Dr. Amy Whittington
Published May 1, 2012
What is your number? Chances are, if you are over 50, you know exactly what your total cholesterol number is. You’re told at every physical, and if it has crept up over 200, or even 180, you’ve likely been prescribed a medication to lower your number to a more acceptable value. If you’ve been treated for cholesterol for a while, you’ve likely reached your treatment goal only to be told at your next visit that the goal number has been lowered again. After all, cholesterol is the villainous dietary component that is the cause of heart disease, and it seems to inexplicably rise in many over 50, right? Well, no, actually. Cholesterol is no villain. It probably isn’t the primary cause of heart disease. And, there is a good explanation for why it tends to rise in those over 50.
In the 1980s, the commonly suggested goal for total cholesterol was 240. The levels were then decreased to 200, and now for many, the goal is 180 or less. The interesting twist is that no number now is considered too low, and I quite often see patients medicated down to 150 or less. Conspiracy theories abound for why these numbers have been tightened repeatedly over the years, and with cholesterol-lowering drugs being arguably the largest moneymaker in the pharmaceutical industry, it’s not hard to understand why these theories exist. Nevertheless, I’m a firm believer that most healthcare practitioners are in the field to help people, and regardless of the type of medicine being practiced, physicians are making the decisions they believe will most benefit their patients. The question is, has the mantra “cholesterol is bad,” been so ingrained in all of us that we have lost sight of the bigger picture? Could low cholesterol be dangerous? Conspiracy theories aside, if we consider the physiological functions of cholesterol we may find that if we lower it too much, it might be detrimental.
Cholesterol performs many important functions in the body. One vital role is as a building block for the membranes that line all of our cells. The fatty make-up of cholesterol is the perfect constituent to separate our cells from fluids but still allow flexibility. Cholesterol is also the main ingredient in the production of all hormones, including the sex hormones estrogen, progesterone, and testosterone. In a study conducted just last year, it was concluded that men who had their testosterone levels normalized with medication had fewer markers for metabolic syndrome (including high cholesterol), than their counterparts with low testosterone. This has led to the postulation that a drop in testosterone might be causing an increase in cholesterol in some men. In other words, as testosterone levels are falling with age, is the body attempting to make more, and in the process producing more cholesterol to use as its backbone?
Cholesterol is also involved in the production of vitamin D, a fat-soluble vitamin that has been linked to decreased cancers, increased bone health, and increased longevity. Low vitamin D levels have become more common in recent years, although it is unclear whether this is related to more awareness and increased testing or an actual decrease in vitamin D levels.
We also know that low levels of cholesterol have been related to increased depression and anxiety, and possibly increased rates of certain cancers. Just what the lower end of total cholesterol should be still remains to be determined. However, the benefits of decreasing cholesterol lower than 200, or certainly below 180, are also undetermined, and risk for heart disease doesn’t rise significantly until that number is closer to 300. In other words, there’s no additional benefit to levels that are “even lower,” and yet millions of people are walking around medicated to the 180s, 170s, or less.
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