How Low Should Your Cholesterol Levels Be?

Ideally, your total cholesterol should be below 150 mg/dL. According to William Castelli, who was the medical director of the Framingham Heart Study for many years, people with a total cholesterol value of less than 150 mg/dL simply don’t get heart attacks. And once someone’s total cholesterol is that low, the ratio between the “good” and “bad” cholesterol simply doesn’t matter.

The total cholesterol value is the single most important clue to a person’s risk of heart attack. Once the cholesterol levels in the blood rise to, say, the mid-160s, then the ratio of good versus bad cholesterol (HDL versus LDL) really starts to matter.

William Castelli once explained, “Four out of five people on this earth can’t get their cholesterol over 150; they don’t get heart attacks. One out of five people can’t get their cholesterol down to 150. They do get heart attacks. And almost all of them live in affluent countries.” The “four out of five people” Castelli meant live in societies that eat a low-fat, high-fiber, largely plant-based diet. That kind of diet keeps blood cholesterol levels naturally low.

To see how cholesterol values relate to the risk of heart attack, look at the graphs on this page:

Coronary Artery Disease Is Not a Mental Disorder

Many laymen and even many doctors like the idea that people can give themselves a serious physical disease just by having bad thoughts, unpleasant feelings, or annoying personality traits. Yet it’s hard to find any scientific evidence that these psychological phenomena have any real effect on health. Nevertheless, the attempt to “psychologize” physical illness persists.

Although many people like the idea that their thoughts can influence their health, people can be amazingly resistant to the idea that their food choices matter. If I were a psychologist, I would use my training to figure out why our doctors in the United States ignore the overwhelming evidence that the standard American diet is the underlying reason for our major causes of death and disability. I’d try to figure out ways to help people realize that they’re eating their way into an early grave. I’d try to find ways to help people improve their diet, so that they can improve their health. Instead, psychologists have been trying to prove that coronary artery disease is a mental disorder. It would be funny if it weren’t so tragic!

By the end of World War II, anyone with common sense and access to the scientific literature should have realized that coronary artery disease results from the foods that people eat, not from the kinds of thoughts and feelings that go on in their minds. For example, heart disease became rare in Norway after the Nazis stole their farm animals and the Norwegians had to switch to a low-fat, plant-based diet. Rich, fatty foods were also in short supply for the civilian population in Germany during the war. As a result, German civilians stopped dying of heart attacks, despite all the stress and terror of Allied bombing raids.

After seeing these data, Nathan Pritikin realized that heart disease results from the foods people eat, not from the emotional stress in their lives. When he got a diagnosis of coronary artery disease, he cleaned up his own diet and encouraged others to do the same.

Nevertheless, Americans still clung to the idea that heart disease is a mental disorder. First, people thought that the cause was “emotional stress.” Then they blamed “type A personality.” Then they blamed “pessimism.” It’s all a crock. Lots of people in China had emotional stress, type A personalities, and pessimism. Yet research showed that they weren’t dying of heart attacks, because their average cholesterol was shockingly low by American standards, thanks to their low-fat, high-fiber diet.

The Plate’s Not Much Better Than the Pyramid

The United States Department of Agriculture has ditched its creepy Food Pyramid, which for many people conjured up grisly images of Aztec human sacrifice.


Unfortunately, the USDA’s new “plate and cup” graphic still provides deadly nutritional advice. It still urges people to eat far more fat, cholesterol, calcium, and animal protein than is good for them. Thus, it will contribute to our major causes of death and disability in the United States, without doing much to solve any of our real public health problems.

myplateThe new “plate and cup” graphic is simply a way to communicate the lessons from the most recent edition of Dietary Guidelines for Americans. Federal law requires these guidelines to be reviewed, and updated if necessary, every five years. The guidelines are created by a joint committee of the USDA and the US Department of Health and Human Services, with input from other federal agencies and the public. The 2010 edition was issued in January 2011.

