China

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?