Cholesterol myths abound. If you are a savvy practitioner, you already know that cholesterol isn’t an undesirable “evil” in the body. It’s a critical, life-giving substance that the liver makes (much more than we would ever eat) to help the body to respond to the environment we ask it to thrive in each day. Cholesterol has many key roles…as a critical part of our immune system, as the core raw material for all steroid hormones, and as s key component of all tens of trillions of cell membranes in our body. Whew: that’s a big job! No wonder low cholesterol as we age increases the risk of many diseases and death itself.
Most media attention is put on warning patients about high cholesterol, but too often, that guidance is not balanced by the equally dramatic risks of pushing cholesterol too low as we age. In fact, low cholesterol is an excellent predictor of earlier death in seniors and the elderly. Our clients and patients need education and empowerment on this topic! Especially when they are choosing unknowingly to use cholesterol-lowering medication that might be overly-suppressing their cholesterol production.
One study found that seniors (age 65 or older) with total cholesterol in the lowest quartile had more than twice the risk of death of those in the highest quartile. This was true even when the data was adjusted to reflect an array of chronic diseases including Type 2 diabetes, hypertension, and existing cardiovascular disease. The study found that total cholesterol levels below 189 increased the risk of death!
Another study of over 100,000 people found that low cholesterol was predictive of mortality with statistical significance in both women and men from age 50 and older. In particular, this included death from cancer, liver disease, and mental illnesses. A more recent study of those 80 years of age and older has shown the same result. This article brings the past decade of research into a poignant clinical question about the overt value of lowering cholesterol.
The risk of infections that require hospitalization (and infections overall) is also inversely related to total cholesterol. This makes sense as LDL is a key component of the immune system (pull it all together: that is why LDL is attracted to damaged or inflamed arteries – as a defensive, healing response – just as your immune system would do if you cut yourself on your arm.)
Another study found a 1500% (yes, 15X) higher risk of developing cancer in those individuals with LDL cholesterol below 70.
As far as high cholesterol is concerned, protecting ourselves from heart disease is largely about keeping our bodies free from chronic inflammation – and thus our arteries largely un-inflamed and not attracting an immune system reaction or the build-up of plaque. Inflammation makes arteries “sticky”. If arteries are healthy a person can have relatively high levels of LDL cholesterol (supported with ample HDL levels as well) with no issues. This is evidenced by clear data that those who are in the hospital actually having had a heart attack are just as likely to have low-normal cholesterol as they are to have high levels. Beyond this, people with low cholesterol get just as atherosclerotic as those with high cholesterol (and here).
The key, of course, is to treat each unique patient as an individual and assess what can uniquely best serve them at this point in their health journey vs. defaulting to a “standard operating procedure”. Medications can be life-saving interventions; they can also be disease-worsening defaults. LDL and HDL are neither inherently “good” nor “bad”. To practice comprehensively, we must be willing to trade our assumptions for careful consideration of each unique case with a “beginner’s mind”. We must consider the environment in which LDL and HDL are functioning and look for specific insights as to how a unique person’s body is thriving (or not) at present.
Want to know more? In the SAFM Cardiovascular Myths and Truths, we do a deep dive into what really matters for CVD risk and what doesn’t. Very specific guidance for patients and clients. Detailed supplement recommendations. Addressing hypertension. Labwork assessment (which ones matter and which ones don’t) and case study practice. Science has learned much in the past decade about the higher value of LDL particle count and size and also the Triglycerides:HDL ratio (vs. just the total amount measured of LDL-C, the typical “bad” lipid).
I hope this information supports you in your work to educate, inspire, and empower your patients and clients.
If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.
If you haven’t done so already, sign up to receive weekly clinical tips like this via email, and you’ll also get automatic access to a free mini clinical course.
Like us on Facebook to get more great clinical tips and to get notifications of my next Facebook Live!