I entirely agree with your assessment. As a biomedical scientist I measured thousands of serum cholesterol levels, and the low levels were very often in very sick people, often elderly and malnourished. I'm reminded of those claiming that excess acidity is the cause of all illness, whereas the truth is that acidosis, like a very low cholesterol, is the RESULT of illness, not the CAUSE.
I'm so delighted that you posted this. I've been so confused by people talking about acidifying and alkalinizing foods. The only good grain is millet. Etc. This has made no sense to me. I get it now, because of your clarity. Thank you.
You are more optimistic than me. We've got an anti science kook running for President in the USA who's polling in double figures and getting applauded by people like Musk, Maher, an ex Twitter CEO, ..etc
It is frightening that it is so easy to restore your faith. He used association of other U-curve graphs to disprove the association in an other u-curve graph. & had one half-baked argument that the reason why lower cholesterol has a high hazard is because people with disease have lower cholesterol by coincidence of being sick. So unfortunate that they have this really great and healthy cholesterol score, but still are dying from cancer and such. When dismissing the U-curve. What should the graph look like then? linear? Would you argue that it is best to have 0 cholesterol?
@@Joop3000 I think you miss the point, if certain diseases naturally drop your cholesterol then this becomes a symptom and the lower cholesterol shouldn’t be read as a cause. To have the correct correlation then those cofounders would need to be filtered out for it to be truly representative of whether or not the cholesterol level of a certain individual represents their risk of getting sick and not related to them already being sick
@@888jucu That is exactly what I got out of it. So, let me ask you then, if we ''filter'' (I don't think this is realistic and based in logic and evidence, but just for the sake of argument) those confounding factors out, what do we end up with then? A linear line going back to 0 cholesterol which is healthiest?
@@Joop3000 I don’t believe zero is realistic nor advisable for the general populace but probably a number significantly less than 230. That said for people with real advanced ASCVD then lowering cholesterol either with lifestyle, drugs or both has proven to be the best for their immediate health outcomes. For the general population what is the best cholesterol target seems to still be of some debate but high cholesterol certainly is well documented to be problematic regardless what certain carnivore advocates may preach. True carnivores in nature do not develop ASCVD so humans being “omnivore” means we are not fully developed to handle large quantities of saturated fats as can been seen by the fact our species develops ASCVD the more we are exposed to saturated fat be it through direct diet or internally produced by “excessive” carb intake etc
It is not the logic that gets us in trouble, it is the low probability premises. Doing the expensive research and data analysis for accurate premises is the hard work.
Similar issue with a recent paper on weight loss being associated with increased mortality where the confounding of disease driven weight loss was so obvious and yet it still hit the headlines that “weight loss can kill you“. Reverse causality. Another good video, Gil. Keep up the good work.
To be fair weight loss is often unhealthy. What people should be focusing on is fat loss and a scale is a poor way of measuring that. People start reducing calories, hydration and protein which results in an unsustainable loss of weight that includes lean mass and reduced basal metabolic rate.
Thanks for this! I remember when I first got my cholesterol taken. It was at a company heath screening. A couple friends had slightly high readings. Mine? In the low 130s. When everyone commented the nurse there immediately jumped in an made a comment that cholesterol can be too low. I blew it off at the time because I was in my twenties. Fast forward to today when I’m 56, I’m still getting low readings. As a vegan it dropped again to 126 which is my lowest and has happened a couple years ago as well. When was this a problem for me? Well, prior to adopting a vegan diet, I was on a low carb diet called GAPS. After that, I experimented with Keto. In BOTH of those communities I started hearing how I needed to raise my cholesterol because of research about low cholesterol. A functional medicine practitioner talked to me about the same thing. My efforts yielded a total of 162. I am thankful that I found a channel where someone actually discusses the actual studies (and posts them!). Thanks again!
I just found this channel and wondered if he has shared this fact with the audience yet; Did you know that Cholesterol is a required precursor to essential hormones: estrogen, testosterone and vitamin D?
@@birdgirl1516 Yes, it is. But today's adults (and many children) have cholesterol levels that are far beyond that necessary for basic bodily functions. No healthy person needs to worry about 'having enough' cholesterol.
Thank you for another straightforward explanation that even a high school dropout could understand. If I had only seen these graphs w/o your explanation, I probably would've thought "oh, I guess they found new evidence." Keep the good work going, a lot of us depend on you.
This is a good explanation and a reminder that correlation is not the same as causation. My 84 YO father died 3 months ago and we had just seen his lung doctor 4 days earlier. His weight was the lowest it had ever been as an adult and his blood pressure was also very low and his cholesterol thanks to taking vytorin was around 150 and frankly, better than mine. An uneducated person (ie. people who listen to "Bro" podcasts) might then conclude that low cholesterol, losing weight, and having low BP is unhealthy but in his case, when he WAS "healthy", he had very high blood pressure. He was in denial about it and I didn't find out about it until 15 years ago when he cut his finger and it would not stop bleeding and the urgent care center saw that his BP was 215 and they had to put him on an IV med to bring it down before letting us leave. After that, I became active in his care and got him a primary care doctor who managed his BP, cholesterol but the damage was done as 6 years later he needed a stent put in and 6 years after that, he had heart failure that thanks in part due to all the COVID lockdowns and in part due to the cardiologist not being aggressive with the water pills and/or wanting to do a valve replacement surgery, he had so much fluid build up in his lungs that by the time they admitted him to the hospital, the damage was done to his lungs and so at that point, surgery was completely off the table and he pretty much had to suffer for 2 1/2 years with home oxygen and being homebound and mostly just getting comfort care which led to him losing weight and his heart getting weaker. If I had a time machine, I would have made sure he got to his doctor sooner.
Catabolic diseases such as cancer and anorexia often cause a decrease in blood cholesterol levels. It's the catabolic diseases causing death, not the low blood cholesterol levels. Reverse causality. Great video.
Thank you for what you do. There’s so much misinformation about nutrition floating around on RUclips. It’s a shame cause people are trying to better their health but getting misinformed by non experts or outright grifters. We need more professionals to do this kind of thing. 👍
BMI is deceptive, not measuring fat storage, but erroneously including increased muscle mass. That standard must be completely replaced by existing alternative measurement of body fat composition, fat/muscle, etc.
I saw this mentioned recently by a couple of other youtube "doctors" as a reason why you don't need to worry about cholesterol ... glad you made this video to clear that up, thank you!
I admit i was sucked in by dr berg and his chiropractic cronies for a while too, until the likes of gil, brad stanfield, and lately physionic, brought me back from the dark side. Watching dr berg et al now is almost cringeworthy.
@@James-zr1lu Right, especially considering the vast amount of evidence showing the positive effects of lowering LDL. One can't claim to be scientific and just ignore dozens/hundreds of other quality studies.
Great video! You see the same sort of curve for level of alcohol use and mortality, where it appears that people who don't drink at all have higher mortality. However, when you control for why a significant proportion of those people aren't drinking (due to health problems), the relationship becomes linear, with healthy people who don't drink having the lowest risk of mortality.