Unfortunately, the guidelines are designed to address two nonexistent problems, while failing to help people avoid or recover from our biggest causes of death and disability. The guidelines are designed to ensure that Americans consume “enough” protein and calcium, even though it’s practically impossible to find any real human beings who have a true deficiency of either one. Meanwhile, the guidelines actually encourage people to eat foods that increase the risk of heart disease, cancer, type 2 diabetes, low back pain, osteoporosis, and autoimmune diseases such as arthritis and type 1 diabetes.

Nutrition scientists have known for more than 100 years that human protein needs are easily met by any practical plant-based diet, as long as people are eating enough food to get enough calories. For more than 50 years, they’ve known that all of our common staple plant foods provide enough of all of the essential amino acids. People would get plenty of protein even if they ate nothing but potatoes; thus, there’s no justification for urging people to eat animal-based “protein foods.”

The “protein foods” that come from animals pose serious health risks. They are devoid of fiber and digestible carbohydrates. Instead, their calories come in the form of fat and protein. Any overload of protein stresses the liver and kidneys. Worse yet, animal proteins also tend to promote cancer, osteoporosis, and autoimmune disease. The heavy dose of calcium from dairy foods actually seems to increase, rather than decrease, the risk of osteoporosis.

The current guidelines also encourage people to eat far more fat than is good for them. The current guidelines do encourage people to eat less saturated fat, but to replace it with polyunsaturated fats. The result would be only a slightly lower risk of heart disease, offset by a higher risk of cancer. Most people should keep their fat intake to 10% or less of calories.

The Dietary Guidelines for Americans do encourage people to eat more fruits and vegetables and to replace refined grain products with whole-grain products. However, they fall far short of telling people how they can achieve optimal health. That’s a scandalous failure, considering how many Americans lack health insurance and thus have limited access to professional guidance, including advice from a registered dietitian.

Like our government’s failure to provide an efficient, publicly-financed universal healthcare system, the shortcomings of the Dietary Guidelines for Americans represent our government’s failure to “promote the general welfare.” Instead, our food and healthcare policies promote the welfare of the powerful corporations that finance our elections and whose lobbyists stalk the halls of Congress.

These problems have persisted for decades. They are not going to solve themselves. These problems will be solved only if health activists work to elect Representatives and Senators and a President who care far more about human beings than about corporations and if health activists provide such pressure during the “public comment” phase for the next edition of the guidelines that USDA will have no choice but to serve the American people instead of the food industry.

French and Japanese Paradoxes

By now, you’ve certainly heard about the “French Paradox,” a dream that entered American consciousness in 1991, when it was described on the television program 60 Minutes. According to this dream, drinking red wine will protect you from heart disease, even if you eat lots of high-fat, high-cholesterol food. Although the risk of heart disease was lower in France than in Britain, the difference was not due to some magical properties of wine. It was due partly to under-reporting of coronary artery disease as a cause of death and partly due to a time-lag effect. It takes a while for a fatty diet to clog up your arteries, and the French hadn’t been eating as much fat as the British had been eating for as long as the British had been eating it. These explanations had been published in the British Medical Journal in 1999. You can read the article for free here.

If you want to eliminate your risk of heart attack, not just decrease it a little, you’d eat a low-fat, purely plant-based diet.

Alcoholic beverages, including wine, can have several effects that influence a person’s risk of dying of a heart attack. Winos who die of cirrhosis of the liver often have amazingly clean arteries. That’s because their liver lost the ability to make cholesterol. Even moderate intake of alcoholic beverages can have several effects on coronary artery disease. The antioxidants in some alcoholic beverages, including wine, could prevent LDL cholesterol from becoming oxidized, and thus could help reduce the buildup of atherosclerotic plaque. Of course, you could get these same antioxidants from plant foods that haven’t been fermented. Alcohol can also thin the blood, and thus help to decrease the chance of a fatal heart attack or ischemic stroke. On the other hand, it would increase the risk of a fatal hemorrhage. I haven’t seen any convincing evidence that adding any form of alcohol to a low-fat, plant-based diet would provide any health benefits.

