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 healthypeople.gov 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?

6 thoughts on “Weight and Cholesterol: When Average Is Abnormal”

  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. 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

  3. 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.

  4. 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.

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