This video would be helped by showing graphs from some of the better, double-blind studies that factor out the people with illness and show the curves where they "should" be. I'm skeptical without seeing those graphs. No dog in this fight, just want to actually see the better evidence.
I can't point to the exact video, but I think he shows one where he puts dot plots of all the studies on a graph and it shows pretty clearly the affect of LDL cholesterol on mortality. If you have time to check out some of his older videos on cholesterol, you will run into it.
The links to the studies are all in the description. The Korean cholestrol study is exceptionally thorough and HUGE. Read the details of it and see. (first link I believe)
Sir, I am a soul who would get behind that except that your thought experiment is entirely invalid. You would not be arguing for people being overweight, hypertensive or pre-diabetic, you would be correcting what the normal healthy range for weight, blood pressure and blood sugar/a1c actually is based on promoting lowest mortality, taking the lowest part of U curves from massive data sets including some amount of rise on both sides to include most healthy people and variation. Based on U curves using the graphs in your video I might assign normal healthy cholesterol as 170-280, healthy BMI as 22-32, healthy blood pressure as 120-160, healthy A1C as 5.6-9. You wouldn't start trying to lower those values unless you were passing the upper end of that normal range and if you were on the lower end you might try to raise them. Cholesterol was frequently in the low to mid 200s in the 1970s and earlier when people had dramatically less diabetes, obesity, chronic inflammatory diseases, exactly where you would expect them naturally to be based on lowest mortality in the data you presented here. Cholesterol is a precursor of many hormones and LDL is a critical component of the immune system in neutralizing bacterial/fungal/viral toxins such as LPS; not having enough LDL can make smaller amounts of toxins fatal.
I see what you mean. we didn't have time to go through it all in this short video but there´s reams of randomized trial data showing a BMI in the obese range or very high BP or HbA1c raise risk of disease and death (same for high cholesterol). that's the trick, our scientific model has to reconcile all existing data
Excellently presented and very interesting! All I can do is repeat the famous words of Dr. John McDougall that "People Love to hear good things about their bad habits", and the internet hugely rewards those claims with tons of hits. Keep doing what you are doing!
McDougall?? rofl, A diet of white rice, fruit, fruit juice and table sugar -- cures diabetes, heart disease, arthritis, obesity, and just about everything, is the claim of Mcdougall
Interesting point in your video is that if your cholesterol is lower than expected, while you never tried to actively lower it,.... it means you probably have a disease you may not even be aware of. I know some people like that, though they are aware of the diseases. But their doctors tell them it's great. They don't tell them that their cholesterol is low because of their other diseases.
Many people for genetic reasons have low cholesterol and that is a healthy marker. It's when your cholesterol declines over time without a reason that it is cause for concern.
Great video with lots of easy to understand information. You have a really great ability at explaining a complicated subject, and making it easy to understand.
For those that are worried about high cholesterol, it might be good to get a CAC score to see if there's any blockages. There is also Life Line screening that will do the same thing if you don't want to go to the doctors to get a referral for CAC. I will be doing the Life Line screening since I have high cholesterol.
A CAC score won't tell you about blockages caused by soft plaque. It will only reveal old, calcified plaque. Your arteries can be nearly fully clogged with a low CAC score.
CAC only detects calcium. Not all of the build up will be calcified, may work in very old people or people who have been developing cholesterol build-up from a young age and gave it years to calcify
I have high total cholesterol and LDL but high HDL and very low triglycerides after switching to a low carb diet. My PC angiogram shows no plagues at all in my arteries and I am a senior. What does that tell you?
From what I’ve learned cholesterol is extremely nuanced. There are many factors involved. lots to know and I’m still learning to help make the best decisions along with my doctor but it’s a team effort.
Look at the level of cholesterol and mental illness and suicide. Under 160 seems to be a problem on this side. Despite these reasonable suppositions, many studies over decades have (for the most part) consistently linked low total serum cholesterol with suicide, violence, and depression. Total cholesterol levels below 160, and especially below 130, correlate with a higher risk of mental problems.
The curves would seem to suggest that cholesterol of 240 is just fine... as long as it's not an upward trend. And BMI of 28 is just fine, even if it's considered overweight. And systolic blood pressure of 140 is just fine. And even that an A1C of 7 is just fine! And that the danger is when these values trend upward over time, which unfortunately they tend to do, into the frank danger zones. I appreciate Dr. Gil's point that the lower end values correspond with chronic disease, and that's different from "higher is healthier;" yet it does seem to me that if strictly following the data, a *little* bit higher is actually, truly healthier! Also, some of these things are not like the others. I've got low (healthy range) blood pressure, 21 BMI, low (healthy range) blood glucose from my low carb, high fat way of eating. I don't have inflammation problems, aches and pains, energy deficits like so many other 50 year olds do, and I'm simply not concerned about my cholesterol. I've got a low resting pulse rate, even, when I tested it at the pharmacy kiosk along with my blood pressure recently. I searched it up and it suggested it could be because a person is old, or an elite athlete. I'm not quite either, so who knows! I feel great and I don't think worrying is going to improve my health OR my disposition.
Thank you so much for empowering your audience and letting us decide on what to do based on the science. It's such a refreshing change from RUclipsrs that use click bait, criticise a persons character that they don't agree with and let their emotions get involved in their efforts to ultimately deliver an otherwise well intentioned message. Great work and thank you again.
In a recent interview with Simon Hill - Walter Willet claimed that aggressive lowering of cholesterol may increase risk of hemorrhagic stroke (according to Mendelian Randomisation data) I’ve never heard this claim before - could you make a video exploring this claim?
I had the same thought, had meant to put it up on Simon Hills video as a query but had forgotten. Would be great to understand this with a bit more context.
@@helenryan2848 I personally haven’t heard much from Mulhotra outside of his cholesterol denialism claims. There’s a great article by Dr Alan Flanagan of Sigma Nutrition explaining the errors in his arguments - look up: *Sigma Nutrition - Low Cholesterol & Increased Mortality Risk?: Clarifying the Confusion*
Googling, I see an article from late 2020 in the Journal of Diabetes Investigation about it. As the article put it: "...all meta‐analyses have shown a net benefit of lowering LDL‐C with statins in reducing atherosclerotic cardiovascular disease (including ischemic stroke), which far outweighs the small risk of hemorrhagic strokes."
it is based of population medians. Meaning, what is average in the population. Doesn't even mean it is healthy. Especially if the average person is unhealthy, like the US
Thank you! I'm so glad I found you, because you are able to explain to lay people. And you illustrate how important it is to be discerning about nutrition/health info that comes out, and not just swallow everyone/everything blindly. I appreciate you!