The French paradox turned out to be a myth. However, there are some Japanese paradoxes that are real. One involves cigarette smoking. The other involves obesity and diabetes.

Japanese smokers are less likely than American smokers to get lung cancer. This is called the Japanese Smoking Paradox. Some people think that it’s because Japanese are smoking safer cigarettes or have some magical protective genes. The more rational explanation is that the Japanese have been eating less fat and animal protein and more vegetables than Americans have been eating. Eating the traditional Japanese diet, as opposed to the standard American diet, helps to protect people against many kinds of cancer, not just lung cancer.

Another paradox involves Japanese children. Over the past few decades, Japanese children have been getting fatter, and the incidence of type 2 diabetes among Japanese children has been going up. This has been happening even though their calorie intake hasn’t increased significantly. They have been eating a lot more fat and animal protein. In other words, they’ve been getting a smaller percentage of their calories from carbohydrates, which were mainly in the form of white rice. So why do the low-carb gurus keep telling me that we need to eat more fat and less carbohydrate? Is this another paradox? If so, what should we call it?

Calcium Supplements: More Heart Attacks, but Also More Osteoporosis

Women in the United States are continually pressured by their doctors and by the media to eat a high-calcium diet and take calcium supplements, supposedly to prevent osteoporosis. I resist this advice, because I’ve known for more than 20 years that osteoporosis is actually most common in the populations with the highest calcium intakes. Now, a study just published in the British Medical Journal warns that calcium supplements could also raise the risk of heart attack, which is the major cause of death in women in the United States.

I found out about the link between high calcium intakes and osteoporosis in the late 1980s, while I was editing a handbook for dietitians. The author wrote that osteoporosis is common only in societies where people eat a lot of dairy products. I was shocked by this information. Later on, I found that both the high protein content and the high calcium content of dairy foods are implicated in causing osteoporosis. For years, Harvard professor Mark Hegsted warned people that osteoporosis was a result of the same kind of diet that causes heart disease. He specifically warned that high calcium intakes probably make osteoporosis worse. Sadly, his warnings fell on deaf ears.

Reading the article in the British Medical Journal made me angry. The study it described was a meta-analysis, which means that it compiled the results of several clinical trials. The researchers found 15 clinical trials in which women were given either calcium or placebo, mostly for the prevention or treatment of osteoporosis. What angered me was the dates of the studies. The earliest one was published in 1989, the latest in 2008. Even by the time the earliest of those studies was done, there was already plenty of reason to believe that calcium supplements would have made the women’s osteoporosis worse, not better. In other words, human research subjects were subjected to unnecessary harm. That sort of thing is a huge violation of medical research ethics. It’s also illegal in civilized countries.

Medical researchers are supposed to do their homework before they start enrolling human beings in a clinical trial. By the time that first study was done, it was already obvious that high calcium intakes make osteoporosis worse, not better. Harvard professor Mark Hegsted explained the problem in an article published in 1986, before the first of the studies included in the meta-analysis.

It’s bad enough that the average doctor has had little to no training in nutrition or dietetics. What’s even worse is that some of the doctors who are doing nutrition studies evidently don’t bother to read the scientific literature on nutrition before they start experimenting on human beings.

According to the article in the British Medical Journal, there were 143 myocardial infarctions in the patients assigned to take calcium and 111 myocardial infarctions in the patients assigned to take a placebo. If these women had been given proper counseling on how to make themselves heart-attack-proof, all of these heart attacks could have been avoided.

Photo by German Tenorio

My Cholesterol Is Too Low for the Heart Attack Risk Calculator!

I tried to use the National Cholesterol Education Program’s Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack. I entered my data on the form, and I got back an error message, telling me to enter a total cholesterol value of 130 or greater! According to the calculator, even if my cholesterol went up to 130 mg/dL, I’d still have less than a 1% chance of having a heart attack within the next 10 years.

