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Wednesday, March 2, 2011

Weight and Cholesterol: When Average Is Abnormal

I just discovered that I’m normal, which means that I’m way below average. I’m 5 foot 5 inches tall and weigh about 125 pounds. That gives me a body mass index of 20.8, which is normal. Yet it also means that I’m skinnier than about 95% of the American women my age. To become officially overweight, I’d have to gain at least 25 pounds. To be as fat as the average American, I’d have to gain a total of 40 pounds. To qualify as obese, I’d have to gain a total of 50 pounds.

If you live in the United States, you have probably noticed that most of the people around you weigh more than they should. That’s because you probably know, more or less instinctively, what healthy people are supposed to look like. Unfortunately, we can’t automatically recognize that some of our other measurements, such as our total cholesterol values, are also wildly abnormal. That’s because nobody has an instinctive feel for what healthy blood values are supposed to be. It’s tempting to evaluate them by comparing them to the average values for our population, but how can we tell if the average value in our population is normal or abnormal?

The U.S. federal government’s “Healthy People 2010” guidelines regarded total cholesterol of 240 mg/dL as “high” and a level of 200 mg/dL as “desirable.” Yet people are still at risk for heart disease as long as their total cholesterol is above 150 mg/dL. The last time my blood was tested, my total cholesterol was 120 mg/dL. According to statistics from the Centers from Diseases Control and Prevention, my total cholesterol level is unusually low. More than 95% of the Americans in my age-group have a total cholesterol value that’s way higher than mine. Yet I suspect that my cholesterol levels, like my weight, are normal and healthy. It’s the average person who’s dangerously abnormal.

The numbers are staggering. People whose cholesterol level is “high” by American standards (over 240 mg/dL) have more than twice as much cholesterol in their blood as I have. The average American has a total cholesterol level of about 200 mg/dL. This means that even the average person has far more cholesterol in his or her blood than I do. No wonder their arteries are getting clogged!

My blood cholesterol level may seem amazingly low, but it’s about average for someone in rural China. In the late 1990s, the China-Cornell-Oxford Project found that the average total cholesterol level in rural Chinese people was 127 mg/dL. As a result, heart attacks were rare in China. Overall, American men were 17 times as likely as Chinese men to get a heart attack. American women were about 6 times as likely as Chinese women to get heart attacks.

In some areas of rural China, coronary artery disease was practically nonexistent. A population of a few hundred thousand people could go for a couple of years without anyone under age 65 dying of a coronary. Not one person. The study didn’t analyze the causes of death among the elderly, but there probably weren’t many coronaries among people over 65, either.

Why were cholesterol values and rates of coronary artery disease so low in China? The study showed that diet makes the difference. Overall, the Chinese were eating only about a tenth as much animal protein and three times as much fiber as Americans were eating. The less animal protein people ate, the lower their cholesterol values were, and the less likely they were to die of heart disease and various cancers. There didn’t seem to be any “safe” level of intake of animal protein. Eating even a small amount of animal protein produced a small but measurable increase in risk. On the other hand, the more vegetables people ate, the safer they were.

My cholesterol values look like those of someone from rural China because I eat no animal protein but lots of rice and other grains and vegetables and beans and fruit. Anyone who thinks that this kind of diet is boring or unsatisfying has simply never had dinner at my house.

I know from reading the scientific literature on nutrition that people in the United States could dramatically improve their health and increase their life expectancy by shifting from the standard American diet, with its heavy emphasis on animal protein and its heavy load of fat, to a diet based on unrefined plant foods. This simple correction in the diet would enable people to drop to a normal weight without counting calories or limiting their portions. It would practically eliminate heart disease and greatly reduce the risk of other diseases. So why doesn’t our government tell us about this?

Worse yet, our government is still urging people to eat animal protein. Although the Healthy People 2020 goals supposedly “reflect strong science,” their dietary advice flies in the face of what we learned from the China-Cornell-Oxford study. In particular, the Web site says the following: “Americans with a healthful diet consume a variety of nutrient-dense foods within and across the food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources.” Since we know from the China-Cornell-Oxford study that eating animal protein is the major contributing cause of our major cause of death, and that there’s no safe level of intake of such foods, why in the name of good common sense is our government saying that a diet that includes these foods is healthful?