Can you tell me why decades of statin use have not decreased cardiovascular disease prevalence ? Why is it that people with low cholesterol get heart attacks? One outlier should invalidate the hypothesis. If this is truly science based, then not one person with low cholesterol should have cardiovascular disease, if this hypothesis were to be true. Sadly, this is not the case, so we are back to the weakest form of evidence in epidemiology , which can be argued for or against and the paradox persists
hi. see here for the 1st Q: ruclips.net/video/-jxdjHMjRK4/видео.html (deaths from heart disease have fallen sharply). see this for the 2nd Q: ruclips.net/video/hfztSGyBf_s/видео.html
Oh my goodness thank you so much for making this video. The dangerous messaging out there is getting out of hand. We need actual doctors like you to set the record straight.
Unfortunately true. I've taken away some decent advice from them, but the total lack of regard for the data made me unsub from both about a year ago. I despise statins and refuse to touch one ever again, but the claims about how they "help no one and only cause harm" are too extreme. It's also absurd to claim a carnivore diet is healthier than a vegan one when fiber intake is directly associated with mortality. (And I friggin love meat.)
@@heathensein6582 layne norton has a doctorate in biochemistry the cattlemens association paid for his degree, he eats meat and has no hangups about it he clears says that the mandellian randomized trials showed high cholesterol is a independent marker for heart disease, even when low triglycerides were accounted for and high hdl it didn't matter so whose ignoring who
@@heathensein6582well, if you have followed Gil you know what he says: it is a marker, but not always associated with higher risk. It often correlates with ApoB which is much much better associated with risk.
@@BasedChadmanGo volunteer at an animal sanctuary and get to know some pigs, chickens and cows. Hang out with them and pet them. You won't love meat anymore.
Gil, Can you please expound on your understanding of the physiologic mechanism by which the cholesterol molecule gets itself positioned beneath the endothelial layer of the systemic artery? In other words, is the endothelial cell actively, or passively, transporting it from the LDL in the bloodstream, through the cell and then expelling it on the other side, or is the cholesterol molecule somehow disrupting the tight junctions between the endothelium and working their way back behind them? If so, how? And if so, why does this never happen in veins and almost never happen in the pulmonary arteries?
I would think if disease is lowering the cholesterol, it would also lower the BMI? But the BMI is up for longevity. How can you have disease lower cholesterol but you gain weight?
love the explanation, I wish you make a series on how to understand and interpret data pulled from studies, but on a side note, what kind of chronic disease that would lower HbA1c or blood pressure ?
"I wanted to take a moment to express my appreciation for this fantastic RUclips channel and the informative content that it provides. This topic is incredibly insightful and well-presented. Thank you for taking the time to share this valuable information with your viewers."
Presumably because too many who have "normal" values have a high baseline lowered by disease. This is an issue with detecting disease states in elite athletes when they have values (in general, not just the ones mentioned) that seem normal but they should really be a lot higher or lower due to their fitness so it will take longer for the disease to be detected.
Because controlled study data results are opposite. The question we should ask is what lowered the parameter? Red flags include cancer, infectious disease, malnutrition, etc. and these causes produce the observation of a "paradox."
Wow, Gil, this was absolutely fantastic. You really put my mind at ease. Thank you so much for this clear, concise, reasonable, rational, scientifically correct explanation. You are doing so much good in this world, and you can tell your mother I said so. (I'm a mom, too, so my guess is she is super proud of you.)
People love good news about their bad habits. Probably the most generally accurate statement I've heard in the health space. I imagine it could be credited for the "cholesterol skeptic" movement.
Just to confuse matters,I remember reading that a small number of people have an extremely negative reaction,in terms of greatly increased risk of suicide,to having their cholesterol lowered.I think I read it in 'Genome,' by Matt Ridley.
You nailed it, Dr Carvalho! Thanks for going the extra mile to dig into the data and explain it so clearly. I wonder if the numbers of people with a given level of a blood marker factors into it those graphs, as well. For example: fewer people have an A1c under 5 (than 5.5) so perhaps a larger proportion have subclinical disease?
The issue I have with this is that is doesn’t seem to count the biggest killer, coronary heart disease, which is ‘typically’ associated with high cholesterol. Surely that should have had a huge impact on the the mortality rate but this doesn’t seem to generate even a blip on that data? That also should have a much higher impact in the data as the death from heart disease would generally be sudden and therefore the cholesterol state would be at its peak.
Wow, thank you for this explanation. I'm particularly and continually confused by diet guidelines these days and health guidelines which are contradictory at best over the last 20 years. I don't know what to eat. I don't know what to think about recent research. It's very difficult to navigate the healthy lifestyle and get it right.
Very true! They contradict each other daily almost . I think eating healthy fruit and veg and occasional meat and fish is the way forward. Moderation like our ancestors ate .
Great explanation, thanks! I've seen people saying on social media that you need to eat plenty of dietary cholesterol to maintain high testosterone levels, even recommending pure butter for gains. Others say pretty much the opposite, that fatty foods are associated with lower testosterone. Could you please clarify?
All sexual hormones in both male and female are made from cholesterol, taken it from food is essential for a normal level. Just look at statistics on the age women get to menopause, 30 years ago it was 50+, today when we eat a lot less cholesterol together with other factors of course, many women see signs of menopause at early '40. It's that just a coincidence?
Interesting ... I am wondering about the size of the risk increase at the lower end. Your argument is interesting, but is it enough to explain the size of the effect. In your opinion does this mean that a) there is a lot more undiagnosed illness than people are aware of, and that is sitting there as a large pool of potential problems representing a large proportion of the population . This is the moderate risk, high population option. b) That the risks of those in this position are very high, so that a limited number of cases are going to be driving the curve up steeply because the risk of mortality is very high. This is the high risk, moderate population option. Or c) something else ?
You nailed it. There is no way it would be that steep... also... what if you have low cholesterol and then get that disease? etc. etc. This assosication to other graphs doesn't prove anything.
Appreciate you sticking to the science and not selling out for money & fame. Too many are just trying to make money with books, podcasts, or some magic elixir. Others are just so caught up in the diet & lifestyle that they push that they won't change or can't see the truth. You and ZOE are my go-to podcasts.
@@Seanonyoutubeagreed... I only listened to about 5 minutes of their crap about the microbiome before I realized they're selling solutions for the problems they're creating. Don't get me wrong, so many people are unhealthy but it's not because they need a supplement to bandaid their processed diet.
So what about the 200 total cholesterol being the max? I've seen where several doctors say 250 is a better limit and the curve demonstrates that. Who set the 200 and on what data? Let's please talk about both sides of this observation.
Both reference articles state optimum range of 210-240 Total, the Denmark says 190 is the high end for LDL, but with HDL of 50, 240 still looks reasonable, vs 200 TC in this video. Is it time to challenge this old guidance?.
Actually, most of these numbers started out by finding out what most people measured. Then they keep revising them as data changes. My last checkup says total cholesterol should be under 200, hdl should be over 60 and ldl under 100.
My cholesterol was 9 and I had very high tryglicerides. My doctor told me I was in danger of having a heart attack. I have never been overweight, but I did have mild fat infiltration of the liver.Since then I have cut out processed foods. I eat a lot of fish and salads, plus lots of EVOO. I take Crestor 5mg, Niacin 3 grams daily, high dose omega 3, bergamot and nattokinase. My bloods are now: serum cholesterol 3.8, HDL 1.6, LDL 2 and my tryglicerides are 0.7. All of my liver enzymes have returned to zero.