(Note: here’s a live version of the tool, which does not give an error message:

If I ran the National Cholesterol Education Program, I’d really educate people about cholesterol. I’d tell them the simple truth: that when you keep your total cholesterol at less than 150 mg/dL, coronary artery disease ceases to exist. Nearly everyone can easily achieve that goal by eating a low-fat (<10% of calories), plant-based diet.

Instead, the NCEP tells people that a total cholesterol level of  up to 200 mg/dL is “desirable.” Lots of people with this “desirable” cholesterol level are dying of heart attacks, which is why many people, including many doctors, are confused.Photo by winnifredxoxo

Clinton’s Heart Problems Really Are a Result of His Diet

Why Won’t More Doctors Tell Their Patients How to Make Themselves Heart-Attack Proof?

Back in 1855, a prominent Baptist preacher told his flock, “A lie will go round the world while truth is pulling its boots on.” Nowadays, lies can travel even more quickly, thanks to the magic of the Internet. On Friday, February 11, 2010, the Associated Press sent around a news item titled “No cure for heart disease, Clinton’s case shows.” According to the article, former President Bill Clinton has just had more surgery to unclog his coronary arteries. He had a quadruple bypass in 2004, and now he has just had surgery to open up one of the bypasses. According to the Associated Press, Clinton’s cardiologist, Dr. Allan Schwartz, told a news conference, “This was not a result of his lifestyle or his diet.” That’s a lie.

Compare what Dr. Schwartz said with the opinion of Dr. William Castelli, who had been chief of the famous Framingham Heart Study. When an interviewer asked how many heart attacks can we wipe out by changes in lifestyle, Dr. Castelli responded, “All of them. There are five billion people on this earth. Four-billion-plus will never get a heart attack. Why can’t we be like them?” Castelli explained that keeping cholesterol low through eating a healthy diet has added benefits: “Studies from China show that if your cholesterol is low, you won’t get breast or colon cancer or diabetes either.”

To make ourselves immune to coronary artery disease, we simply need to keep our total cholesterol below 150 mg/dL. Castelli explained, “Your cells need cholesterol to make cell membranes and hormones. But when your total cholesterol is over 150—or your LDL [“bad”] cholesterol is over 90—the cells have more cholesterol than they can use and no way to get rid of the excess. They can’t break down or oxidize it, so it starts to pile up as a waxy deposit that will eventually choke the cells.”

Population studies have shown that people who eat a low-fat, plant-based diet are “immune” to coronary artery disease. Even when a population with a high risk of heart disease is deprived of their favorite fatty, animal-based foods, as a result of food rationing during wartime, their risk of heart attack plummets. It comes right back after people resume their old eating habits, so the problem is dietary, not genetic. Dr. Caldwell Esselstyn ( has shown that even patients with advanced coronary artery disease can make themselves “heart-attack proof” by switching to a low fat (<10% of calories), plant-based diet.

Bill Clinton’s heart disease could have ended his life and may still do so. One prominent physician has pointed out that bypass surgery does almost nothing to save lives, and he provoked a controversy by arguing that Clinton’s bypass surgery has had a detrimental effect on the former President’s mental functioning. The bypass surgery itself dislodges bits of crud from the major arteries, which then cause tiny blockages (mini-strokes) in the brain. The decline in mental functioning after bypass surgery is so well recognized in medical circles that they have a slang term for it: “pump head.”

Like the sex scandal that led to his impeachment, Clinton’s heart problems result from his indulgence of unhealthy appetites. Articles about Clinton’s heart problems represent a “teachable moment” to tell the American public what a healthy diet really is. Yet once again, this opportunity is squandered.

