al now is almost cringeworthy.
@@James-zr1lu Right, especially considering the vast amount of evidence showing the positive effects of lowering LDL. One can't claim to be scientific and just ignore dozens/hundreds of other quality studies.
Gil, Can you please expound on your understanding of the physiologic mechanism by which the cholesterol molecule gets itself positioned beneath the endothelial layer of the systemic artery? In other words, is the endothelial cell actively, or passively, transporting it from the LDL in the bloodstream, through the cell and then expelling it on the other side, or is the cholesterol molecule somehow disrupting the tight junctions between the endothelium and working their way back behind them? If so, how? And if so, why does this never happen in veins and almost never happen in the pulmonary arteries?
Sir, I am a soul who would get behind that except that your thought experiment is entirely invalid. You would not be arguing for people being overweight, hypertensive or pre-diabetic, you would be correcting what the normal healthy range for weight, blood pressure and blood sugar/a1c actually is based on promoting lowest mortality, taking the lowest part of U curves from massive data sets including some amount of rise on both sides to include most healthy people and variation. Based on U curves using the graphs in your video I might assign normal healthy cholesterol as 170-280, healthy BMI as 22-32, healthy blood pressure as 120-160, healthy A1C as 5.6-9. You wouldn't start trying to lower those values unless you were passing the upper end of that normal range and if you were on the lower end you might try to raise them. Cholesterol was frequently in the low to mid 200s in the 1970s and earlier when people had dramatically less diabetes, obesity, chronic inflammatory diseases, exactly where you would expect them naturally to be based on lowest mortality in the data you presented here. Cholesterol is a precursor of many hormones and LDL is a critical component of the immune system in neutralizing bacterial/fungal/viral toxins such as LPS; not having enough LDL can make smaller amounts of toxins fatal.
I see what you mean. we didn't have time to go through it all in this short video but there´s reams of randomized trial data showing a BMI in the obese range or very high BP or HbA1c raise risk of disease and death (same for high cholesterol). that's the trick, our scientific model has to reconcile all existing data
Just to confuse matters,I remember reading that a small number of people have an extremely negative reaction,in terms of greatly increased risk of suicide,to having their cholesterol lowered.I think I read it in 'Genome,' by Matt Ridley.
BMI is deceptive, not measuring fat storage, but erroneously including increased muscle mass. That standard must be completely replaced by existing alternative measurement of body fat composition, fat/muscle, etc.
You nailed it, Dr Carvalho! Thanks for going the extra mile to dig into the data and explain it so clearly. I wonder if the numbers of people with a given level of a blood marker factors into it those graphs, as well. For example: fewer people have an A1c under 5 (than 5.5) so perhaps a larger proportion have subclinical disease?
I would think if disease is lowering the cholesterol, it would also lower the BMI? But the BMI is up for longevity. How can you have disease lower cholesterol but you gain weight?
love the explanation, I wish you make a series on how to understand and interpret data pulled from studies, but on a side note, what kind of chronic disease that would lower HbA1c or blood pressure ?
So what about the 200 total cholesterol being the max? I've seen where several doctors say 250 is a better limit and the curve demonstrates that. Who set the 200 and on what data? Let's please talk about both sides of this observation.
Both reference articles state optimum range of 210-240 Total, the Denmark says 190 is the high end for LDL, but with HDL of 50, 240 still looks reasonable, vs 200 TC in this video. Is it time to challenge this old guidance?.
Unfortunately true. I've taken away some decent advice from them, but the total lack of regard for the data made me unsub from both about a year ago. I despise statins and refuse to touch one ever again, but the claims about how they "help no one and only cause harm" are too extreme. It's also absurd to claim a carnivore diet is healthier than a vegan one when fiber intake is directly associated with mortality. (And I friggin love meat.)
@@heathensein6582 layne norton has a doctorate in biochemistry the cattlemens association paid for his degree, he eats meat and has no hangups about it he clears says that the mandellian randomized trials showed high cholesterol is a independent marker for heart disease, even when low triglycerides were accounted for and high hdl it didn't matter so whose ignoring who
@@heathensein6582well, if you have followed Gil you know what he says: it is a marker, but not always associated with higher risk. It often correlates with ApoB which is much much better associated with risk.
@@BasedChadmanGo volunteer at an animal sanctuary and get to know some pigs, chickens and cows. Hang out with them and pet them. You won't love meat anymore.
This is interesting. I've always wondered if there is a cholesterol level that is too low. My husband is on atorvastatin and his level is 122. When he started it years ago his cholesterol was in the 240 range. I'm thinking of cutting his atorvastatin dosage because that level seems quite low to me.