Your explanation regarding the higher mortality rate of people with low cholesterol due to other underlying conditions (cancer, infections) that lower cholesterol sounds reasonable, although there should be data available on the cause of death and hence the curve can be re-drawn by excluding those. What is missing from all your videos explaining this paradox is the fact that the lowest risk (hazard ratio of 1.0) is among people having higher cholesterol than the recommended limit? For that, which is the key take away from this chart, you provide no explanation! Do you have one?
The mystery remains. He didn't show that the low mortality point at total cholesterol 230 was bad. We need longitudinal data: people with cholesterol of 200 live longer than those of 230 starting at age 70.
Thanks for making this. A friend of mine recently sent me an article arguing that people with high cholesterol live longer 🤦🏻♂️. I read the article and it referred to the u-curve and the study was specifically looking at people over 60 which I think would skew these numbers even more. I shared the link to this video with him 💕
This is interesting. I've always wondered if there is a cholesterol level that is too low. My husband is on atorvastatin and his level is 122. When he started it years ago his cholesterol was in the 240 range. I'm thinking of cutting his atorvastatin dosage because that level seems quite low to me.
That level seems healthy to me. For one thing, there is no evidence that intensive cholesterol lowering is dangerous. Quite the opposite ... studies show that achieving very low levels reduces the rate of major adverse cardiovascular events. Brown and Goldstein won a Nobel Prize for their work on cholesterol. They conclude that "plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl (Fig. 16 and ref. 120). In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels (9,119). Second, the LDL level in newborn humans is approximately 30 mg/dl (121), well within the range that seems to be appropriate for receptor binding (Fig. 16). Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl. " www.science.org/doi/10.1126/science.3513311?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
It not all about one number on one test. Must look at big picture and must review his age, race, activity levels, diet and about 19 other blood markers to establish present status. Plus helps to know CAC score or CT scan.
@@DrAJ_LatinAmerica Thank you for your reply. My husband is high risk. Balloon angioplasty 20 years ago, heart attack with stent 6 years ago. One artery still has blockage, but I think his mind/memory has been affected (normal scan for age) and he is bursting out with fast growing skin cancers. He's also a sugar addict. He is 84 years old, though and very stubborn. He totally ignores his health. I need to make him a cardiology appointment soon.
@@jjbud3124 definitely some serious issues. At his age, he needs to do what make him happy. Definitely need to be working very closely with your doctor(s). Always Keep in mind the internet is just very rough broad strokes of information. Not medical advice regarding your husband specifically. All things are case by case, person by person. No one set diet or set of rules applies to everyone. Millions will say people don't need to take a statin medication. However millions are not your husband. Again your doctor has to look at all evidence AND has to base the treatment on the specific wishes of your husband and an agreement to follow treatment. I'm always surprised, but there are many (millions) who refuse to stop drinking, smoking, over eating, eating junk foods,..... Freedom is a double edge sword. But of luck, keep trying and God bless 🙏💪
A1c is impacted by life-span of blood cells, so it is important to control for that first. Here is one paper: "However, in sensitivity analyses among persons with anemia (10.2% of the study population), we observed stronger associations of low HbA1c with all-cause mortality (1.60, 95% CI: 1.07-2.39), cancer mortality (1.94, 95% CI: 1.03-3.65), and cardiovascular death (1.51, 95% CI: 0.74-3.09). Among participants without anemia, the results were somewhat attenuated but remained significant for all-cause mortality (1.22, 95% CI: 1.03-1.46) and cancer death (1.35, 95% CI: 1.05-1.74)." There is a statistically significant increase even among non-anemic patients, so there might be other disease processes occurring that can artificially lower A1C (my hypothesis). For the record, my A1C was measured recently at 4.9% and I'm very much not anemic, so I will followup to let you know if I've died.
I entirely agree with your assessment. As a biomedical scientist I measured thousands of serum cholesterol levels, and the low levels were very often in very sick people, often elderly and malnourished. I'm reminded of those claiming that excess acidity is the cause of all illness, whereas the truth is that acidosis, like a very low cholesterol, is the RESULT of illness, not the CAUSE.
It can be both just like high cholesterol can be due to diet/genetics or disease
I'm so delighted that you posted this. I've been so confused by people talking about acidifying and alkalinizing foods. The only good grain is millet. Etc. This has made no sense to me. I get it now, because of your clarity. Thank you.
Dr. Atkins had a heart attack and a history of heart disease and he was overweight.
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Epic Gil. Because of science communicators like you, faith is being restored in the clinical guidelines and your viewers are leading healthier lives
You are more optimistic than me. We've got an anti science kook running for President in the USA who's polling in double figures and getting applauded by people like Musk, Maher, an ex Twitter CEO, ..etc
It is frightening that it is so easy to restore your faith. He used association of other U-curve graphs to disprove the association in an other u-curve graph. & had one half-baked argument that the reason why lower cholesterol has a high hazard is because people with disease have lower cholesterol by coincidence of being sick. So unfortunate that they have this really great and healthy cholesterol score, but still are dying from cancer and such.
When dismissing the U-curve. What should the graph look like then? linear? Would you argue that it is best to have 0 cholesterol?
@@Joop3000 I think you miss the point, if certain diseases naturally drop your cholesterol then this becomes a symptom and the lower cholesterol shouldn’t be read as a cause. To have the correct correlation then those cofounders would need to be filtered out for it to be truly representative of whether or not the cholesterol level of a certain individual represents their risk of getting sick and not related to them already being sick
@@888jucu That is exactly what I got out of it. So, let me ask you then, if we ''filter'' (I don't think this is realistic and based in logic and evidence, but just for the sake of argument) those confounding factors out, what do we end up with then? A linear line going back to 0 cholesterol which is healthiest?
@@Joop3000 I don’t believe zero is realistic nor advisable for the general populace but probably a number significantly less than 230. That said for people with real advanced ASCVD then lowering cholesterol either with lifestyle, drugs or both has proven to be the best for their immediate health outcomes. For the general population what is the best cholesterol target seems to still be of some debate but high cholesterol certainly is well documented to be problematic regardless what certain carnivore advocates may preach. True carnivores in nature do not develop ASCVD so humans being “omnivore” means we are not fully developed to handle large quantities of saturated fats as can been seen by the fact our species develops ASCVD the more we are exposed to saturated fat be it through direct diet or internally produced by “excessive” carb intake etc
I just came across your channel. This is cool. Your logic is flawless
He must be Vulcan 😂.
It is not the logic that gets us in trouble, it is the low probability premises. Doing the expensive research and data analysis for accurate premises is the hard work.
Similar issue with a recent paper on weight loss being associated with increased mortality where the confounding of disease driven weight loss was so obvious and yet it still hit the headlines that “weight loss can kill you“. Reverse causality. Another good video, Gil. Keep up the good work.
