Dr. Amy's May Wellness Tip
Cholesterol - How Low is Too Low?
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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With obvious beneficial functions of cholesterol paired with known side effects of low levels, it is obvious that we at least need to consider medicating less, and allowing cholesterol levels to rise again. As you contemplate this, also realize that the medications that are being used, and likely over-used, are not without their own side effects. The most common cholesterol medications, the statin family of pharmaceuticals, have long been related to myalgia (generalized pain), possible liver damage, and more recently to dementia. In February of this year, the FDA added dementia to the label as a side effect of these drugs, along with elevated blood sugar level (which, ironically, is a co-morbidity for many who are taking statins). Many argue that the benefits still outweigh the risks, but you should ask yourself if you are really benefiting enough from these medications to justify their side effects.
Reports of over-inflated statin results and questions of whether their use decreases disease or death at all are around, but again, conspiracies aside, we need to be aware of the physiology to question whether we’ve over-villainized cholesterol. For years we blamed cholesterol for heart disease nearly exclusively. We now know that inflammation in arterial walls is likely the instigator, and without these damaged walls, cholesterol has nothing to stick to and won’t cause hardening of the walls (arteriosclerosis) or a clot (atherosclerosis). This is why so many people who do have high cholesterol, especially young people who have familial hypercholesterolemia, don’t usually have heart attacks at a young age. Additionally, cholesterol won’t stick to the walls unless it becomes oxidized, or damaged by free radicals. If you want to decrease your chances of a heart attack, decrease your inflammation and increase your anti-oxidants (your doctor should be able to tell you how to eat a low inflammatory, high anti-oxidant diet).
All of this isn’t to say that cholesterol shouldn’t be held in check, as it does also play a role in heart disease. The point is simply this: cholesterol, like most substances that occur naturally in the body, serves many important roles. We have become so focused on keeping it low that we just might have lost sight of its necessity, and become too tolerable of medication side effects that may not be necessary at all. It’s important to know your number, so as always, see your doctor for your physical, but don’t be afraid to ask the question, “How low is too low?”
Take Care & Stay Healthy,
Dr. Amy Whittington
100 per cent true