Photo by sharedferret

What People Can Achieve by Eating a Low-Fat, Plant-Based Diet

If you have any chronic health problem, I don’t care what it is, consider making a change in your diet. Often, a simple exclusion diet protocol can help you cure devastating diseases like type 2 diabetes or rheumatoid arthritis. It can also make you heart-attack-proof and reduce your risk of cancer. A change to a low-fat, plant-based diet is simple and cheap and has no side effects. If you have any serious health problem, talk to a registered dietitian (look for the “RD” after their name) as well as your doctor before making a change in diet.

Lose Weight

The secret to effortless weight loss is to go ape and eat plants. Switch to a high-fiber, low-fat diet based on unrefined starches and lots of vegetables. Eat as much of these foods as you can hold, and you’ll be less tempted to snack on high-calorie junk food.

Stop Multiple Sclerosis

Dr. Roy Swank showed that you can stop the progression of multiple sclerosis just by taking the animal products and fat out of the diet. Dr. John McDougall is carrying on this research.

Become Heart-Attack-Proof

Dr. Caldwell Esselstyn took a bunch of patients with advanced coronary artery disease and made them “heart-attack-proof” just by teaching them to eat the right kinds of food.

Cure Type 2 Diabetes

Dr. Neal Barnard proved that a low-fat, plant-based diet is better than the American Diabetes Association’s standard dietary recommendations for controlling type 2 diabetes. Dr. Joel Fuhrman’s patients with type 2 diabetes become “undiabetic” within a matter of weeks if they eat that way.

Dramatically Reduce Your Risk of Cancer

T. Colin Campbell, PhD, a world-famous nutritional biochemist and nutritional epidemiologist, has shown that the more animal-based foods people eat, the higher their risk of cancer. In animal models, scientists could turn the development of tumors on and off just by increasing or decreasing the amount of animal protein in the diet.

Fight Arthritis

Arthritis is not an inevitable consequence of age. It is comparatively rare in societies where people eat a low-fat, plant-based diet. About 70% of people with the most common form of inflammatory arthritis, rheumatoid arthritis, can expect dramatic benefits, and often a cure, in less than 4 weeks of diet change. The diet must be followed strictly—medications are reduced and stopped as improvements occur.

Prevent Osteoporosis

Osteoporosis is reversible, if you eat a plant-based diet, get reasonable exposure to sunshine, and get some exercise. Believe it or not, dairy products actually make osteoporosis worse.

Relieve Inflammatory Bowel Diseases

Inflammatory bowel diseases occur almost exclusively in parts of the world where the diet is high in meat and dairy foods, and are rare in countries where people still consume starch-based, almost entirely vegetarian meals.

Avoid Surgery for Gallstones

Gallstones are usually made of cholesterol, and they result when people overload their system with fatty, high-cholesterol foods.

Prevent Varicose Veins, Hemorrhoids, Hiatal Hernia, Uterine Prolapse

All of those disorders result from constipation. When people strain to move their bowels, the abnormally high pressure in the belly can damage the valves in the veins and push various organs out of their normal positions.

Appendicitis and Diverticulosis

The high-protein, low-fiber Western diet is the cause of appendicitis and diverticulosis.

The List Goes On and On

Many other diseases have been shown to be the result of the rich, fatty, low-fiber standard American diet. I should also have listed acne, bad breath, body odor, and erectile dysfunction, along with kidney and liver disease. The sad thing is that many people unwittingly subject themselves to these diseases in their attempt to avoid “protein deficiency,” even though protein deficiency isn’t a real problem in human beings. After all, where do gorillas get their protein?

How Low Should Total Cholesterol Be?

Below 150 mg/dL, According to Dr. Caldwell Esselstyn

“Based on the groundbreaking results of his 20-year nutritional study—the longest study of its kind ever conducted—this book explains, with irrefutable scientific evidence, how we can end the heart disease epidemic in this country forever by changing what we eat. Here, Dr. Esselstyn convincingly argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects.”

Heart attack is virtually nonexistent in populations whose heavily plant-based diet keeps the average person’s total cholesterol below 150 mg/dL.