To be fair weight loss is often unhealthy. What people should be focusing on is fat loss and a scale is a poor way of measuring that. People start reducing calories, hydration and protein which results in an unsustainable loss of weight that includes lean mass and reduced basal metabolic rate.
Thanks for this! I remember when I first got my cholesterol taken. It was at a company heath screening. A couple friends had slightly high readings. Mine? In the low 130s. When everyone commented the nurse there immediately jumped in an made a comment that cholesterol can be too low. I blew it off at the time because I was in my twenties. Fast forward to today when I’m 56, I’m still getting low readings. As a vegan it dropped again to 126 which is my lowest and has happened a couple years ago as well.
When was this a problem for me? Well, prior to adopting a vegan diet, I was on a low carb diet called GAPS. After that, I experimented with Keto. In BOTH of those communities I started hearing how I needed to raise my cholesterol because of research about low cholesterol. A functional medicine practitioner talked to me about the same thing. My efforts yielded a total of 162. I am thankful that I found a channel where someone actually discusses the actual studies (and posts them!). Thanks again!
I just found this channel and wondered if he has shared this fact with the audience yet; Did you know that Cholesterol is a required precursor to essential hormones: estrogen, testosterone and vitamin D?
@@birdgirl1516 It's the dose that makes the poison.
@@birdgirl1516 Yes, it is. But today's adults (and many children) have cholesterol levels that are far beyond that necessary for basic bodily functions. No healthy person needs to worry about 'having enough' cholesterol.
Thank you for another straightforward explanation that even a high school dropout could understand. If I had only seen these graphs w/o your explanation, I probably would've thought "oh, I guess they found new evidence." Keep the good work going, a lot of us depend on you.
I find it chilling knowing that your videos NOW will probably wind up saving my life when I turn 60.
I appreciate your dedication to digging into this important issue.
As a physician for 35 years, this presentation is eye opening. Medical disease prevention criteria now seem backwards!
Thank you! As a heart disease patient, this information is definitely of great importance.
This is a good explanation and a reminder that correlation is not the same as causation. My 84 YO father died 3 months ago and we had just seen his lung doctor 4 days earlier. His weight was the lowest it had ever been as an adult and his blood pressure was also very low and his cholesterol thanks to taking vytorin was around 150 and frankly, better than mine. An uneducated person (ie. people who listen to "Bro" podcasts) might then conclude that low cholesterol, losing weight, and having low BP is unhealthy but in his case, when he WAS "healthy", he had very high blood pressure. He was in denial about it and I didn't find out about it until 15 years ago when he cut his finger and it would not stop bleeding and the urgent care center saw that his BP was 215 and they had to put him on an IV med to bring it down before letting us leave. After that, I became active in his care and got him a primary care doctor who managed his BP, cholesterol but the damage was done as 6 years later he needed a stent put in and 6 years after that, he had heart failure that thanks in part due to all the COVID lockdowns and in part due to the cardiologist not being aggressive with the water pills and/or wanting to do a valve replacement surgery, he had so much fluid build up in his lungs that by the time they admitted him to the hospital, the damage was done to his lungs and so at that point, surgery was completely off the table and he pretty much had to suffer for 2 1/2 years with home oxygen and being homebound and mostly just getting comfort care which led to him losing weight and his heart getting weaker. If I had a time machine, I would have made sure he got to his doctor sooner.
Probably ate many carbs
Catabolic diseases such as cancer and anorexia often cause a decrease in blood cholesterol levels. It's the catabolic diseases causing death, not the low blood cholesterol levels. Reverse causality. Great video.
Thank you for what you do. There’s so much misinformation about nutrition floating around on RUclips. It’s a shame cause people are trying to better their health but getting misinformed by non experts or outright grifters. We need more professionals to do this kind of thing. 👍
Outright grifters is very accurate. Won't mention any names though!
BMI is deceptive, not measuring fat storage, but erroneously including increased muscle mass.
That standard must be completely replaced by existing alternative measurement of body fat composition, fat/muscle, etc.
Hi Gil.I just came across your channel.I am very impressed.We need more people like you to cut through the confusion.We should connect.
man, you nailed it. Beautiful, thank you. Love clear explanations of scientific realities.
I saw this mentioned recently by a couple of other youtube "doctors" as a reason why you don't need to worry about cholesterol ... glad you made this video to clear that up, thank you!
chiropractic "doctors" no doubt
It's always painful to listen to professionals speak on things they don't have a clear grasp.
I admit i was sucked in by dr berg and his chiropractic cronies for a while too, until the likes of gil, brad stanfield, and lately physionic, brought me back from the dark side. Watching dr berg et al now is almost cringeworthy.
@@James-zr1lu Right, especially considering the vast amount of evidence showing the positive effects of lowering LDL. One can't claim to be scientific and just ignore dozens/hundreds of other quality studies.
You deserve an award. Your fact-checking is as valuable as anything issued by the Surgeon General.
Great video! You see the same sort of curve for level of alcohol use and mortality, where it appears that people who don't drink at all have higher mortality. However, when you control for why a significant proportion of those people aren't drinking (due to health problems), the relationship becomes linear, with healthy people who don't drink having the lowest risk of mortality.
That's good information to share thank you
So these u curves can be read as an indication of how uncommon being healthy actually is.
excellent realization
That's exactly what I thought. The paradox might be caused by a lack of healthy people!
@@bobbenoit8470 wouldn’t have to be unhealthy. It’s all dependent on when these measurements are taken: at death, 1 year out, and so on.
This video would be helped by showing graphs from some of the better, double-blind studies that factor out the people with illness and show the curves where they "should" be. I'm skeptical without seeing those graphs. No dog in this fight, just want to actually see the better evidence.
I can't point to the exact video, but I think he shows one where he puts dot plots of all the studies on a graph and it shows pretty clearly the affect of LDL cholesterol on mortality. If you have time to check out some of his older videos on cholesterol, you will run into it.
You are correct. He needs to do better. My friend was even more confused. I think your suggestion would make it clearer.
The links to the studies are all in the description. The Korean cholestrol study is exceptionally thorough and HUGE. Read the details of it and see. (first link I believe)
Sir, I am a soul who would get behind that except that your thought experiment is entirely invalid. You would not be arguing for people being overweight, hypertensive or pre-diabetic, you would be correcting what the normal healthy range for weight, blood pressure and blood sugar/a1c actually is based on promoting lowest mortality, taking the lowest part of U curves from massive data sets including some amount of rise on both sides to include most healthy people and variation.
Based on U curves using the graphs in your video I might assign normal healthy cholesterol as 170-280, healthy BMI as 22-32, healthy blood pressure as 120-160, healthy A1C as 5.6-9. You wouldn't start trying to lower those values unless you were passing the upper end of that normal range and if you were on the lower end you might try to raise them.
Cholesterol was frequently in the low to mid 200s in the 1970s and earlier when people had dramatically less diabetes, obesity, chronic inflammatory diseases, exactly where you would expect them naturally to be based on lowest mortality in the data you presented here. Cholesterol is a precursor of many hormones and LDL is a critical component of the immune system in neutralizing bacterial/fungal/viral toxins such as LPS; not having enough LDL can make smaller amounts of toxins fatal.
