The People's Perspective on Medicine

Can Cholesterol Go Too Low?

Too low cholesterol has unexpected and potentially harmful complications including an increased risk for bleeding strokes.

Goldilocks didn’t know beans about cholesterol, but she was an expert on porridge–not too hot, not too cold. We wish cardiologists were more willing to follow her example.

Everybody knows that when cholesterol gets really high (familial hypercholesterolemia), it increases the risk of heart attacks and strokes. But did you know that when cholesterol is too low that can also be dangerous?

What Are the Dangers of Low Cholesterol?

A study has confirmed that low cholesterol increases the risk of bleeding strokes. These events are less common than strokes caused by blood clots, but potentially even more devastating.

Dr. David L. Tirschwell reported to the American Heart Association in 1999 that people with cholesterol under 180 had twice the risk of strokes caused by bleeding into the brain as those with cholesterol counts around 230. The idea that low cholesterol levels could increase the hazard of a devastating hemorrhagic stroke doubtless came as a shock to many cardiologists and neurologists who believe you can’t have too low a golf score or cholesterol level.

This is not to suggest that high cholesterol isn’t a problem: by the time cholesterol gets up to 280, the risk of stroke caused by a blood clot doubles, compared to the risk for people with cholesterol around 230. The ideal, according to Tirschwell, is probably to keep cholesterol near 200.

That is roughly a target once established by the National Cholesterol Education Program. Dr. Tirschwell told the Associated Press, “I swear I didn’t plan it that way.”

Although Dr. Tirschwell’s research surprised many people, the finding that low cholesterol may put people at risk is not. Over 30 years ago, Japanese researchers found that men with cholesterol below 178 and women with readings lower than 190 had a higher risk of cerebral hemorrhage.

And back in 1986, American investigators reported from a long-term study in Honolulu that middle-aged men were safest when their cholesterol was between 200 and 220. Those with cholesterol below 150 had four times the risk of bleeding stroke.

Do We Need Cholesterol?

Clearly, heart disease and stroke are more complicated than cholesterol alone. Scientists think that a certain amount of cholesterol is necessary to maintain the integrity of blood vessels in the brain.

Cholesterol may also affect neurochemistry. Researchers have been puzzled by the recurrent association of low cholesterol and violent death, especially from suicide. Cholesterol that is very low may alter mood and affect behavior in ways that are not completely understood.

Cardiologists have long known that total cholesterol is not the only important risk factor for heart attack and stroke. Many people with cholesterol levels under 200 still get heart attacks.

Different Kinds of Cholesterol

Part of the story may be the different types of cholesterol. High-density lipoprotein (HDL), the “good” cholesterol, can be protective. The ratio of total cholesterol to HDL is crucial. It should ideally be 4.5 or below. Triglycerides may play a more important role than cardiologists once thought. Keeping triglycerides below 100 makes sense to us. That can happen by reducing carbohydrate intake and adding fish to the diet.

Keeping Your Heart Healthy

Anyone who would like to get beyond the cholesterol craziness might find our chapter on Heart Disease in the 524-page book Best Choices from The People’s Pharmacy quite helpful. In it we mention that physicians have known for more than three decades that there are over 240 risk factors for coronary heart disease.

Why American medicine has focused almost exclusively on cholesterol remains a mystery to us. Perhaps it has something to do with the pharmaceutical industry. No doubt you have heard the phrase, “When all you have is a hammer, everything looks like a nail.” Doctors do have powerful statin-type cholesterol-lowering drugs, but they come with a price, ie, some potentially serious side effects.

Americans have a hard time with moderation. We’ve met many people who continue to strive for lower cholesterol even when they get their number below 200. But as Goldilocks would tell you, cholesterol shouldn’t be too high or too low. Somewhere around 200 is probably just about right.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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My husband is 85 and got a couple of stents about 20 years ago, and two years ago, he had mitral valve and tricuspid valve repair. He was on Warfarin for about 9 years for an arrhythmia prior to that. That was corrected during his valve repair and he has had no issues with that since. He also got a pacemaker after the surgery, because the common side effect of valve repair is a slow pulse. He recovered very well and has had no more heart issues. His heart has returned to normal size. He has never had high cholesterol. Yet, he is on Lipitor 10 mg, which has caused his total cholesterol to be 95. His LDL is 28, HDL is 59, and triglycerides are very low. He is slow thinking and moving, has no energy, and is quite depressed. I told him to stop taking the Lipitor until the numbers are more reasonable, because this is crazy! What’s the matter with the PCs and cardiologists that they will just let this go on as if it’s normal?

I have been having memory issues, anxiety, irritability and focussing issues. My cholesterol is extremely low (around 78) and my blood pressure is naturally low as well.

I am 56, exercise almost every day, juice, and eat very healthy. I do eat meat and use good fats as well.

Could the low cholesterol be the reason for these symptoms and how can I raise the levels permanently? I have recently had mini strokes and don’t this to lead to a major stroke.