  1. Found you via Fanatic cook. Nice blog And impressive numbers.

    Would love to read a post that gives more specifics about your own diet - are you a pure vegan? If not what animal products do you eat? Dairy? What are your fat sources? Any limits on certain foods in your diet - nuts for instance? Calorie limits? Do you exercise? How about your family history? Curious minds want to know....Seriously, we need real success stories from real people, not hype.

    Thanks for this post.

    Peggy Polaeczky, MD

  2. Here's the best collection of real success stories that I've seen:

    They've all restored their health by eating a low-fat, high-fiber, purely plant-based diet. That's how I eat, except that I sneak a few potato chips or a piece of dark chocolate every now and then.

  3. I don't count calories, and I don't go to a gym to work out. I normally walk a few miles a day.

  4. Are you concerned that, globally, the lower a person's cholesterol the higher the total mortality rate? And that death rate and longevity is maximal, in global correlative studies, with a cholesterol level between 210 and 220 mg/dl?

    What about Ukraine? They have the highest rate of heart disease on earth with total cholesterol levels below that of Japan, the country with the lowest heart disease rate?

    The idea that low cholesterol = good, and high cholesterol = bad is nice and simple and sweet like the human brain likes things. But it is not congruent with reality.

  5. What makes you think that the average total cholesterol level is lower in the Ukraine than in Japan? That would certainly be interesting, if it were true.

  6. As a health care professional, cholesterol free vegan diets do not make cholesterol low in all people- as genetic high cholesterol is a liver function issue and is not set off from dietary fats. My afmily is a classic example. The acidity in foods/beverages worsen lipid levels in these genetic people. Plus, statistically according to the AHA half of all heart atttacks occur in people with cholesterol levels BELOW 200.

  7. Many heart attacks do occur in people with total cholesterol between 150 and 200 mg/dL. However, the Framingham study found that heart attacks are practically nonexistent among people whose cholesterol is below 150 mg/dL. Other epidemiologic studies and clinical studies point to the same conclusion. The AHA's cutoff is simply too high.

    The AHA should be urging people to make themselves heart-attack-proof by achieving a total cholesterol level of below 150, not below 200. Nearly everyone can achieve that level if they eat a low-fat, high-fiber, plant-based diet.

    The cholesterol in the food is not the only cause of high blood cholesterol. Although plant-based foods contain practically zero cholesterol, a vegan can have high cholesterol levels from eating too much fat, including too much olive oil. There are plenty of "junk food vegans" who have fattened themselves on potato chips and olive oil and other processed foods. These individuals also tend to have high cholesterol and are at risk of dying of coronary artery disease.

    There is a hereditary disease called familial hypercholesterolemia (FH). However, FH is so rare that the people in your family probably don't have it. FH occurs in about 1 in 500 persons of European ancestry. If you have one copy of the FH gene, then your cholesterol will be so high that you will have visible deposits of cholesterol in your skin and obvious problems with your joints. About 1 in a million persons have two copies of the FH gene. They usually die by age 30 unless they receive heroic treatment, such as a liver transplant. Of course, a low-fat diet is an essential part of managing FH, for people with either one copy of the gene or two. So if you and your relatives do have FH, it's all the more reason to cut way back on your fat consumption and to stop eating any cholesterol whatsoever.

    There are a few other medical problems that can cause high cholesterol levels. One of them is hypothyroidism. Low thyroid levels can even lead to high cholesterol levels in a natural carnivore, such as a dog.

    I'm not sure where you got the idea that acidity of food and beverages causes high cholesterol. The fatty foods that promote high cholesterol tend to add a lot of acid to the bloodstream (high potential renal acid load) because they are rich in phosphorus and high-sulfur protein. The fruits and vegetables that help to reduce blood cholesterol foods tend to produce a mild NEGATIVE net potential renal acid load (ie, are mildly alkalinizing) because they contain potassium and magnesium. Note that potential renal acid load refers to the effect of the food on the acid load in the bloodstream after digestion, not on the pH of the food in your mouth. Some organic acids, such as citric acid, are easily broken down in the liver and do not increase potential renal acid load. So even though oranges and lemons are acidic in your mouth, which is why they taste sour, they have a net alkalinizing effect on the bloodstream. In contrast, the phosphoric acid in soft drinks and the benzoic acid in cranberries cannot be broken down into nonacidic substances and therefore do increase potential renal acid load.