I see what you mean. we didn't have time to go through it all in this short video but there´s reams of randomized trial data showing a BMI in the obese range or very high BP or HbA1c raise risk of disease and death (same for high cholesterol). that's the trick, our scientific model has to reconcile all existing data
Excellently presented and very interesting! All I can do is repeat the famous words of Dr. John McDougall that "People Love to hear good things about their bad habits", and the internet hugely rewards those claims with tons of hits. Keep doing what you are doing!
McDougall?? rofl, A diet of white rice, fruit, fruit juice and table sugar -- cures diabetes, heart disease, arthritis, obesity, and just about everything, is the claim of Mcdougall
Can you please start writing a book on nutrition and these related topics…
We need a voice like yours out there.
Interesting point in your video is that if your cholesterol is lower than expected, while you never tried to actively lower it,.... it means you probably have a disease you may not even be aware of.
I know some people like that, though they are aware of the diseases. But their doctors tell them it's great. They don't tell them that their cholesterol is low because of their other diseases.
Many people for genetic reasons have low cholesterol and that is a healthy marker. It's when your cholesterol declines over time without a reason that it is cause for concern.
@@JoeS97756as stated at 6:47
Great video with lots of easy to understand information. You have a really great ability at explaining a complicated subject, and making it easy to understand.
For those that are worried about high cholesterol, it might be good to get a CAC score to see if there's any blockages. There is also Life Line screening that will do the same thing if you don't want to go to the doctors to get a referral for CAC. I will be doing the Life Line screening since I have high cholesterol.
In Wales this will cost around £700. This is too much for many people.
A CAC score won't tell you about blockages caused by soft plaque. It will only reveal old, calcified plaque. Your arteries can be nearly fully clogged with a low CAC score.
@@amyntas97jones29 I live in Southern California and it costs $159.
About one-fourth to one-third of the total incident cardiovascular disease events occur in those with a CAC of zero. - AHA
CAC only detects calcium. Not all of the build up will be calcified, may work in very old people or people who have been developing cholesterol build-up from a young age and gave it years to calcify
I have high total cholesterol and LDL but high HDL and very low triglycerides after switching to a low carb diet. My PC angiogram shows no plagues at all in my arteries and I am a senior. What does that tell you?
From what I’ve learned cholesterol is extremely nuanced. There are many factors involved. lots to know and I’m still learning to help make the best decisions along with my doctor but it’s a team effort.
Just popping in to say thanks for the great video!
Look at the level of cholesterol and mental illness and suicide. Under 160 seems to be a problem on this side.
Despite these reasonable suppositions, many studies over decades have (for the most part) consistently linked low total serum cholesterol with suicide, violence, and depression. Total cholesterol levels below 160, and especially below 130, correlate with a higher risk of mental problems.
"correlate". Is there any evidence that points to causation?
The curves would seem to suggest that cholesterol of 240 is just fine... as long as it's not an upward trend. And BMI of 28 is just fine, even if it's considered overweight. And systolic blood pressure of 140 is just fine. And even that an A1C of 7 is just fine! And that the danger is when these values trend upward over time, which unfortunately they tend to do, into the frank danger zones. I appreciate Dr. Gil's point that the lower end values correspond with chronic disease, and that's different from "higher is healthier;" yet it does seem to me that if strictly following the data, a *little* bit higher is actually, truly healthier! Also, some of these things are not like the others. I've got low (healthy range) blood pressure, 21 BMI, low (healthy range) blood glucose from my low carb, high fat way of eating. I don't have inflammation problems, aches and pains, energy deficits like so many other 50 year olds do, and I'm simply not concerned about my cholesterol.
I've got a low resting pulse rate, even, when I tested it at the pharmacy kiosk along with my blood pressure recently. I searched it up and it suggested it could be because a person is old, or an elite athlete. I'm not quite either, so who knows! I feel great and I don't think worrying is going to improve my health OR my disposition.
It's so funny watching you grasping at straws
Helpful as always. Well presented.
Excellent explanation! 🎉 thank you!
Excellent explanations. Finally, some proper medical interpretation of this phenomenon.
Thank you so much for empowering your audience and letting us decide on what to do based on the science. It's such a refreshing change from RUclipsrs that use click bait, criticise a persons character that they don't agree with and let their emotions get involved in their efforts to ultimately deliver an otherwise well intentioned message. Great work and thank you again.
Amazing scientific insight, I am wondering if the "U shaped" curve is also what explains the benefits for alcohol and coffee.
This is becoming my favorite nutrition channel.
In a recent interview with Simon Hill - Walter Willet claimed that aggressive lowering of cholesterol may increase risk of hemorrhagic stroke (according to Mendelian Randomisation data)
I’ve never heard this claim before - could you make a video exploring this claim?
I heard that too and was surprised. Thanks for mentioning it here.
I had the same thought, had meant to put it up on Simon Hills video as a query but had forgotten.
Would be great to understand this with a bit more context.
Dr Aseem Mulhotra has a lot of interesting information also.
@@helenryan2848 I personally haven’t heard much from Mulhotra outside of his cholesterol denialism claims. There’s a great article by Dr Alan Flanagan of Sigma Nutrition explaining the errors in his arguments - look up: *Sigma Nutrition - Low Cholesterol & Increased Mortality Risk?: Clarifying the Confusion*
Googling, I see an article from late 2020 in the Journal of Diabetes Investigation about it. As the article put it:
"...all meta‐analyses have shown a net benefit of lowering LDL‐C with statins in reducing atherosclerotic cardiovascular disease (including ischemic stroke), which far outweighs the small risk of hemorrhagic strokes."
Doctor , THIS IS REAL AND QUALITY MEDICAL SCIENCE you present for your You tube public. Thank you again ! All the best and keep the standards up.
Thank u Sir. In depth understanding leaves no confusiom.
Dr. Gil, Thanks again for your easy to understand explanation of such a heated topic. Your dedication is truly appreciated and has taught me so much.
I understand low BMI (you could be wasting away). I don't understand an A1c under 6. What fatal disease is associated with low A1c?
@@rubygreta1 plug the question into google
@@rubygreta1 Just taking a guess here, but I wonder if it could be a side effect of lack of appetite.
Wow, yet another wonderful video!
This is truly fascinating and such a great explanation! Just goes to show, we shouldn’t take research data at face value out of context!
that was very informative and easy to understand. Thank you!
Who determines the healthy or middle range? for Cholesterol, BMI, and blood pressure?
Scientific Studies are how scientists find those values. They do not "determine" them, Science reveals them.
it is based of population medians. Meaning, what is average in the population. Doesn't even mean it is healthy. Especially if the average person is unhealthy, like the US
3:30 in and I'm puzzled. Looking forward to the conclusion.
It's like losing weight. That happening for no reason (diet, exercise) is usually mentioned as a cancer symptom.
Thank you! I'm so glad I found you, because you are able to explain to lay people. And you illustrate how important it is to be discerning about nutrition/health info that comes out, and not just swallow everyone/everything blindly. I appreciate you!