I work in Health Screening where I check shoppers’ cholesterol at grocery stores for free. Today I had a tall skinny guy come by. I checked his blood, and it came out 122 total cholesterol. He started to flip out on me saying that was too high for him, and that the last time he checked it, it was 97. I was like “Um, that is NOT GOOD.” He kept telling me that NOOO, his Cardiologist said it was fine to have it that low. I told him that his body needs cholesterol to function and keep healthy. He thought I was crazy and got mad and took his papers and walked off saying my machine was wrong. LOL. And doctors are giving out completely wrong info.

My husband had a cholesterol blockage stroke, high in one carotid artery, in 2007. He has healed very well even tho’ the blockage remains. The Docs put him on blood thinners, blood pressure meds and statin drugs of course. I begged them to take him off the bp med (he’s never had any high bp and is in very good physical condition)(an avid golfer) but was afraid to ask for adjustments of the other meds. But lately his total cholesterol has gone too low IMHO, around 150-160. He is showing signs of fast aging like slow thinking, old-sounding voice, bad short term memory, even minor hallucinations, like remembering something that didn’t really happen. I’m convinced that he needs to back off the statins but that’s scary & of course his Docs disagree. . . . thank u4 this report

Lolly, Did you ever rectify this? I realize it is 2 years later but I see my husband’s brain deteriorating also at 160. Please advise if you get this. BTW, he is not on statins, it just started dropping…. Thank You

My doctor said I had a little of low cholesterol levels so he recommended to eat fish o_o i don’t really know but I’m only 20 and my dad died in his 30s from a stroke. HELP!

I just went to my doctor this morning for results of lab work. The last time my cholesterol was high.. He wanted me to take statins I refused and told him I would do it my way….fish oil capsules 1 daily and Red yeast rice.. 2 daily. Cholesterol went down and good went up. He was surprised and asked what I did… He was fine with that. I don’t want mine to go any lower it is 197 now it was 203 which I don’t consider high. All blood work was spot on. I suggest Red Rice Yeast for those with high cholesterol . Just my opinion and it works for me. Good luck to all.

I have very low cholesterol also with the total being as low as 79. I have always asked doctors about it but all they ever say is “thats great”! I knew better though and thought that if it is ok or normal than why do the test results say that it is out on the low end. Most tests have a high or low comment when the values are out.

Once while in the hospital a nurse came to my room and said she noticed my cholesterol levels were very low showed I had low cholesterol and she was curious because she also had low levels. I did get stage 2b breast cancer and have survived 10 years now. I hope I never get a stroke but I do hope they come out with meds that will raise cholesterol.

Cholesterol of 69 and lol of 9 sounds dangerous. I have a pace maker and a defibrillator. Rad and raynonsense disease, are these numbers out ofor control

I too have LOW cholesterol. My LDL’s were 17 when checked in June 2015. My total was 82. My Triglycerides were 32
I have chronic pancreatitis and maybe a fatty liver. I weigh 160 and am 6 foot tall. I cannot find a doctor that says the above is a problem but I feel awful and have no energy. How do you raise your cholesterol? I have tried shrimp, beef, eggs, butter, bacon etc. Any doctor referrals? Any good reads to help me?

Rick, I am not sure if I can help but let me tell you a little about what is happening to me and the doctor I am using. My cholesterol level is -77 crazy right? I have had a major skin issue for the last year plus no energy, depression…etc. Come to find out, my body is also not producing hormones because the body needs cholesterol in order to do so. I have just discovered all of this in the last couple of weeks and am trying to put my body back on track naturally with supplements and diet. I am now taking hormones. My doctor is an MD who now practices getting to the cellular level of what is going on in the body. If you are still struggling maybe she can help. Dr. C Matzinger, Institute of Healing in Las Vegas. I am still in repair mode but have noticed a considerable difference in my energy levels and mood, plus my skin is getting better everyday, less episodes of itching and swelling.

Rick, I am not sure if I can help but let me tell you a little about what is happening to me and the doctor I am using. My cholesterol level is -77 crazy right? I have had a major skin issue for the last year plus no energy, depression…etc. Come to find out, my body is also not producing hormones because the body needs cholesterol in order to do so. I have just discovered all of this in the last couple of weeks and am trying to put my body back on track naturally with supplements and diet. I am now taking hormones. My doctor is an MD who now practices getting to the cellular level of what is going on in the body. If you are still struggling maybe she can help. I am still in repair mode but have noticed a considerable difference in my energy levels and mood, plus my skin is getting better everyday, less episodes of itching and swelling.

My cholesterol is consistently low. The last time is was checked it was 102. The low end of normal is 124. I have a feeling that it being this low is not good for my health.

There are two ways of looking at this controversy. – prevention of heart disease and – treatment of existing heart disease (those with heart attacks, stents bypass). For existing heart disease, statins are a must prescribed drug by most cardiologists. Levels of LDL should be less than 75. Total cholesterol is difficult to determine as an indicator casue it can be achieved in many ways. If one has a low normal good cholesterol HDL of 40 and a LDL of 65, the only way to get to total cholesterol of 180 would be to have a triglyceride level of 375. That number by any means is unacceptable to either preventive or primary treatments. The only way to improve that goal would be to raise HDL which is very difficult and influenced as much by genetics as diet. It is a tricky science, but he body and brain needs cholesterol to function, but a high triglyceride level is very very dangerous. There are no easy answers. Patients should discuss this article with their doctor for their own specific concerns.