That level seems healthy to me. For one thing, there is no evidence that intensive cholesterol lowering is dangerous. Quite the opposite ... studies show that achieving very low levels reduces the rate of major adverse cardiovascular events. Brown and Goldstein won a Nobel Prize for their work on cholesterol. They conclude that "plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl (Fig. 16 and ref. 120). In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels (9,119). Second, the LDL level in newborn humans is approximately 30 mg/dl (121), well within the range that seems to be appropriate for receptor binding (Fig. 16). Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl. " www.science.org/doi/10.1126/science.3513311?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
It not all about one number on one test. Must look at big picture and must review his age, race, activity levels, diet and about 19 other blood markers to establish present status. Plus helps to know CAC score or CT scan.
@@DrAJ_LatinAmerica Thank you for your reply. My husband is high risk. Balloon angioplasty 20 years ago, heart attack with stent 6 years ago. One artery still has blockage, but I think his mind/memory has been affected (normal scan for age) and he is bursting out with fast growing skin cancers. He's also a sugar addict. He is 84 years old, though and very stubborn. He totally ignores his health. I need to make him a cardiology appointment soon.
@@jjbud3124 definitely some serious issues. At his age, he needs to do what make him happy. Definitely need to be working very closely with your doctor(s). Always Keep in mind the internet is just very rough broad strokes of information. Not medical advice regarding your husband specifically. All things are case by case, person by person. No one set diet or set of rules applies to everyone. Millions will say people don't need to take a statin medication. However millions are not your husband. Again your doctor has to look at all evidence AND has to base the treatment on the specific wishes of your husband and an agreement to follow treatment. I'm always surprised, but there are many (millions) who refuse to stop drinking, smoking, over eating, eating junk foods,..... Freedom is a double edge sword. But of luck, keep trying and God bless 🙏💪
Wow, thank you for this explanation. I'm particularly and continually confused by diet guidelines these days and health guidelines which are contradictory at best over the last 20 years. I don't know what to eat. I don't know what to think about recent research. It's very difficult to navigate the healthy lifestyle and get it right.
Very true! They contradict each other daily almost . I think eating healthy fruit and veg and occasional meat and fish is the way forward. Moderation like our ancestors ate .
The issue I have with this is that is doesn’t seem to count the biggest killer, coronary heart disease, which is ‘typically’ associated with high cholesterol. Surely that should have had a huge impact on the the mortality rate but this doesn’t seem to generate even a blip on that data? That also should have a much higher impact in the data as the death from heart disease would generally be sudden and therefore the cholesterol state would be at its peak.
Great video! Statins helped me but I stopped after 3 months. From there, diet and walking. Not so much diet as a lifestyle change. Meat was causing belly pain where my gallbladder area is and in my colon. Screw anymore surgeries, I went vegetarian 🥗. Best decision of my life.
excellent - I was also wondering the correct interpretation of the cholesterol U-curve presented in other vidéos. As a layman, I am not equipped with the knowledge to put this information in the right context. What's amazes me is that epidemiologist did not put the correct interpretation either. Thank you for this information.
Interesting ... I am wondering about the size of the risk increase at the lower end. Your argument is interesting, but is it enough to explain the size of the effect. In your opinion does this mean that a) there is a lot more undiagnosed illness than people are aware of, and that is sitting there as a large pool of potential problems representing a large proportion of the population . This is the moderate risk, high population option. b) That the risks of those in this position are very high, so that a limited number of cases are going to be driving the curve up steeply because the risk of mortality is very high. This is the high risk, moderate population option. Or c) something else ?
You nailed it. There is no way it would be that steep... also... what if you have low cholesterol and then get that disease? etc. etc. This assosication to other graphs doesn't prove anything.
Oh boy does this answer a question I formed yesterday after watching one of the "Doctors" vids, where he put up a chart that shocked me! It showed cholesterol number ranges and associated them with good, ok, and bad, colored in Green, Yellow, and Red. This was a very odd chart to me because the "good" range was in fact from about 200-260, ok from 260 to about 340, and over 340 RED. He said however even 350 could be ok for some people! More surprising was the ranges below 200. That started yellow, and when it dropped to under about 100, there was a BIG RED. And yes, he emphasized that was the major risk of death area. I've just stopped watching any of these vids now, but now I know where their data is coming from. Thanks.
Catabolic diseases such as cancer and anorexia often cause a decrease in blood cholesterol levels. It's the catabolic diseases causing death, not the low blood cholesterol levels. Reverse causality. Great video.
Wow, Gil, this was absolutely fantastic. You really put my mind at ease. Thank you so much for this clear, concise, reasonable, rational, scientifically correct explanation. You are doing so much good in this world, and you can tell your mother I said so. (I'm a mom, too, so my guess is she is super proud of you.)