Can you tell me why decades of statin use have not decreased cardiovascular disease prevalence ? Why is it that people with low cholesterol get heart attacks? One outlier should invalidate the hypothesis. If this is truly science based, then not one person with low cholesterol should have cardiovascular disease, if this hypothesis were to be true. Sadly, this is not the case, so we are back to the weakest form of evidence in epidemiology , which can be argued for or against and the paradox persists
hi. see here for the 1st Q: ruclips.net/video/-jxdjHMjRK4/видео.html (deaths from heart disease have fallen sharply). see this for the 2nd Q: ruclips.net/video/hfztSGyBf_s/видео.html
Excellent presentation. Thank you.
Oh my goodness thank you so much for making this video. The dangerous messaging out there is getting out of hand. We need actual doctors like you to set the record straight.
Great video ! Thank you!
Berg and Ekberg and consorts will completely ignore and discard this explanation.
Just as you people do with high cholesterol
Unfortunately true. I've taken away some decent advice from them, but the total lack of regard for the data made me unsub from both about a year ago.
I despise statins and refuse to touch one ever again, but the claims about how they "help no one and only cause harm" are too extreme.
It's also absurd to claim a carnivore diet is healthier than a vegan one when fiber intake is directly associated with mortality. (And I friggin love meat.)
@@heathensein6582 layne norton has a doctorate in biochemistry the cattlemens association paid for his degree, he eats meat and has no hangups about it he clears says that the mandellian randomized trials showed high cholesterol is a independent marker for heart disease, even when low triglycerides were accounted for and high hdl it didn't matter so whose ignoring who
@@heathensein6582well, if you have followed Gil you know what he says: it is a marker, but not always associated with higher risk. It often correlates with ApoB which is much much better associated with risk.
@@BasedChadmanGo volunteer at an animal sanctuary and get to know some pigs, chickens and cows. Hang out with them and pet them. You won't love meat anymore.
You and Dr. Seheult are the only MDs on RUclips I trust.
Thank you! This video is useful
I love information. And your study of studies (meta-analysis) is the cream of the crop. Thank you for helping me on my health journey.
Gil,
Can you please expound on your understanding of the physiologic mechanism by which the cholesterol molecule gets itself positioned beneath the endothelial layer of the systemic artery? In other words, is the endothelial cell actively, or passively, transporting it from the LDL in the bloodstream, through the cell and then expelling it on the other side, or is the cholesterol molecule somehow disrupting the tight junctions between the endothelium and working their way back behind them? If so, how? And if so, why does this never happen in veins and almost never happen in the pulmonary arteries?
As always, your videos are a great asset for understanding complex medical findings. Obrigado!
I would think if disease is lowering the cholesterol, it would also lower the BMI? But the BMI is up for longevity. How can you have disease lower cholesterol but you gain weight?
Yup, I hear ya..
Great video packed with important information. Thanks
love the explanation, I wish you make a series on how to understand and interpret data pulled from studies, but on a side note, what kind of chronic disease that would lower HbA1c or blood pressure ?
Beautifully conveyed. 💯
"I wanted to take a moment to express my appreciation for this fantastic RUclips channel and the informative content that it provides. This topic is incredibly insightful and well-presented. Thank you for taking the time to share this valuable information with your viewers."
Bravo - Love how you explain complicated issues in a way that makes them easy to understand.
I would love to hear your explanation why higher than normal BMI, A1C, BP and cholesterol are associated with the lowest mortality.
Presumably because too many who have "normal" values have a high baseline lowered by disease. This is an issue with detecting disease states in elite athletes when they have values (in general, not just the ones mentioned) that seem normal but they should really be a lot higher or lower due to their fitness so it will take longer for the disease to be detected.
Because controlled study data results are opposite. The question we should ask is what lowered the parameter? Red flags include cancer, infectious disease, malnutrition, etc. and these causes produce the observation of a "paradox."
So why don't you listen to this video?
What you're asking for is repeatedly and directly addressed in this video.
He already answered that question. You need to keep watching the video until you understand it.
Nice! Always looking for good evidence to continue taking care of myself!
You make some of the best health related videos out there Gil! Huge thumbs up for this well put together presentation of the facts. Thank you!
Hats off to you for showing what a great dr with common sense is.
I also can imagine that some 'experts' use this intentionally to mislead people to promote certain diets and for their own popularity.
It would be criminal if they knowingly misinterpreted the data - it’s more likely they are just ignorant. Still, it’s no excuse for misleading people.
The graphs are very interesting and stir up many questions, like the "why factor" .. why did it change? AIC, Cholesterol, BMI ... causation!
Wow, Gil, this was absolutely fantastic. You really put my mind at ease. Thank you so much for this clear, concise, reasonable, rational, scientifically correct explanation. You are doing so much good in this world, and you can tell your mother I said so. (I'm a mom, too, so my guess is she is super proud of you.)
Your videos are superb. Sadly, there are medical doctors who are not delivering accurate messaging according to real science.
People love good news about their bad habits. Probably the most generally accurate statement I've heard in the health space. I imagine it could be credited for the "cholesterol skeptic" movement.
"People love good news about their bad habits." -- great point and well said.
@@JonathanBennett84 credit to John A. McDougall
Excellently explained, like always!
Just to confuse matters,I remember reading that a small number of people have an extremely negative reaction,in terms of greatly increased risk of suicide,to having their cholesterol lowered.I think I read it in 'Genome,' by Matt Ridley.
Maybe it lowered testosterone levels?
@@beemrmem3 I bet that's right
Quality information and delivery!
You nailed it, Dr Carvalho! Thanks for going the extra mile to dig into the data and explain it so clearly.
I wonder if the numbers of people with a given level of a blood marker factors into it those graphs, as well. For example: fewer people have an A1c under 5 (than 5.5) so perhaps a larger proportion have subclinical disease?
@7:52 a brilliant point and so eloquently presented!
The issue I have with this is that is doesn’t seem to count the biggest killer, coronary heart disease, which is ‘typically’ associated with high cholesterol. Surely that should have had a huge impact on the the mortality rate but this doesn’t seem to generate even a blip on that data? That also should have a much higher impact in the data as the death from heart disease would generally be sudden and therefore the cholesterol state would be at its peak.
Wow, thank you for this explanation. I'm particularly and continually confused by diet guidelines these days and health guidelines which are contradictory at best over the last 20 years. I don't know what to eat. I don't know what to think about recent research. It's very difficult to navigate the healthy lifestyle and get it right.
Very true! They contradict each other daily almost . I think eating healthy fruit and veg and occasional meat and fish is the way forward. Moderation like our ancestors ate .
Hello Sir :) Which cholesterol levels are you discussing here ? The HDL ( the good one ) or the LDL ( the bad one ) ??
Great video.
You're very smart
This may be the most informative video I've ever seen. Thank you.
Great explanation, thanks! I've seen people saying on social media that you need to eat plenty of dietary cholesterol to maintain high testosterone levels, even recommending pure butter for gains. Others say pretty much the opposite, that fatty foods are associated with lower testosterone. Could you please clarify?