My doctor has been pushing for me to take a statin, which I have refused. I am a Type 2 diabetic and my last cholesterol test was 153. However my Triglycerides were 231, HDL 29, VLDS 46 and LDL 78. I am female, 67, have a BMI of 36, work full-time and am moderately sedentary. I have no other health issues and my doctor says my diabetes control is excellent while taking twice daily 2 500mg Metformin and 1 1mg Glimepiride. I have recently lost 7 pounds and now that the weather is cooling down, I will be increasing my walking activity to two miles daily. I have reviewed the side effects of statins and believe they are a greater risk to me than my current state of health.

RT: Try lowering Carb/Sugar to decrease Triglycerides… Kudos to you for not taking a statin, which are riddled with a plethora of side effects, most physicians are not even remotely aware of.

OFF TOPIC: I really like the new web design for topics and comments.

Thanks!

I agree that we should have low triglycerides (by eating fish /taking fish oil and favoring slow carbs). I also understand that how high the levels of cholesterol may be less important than how sticky your LDL cholesterol is. Since over half of the people having heart attacks had “normal” cholesterol levels, this does not seem to be a good predictor. Some of our more holistic heart specialists emphasize keeping blood stickyness down in addition to healthy eating, exercise, getting enough sleep and reducing stress. I enjoyed The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease-and the Statin-Free Plan That Will,by Jonny Bowden, and Dr Stephen Sinatra. If you like to read, I also suggest Vitamin K2 and the Calcium Paradox by Kate Rheaume-Bleue. These are both very good books, pretty easy to read. May even be in your library! Thanks for the discussion…

This is an interesting topic that I would like to follow.

I want to send this to my doctor who was insisting that I take statins because my cholesterol hit 230. I got it down to 203 with diet and exercise and that’s where I’ll try to keep it!

Deb…good luck sharing with your doctor…most are too proud, know-it-alls…how dare you tell me how to do my job. At least in my experience and from what many others have shared with me…maybe consider familiarizing yourself with statistics, and ask you doctor if he is making his recommendation based on the drug company hyped Relative Risk Reduction or the more factual Absolute Risk Reduction..here is a good explanation: http://www.patient.co.uk/health/Risks-of-Disease-Absolute-and-Relative.htm
Good luck and do not be bullied into doing something you do not want to do!!

This article would be more helpful if you could instruct those of us with low cholesterol HOW to raise. Mine is at 110 and the only time it went up was about 20 years ago when I got hooked on microwave popcorn. My Dr. had a fit and told me to stop it. Come to find out corn is one of the things I’m sensitive to as well.

I have no veggie oils in the house, other than Extra Virgin Olive oil. I started an afternoon hot chocolate habit almost fifteen years ago and I’ve lost about 100 pounds and my skin is amazing, especially for an almost 69 year old. I use a heaping two TB measure with organic cocoa powder in the cup, stevia, boiling water and about 6-7 tsp. of heavy cream.

So what’s a body to do when my diet contains a lot of natural oils? I use palm oil and organic bacon drippings for sauteing etc.

Yes, I have had both a stroke and a heart attack but that was because my Pfen-fen impaired mitral valve kicked out clots. I had a valve job and my repaired (not replaced) valve is doing great. No, I don’t take the blood thinners because of some severe reactions but my Dr. yelled at me for stopping them. I’m using cayenne, omega 3, vitamin E, nattokinase, and gingko biloba. No problems since.

There was no mention of LDL, bad cholesterol. Many Doctors want this to be less than 75 if one has a high calcium score (plaque build up).

To get higher cholesterol just eat lots of eggs and butter.
My cholesterol was over 300 and was given Crestor, it lowered my cholesterol in 30 days to normal levels, to 172. And my doctor wanted me to continue with Crestor 20mg per day, and I was afraid that it will lower my cholesterol to 0.

I just planned not to take the medication any more and start eating more eggs and make sure cholesterol stays at a healthy level. Too low cholesterol might be linked with dementia, prevents hormones to work properly etc. So keep eating eggs. We need cholesterol, it is our friend.

I would suggest you read “The Big Fat Surprise” by Nina Teichholz, and have her on your program. The book investigates the “science” behind the war on heart disease, and how the investigators got it wrong. VERY INTRIGUING!

Keep listening. We will have an interview with her in the next several months.

And yet heart disease research shows cholesterol below 160 to be the “Heart Attack Free Zone”.

So we increase the odds of a bleeding stroke by lowering our cholesterol below 200,…BUT we decrease the odds of coronary heart disease AND the more common kind of stroke.

Since coronary disease is the leading cause of death in this country, and causes the more common type of stroke as well as heart disease, it seems absurd to suggest that people would be better off keeping their number above 200!

If you can do it, get your number below 160 and sleep soundly knowing you’ve protected your health.

We disagree that 160 or below should be the goal. There are many factors that go into the risk of heart disease (or stroke, for that matter) and cholesterol is only one of them. Focusing exclusively on cholesterol is unlikely to be helpful.

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