All sexual hormones in both male and female are made from cholesterol, taken it from food is essential for a normal level. Just look at statistics on the age women get to menopause, 30 years ago it was 50+, today when we eat a lot less cholesterol together with other factors of course, many women see signs of menopause at early '40. It's that just a coincidence?
Wonderful explanation and clears up a lot of confusion.
Interesting ... I am wondering about the size of the risk increase at the lower end. Your argument is interesting, but is it enough to explain the size of the effect. In your opinion does this mean that a) there is a lot more undiagnosed illness than people are aware of, and that is sitting there as a large pool of potential problems representing a large proportion of the population . This is the moderate risk, high population option. b) That the risks of those in this position are very high, so that a limited number of cases are going to be driving the curve up steeply because the risk of mortality is very high. This is the high risk, moderate population option. Or c) something else ?
You nailed it. There is no way it would be that steep... also... what if you have low cholesterol and then get that disease? etc. etc. This assosication to other graphs doesn't prove anything.
Well presented doc.
Appreciate you sticking to the science and not selling out for money & fame. Too many are just trying to make money with books, podcasts, or some magic elixir. Others are just so caught up in the diet & lifestyle that they push that they won't change or can't see the truth. You and ZOE are my go-to podcasts.
ZOE?
ZEO is a perfect example of selling out lol
@@Seanonyoutubeagreed... I only listened to about 5 minutes of their crap about the microbiome before I realized they're selling solutions for the problems they're creating. Don't get me wrong, so many people are unhealthy but it's not because they need a supplement to bandaid their processed diet.
thank you very well presented info
So what about the 200 total cholesterol being the max? I've seen where several doctors say 250 is a better limit and the curve demonstrates that. Who set the 200 and on what data? Let's please talk about both sides of this observation.
Both reference articles state optimum range of 210-240 Total, the Denmark says 190 is the high end for LDL, but with HDL of 50, 240 still looks reasonable, vs 200 TC in this video. Is it time to challenge this old guidance?.
Actually, most of these numbers started out by finding out what most people measured. Then they keep revising them as data changes.
My last checkup says total cholesterol should be under 200, hdl should be over 60 and ldl under 100.
My cholesterol was 9 and I had very high tryglicerides. My doctor told me I was in danger of having a heart attack. I have never been overweight, but I did have mild fat infiltration of the liver.Since then I have cut out processed foods. I eat a lot of fish and salads, plus lots of EVOO. I take Crestor 5mg, Niacin 3 grams daily, high dose omega 3, bergamot and nattokinase. My bloods are now: serum cholesterol 3.8, HDL 1.6, LDL 2 and my tryglicerides are 0.7. All of my liver enzymes have returned to zero.
This channel is perfect for science understanding!
Gil, thank you, a really interesting and enlightening video.
Your explanation regarding the higher mortality rate of people with low cholesterol due to other underlying conditions (cancer, infections) that lower cholesterol sounds reasonable, although there should be data available on the cause of death and hence the curve can be re-drawn by excluding those. What is missing from all your videos explaining this paradox is the fact that the lowest risk (hazard ratio of 1.0) is among people having higher cholesterol than the recommended limit? For that, which is the key take away from this chart, you provide no explanation! Do you have one?
The mystery remains. He didn't show that the low mortality point at total cholesterol 230 was bad. We need longitudinal data: people with cholesterol of 200 live longer than those of 230 starting at age 70.
@@kennethyuman1940 look up framingham study. it's all there in the original graphs. also, all his source studies are linked in the description.
Thank you for explaining. Too much social media...carnivore and keto people....get this incorrectly and even backwards.
How are they getting it backwards? Fat is important.
Thanks for making this. A friend of mine recently sent me an article arguing that people with high cholesterol live longer 🤦🏻♂️.
I read the article and it referred to the u-curve and the study was specifically looking at people over 60 which I think would skew these numbers even more.
I shared the link to this video with him 💕
This is interesting. I've always wondered if there is a cholesterol level that is too low. My husband is on atorvastatin and his level is 122. When he started it years ago his cholesterol was in the 240 range. I'm thinking of cutting his atorvastatin dosage because that level seems quite low to me.
That level seems healthy to me. For one thing, there is no evidence that intensive cholesterol lowering is dangerous. Quite the opposite ... studies show that achieving very low levels reduces the rate of major adverse cardiovascular events. Brown and Goldstein won a Nobel Prize for their work on cholesterol. They conclude that "plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl (Fig. 16 and ref. 120). In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels (9,119). Second, the LDL level in newborn humans is approximately 30 mg/dl (121), well within the range that seems to be appropriate for receptor binding (Fig. 16). Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl. " www.science.org/doi/10.1126/science.3513311?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
It not all about one number on one test. Must look at big picture and must review his age, race, activity levels, diet and about 19 other blood markers to establish present status. Plus helps to know CAC score or CT scan.
@@DrAJ_LatinAmerica Thank you for your reply. My husband is high risk. Balloon angioplasty 20 years ago, heart attack with stent 6 years ago. One artery still has blockage, but I think his mind/memory has been affected (normal scan for age) and he is bursting out with fast growing skin cancers. He's also a sugar addict. He is 84 years old, though and very stubborn. He totally ignores his health. I need to make him a cardiology appointment soon.
@@jjbud3124 definitely some serious issues. At his age, he needs to do what make him happy. Definitely need to be working very closely with your doctor(s). Always Keep in mind the internet is just very rough broad strokes of information. Not medical advice regarding your husband specifically. All things are case by case, person by person. No one set diet or set of rules applies to everyone. Millions will say people don't need to take a statin medication. However millions are not your husband. Again your doctor has to look at all evidence AND has to base the treatment on the specific wishes of your husband and an agreement to follow treatment. I'm always surprised, but there are many (millions) who refuse to stop drinking, smoking, over eating, eating junk foods,..... Freedom is a double edge sword. But of luck, keep trying and God bless 🙏💪
Great Video!!! Thanks Dr Gil!!
Not understanding how 5.5 and a disasterous 10.0 A1c has the same rate. What disease is associated with a good A1c?
A1c is impacted by life-span of blood cells, so it is important to control for that first. Here is one paper:
"However, in sensitivity analyses among persons with anemia (10.2% of the study population), we observed stronger associations of low HbA1c with all-cause mortality (1.60, 95% CI: 1.07-2.39), cancer mortality (1.94, 95% CI: 1.03-3.65), and cardiovascular death (1.51, 95% CI: 0.74-3.09). Among participants without anemia, the results were somewhat attenuated but remained significant for all-cause mortality (1.22, 95% CI: 1.03-1.46) and cancer death (1.35, 95% CI: 1.05-1.74)."
There is a statistically significant increase even among non-anemic patients, so there might be other disease processes occurring that can artificially lower A1C (my hypothesis). For the record, my A1C was measured recently at 4.9% and I'm very much not anemic, so I will followup to let you know if I've died.
I learned something new today. Thank you.