Moderation Kills

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However, as Dr. Esselstyn wrote in the Cleveland Clinic Journal of Medicine, in regard to cholesterol lowering, moderation kills. “Even if all Americans kept their total cholesterol below 200 mg/dL, as recommended by the American Heart Association, millions would develop coronary artery disease.” Strong evidence shows we need to keep our total cholesterol under 150 mg/dL in order to stem the American epidemic of coronary artery disease, our number-one killer. What kind of evidence? In many cultures, coronary artery disease is practically unheard of when total serum cholesterol levels are under 150 mg/dL. In the United States, the famous Framingham Heart Study demonstrated that few of those with levels below 150 mg/dL developed heart disease, and none died from it.

What if we don’t want just low risk for a heart attack, but no risk? One great stumbling block has been that government and national health organizations appear to have taken the patronizing view that the public can’t handle the truth and would rather the science be watered down.

In my video Everything in Moderation? Even Heart Disease? you can see the data from a 26-year follow-up of the Framingham Heart Study comparing the cholesterol levels of people who get heart attacks and the cholesterol levels of those who don’t. The study suggests that because we now know that 35% of heart attacks occur in people with total cholesterol levels of 150-200 mg/dL, a target level of only 200 mg/dL guarantees that millions of U.S. citizens will die from coronary artery disease.

Dr. Esselstyn states, “We cannot continue to have public and private organizations on the forefront of health leadership recommend to the public a dietary plan that guarantees that millions will perish from the very disease the guidelines were supposed to prevent. With its lack of fiber and antioxidants, and its emphasis on animal protein, fat, and extreme free-radical production, the US diet is largely responsible for our bitter harvest of [chronic] diseases….” He continues, “If the coronary artery disease epidemic is seen as a raging fire, and cholesterol and fats as the fuels, the AHA [American Heart Association] has merely recommended cutting the flow of fuel. The only tenable solution is to cut off the fuel supply altogether—by reducing cholesterol levels to those proven to prevent coronary artery disease.”

It’s worth closely examining the Framingham data. At first, it seems those who get heart disease and those who don’t have very similar cholesterol levels, but that’s only at “normal” levels. To get an Optimal Cholesterol Level, one has to eat an exceedingly healthy diet. It’s worth it, though, since we’re not just talking life and death with heart disease, but life and the number-one cause of death.


What’s so bad about having high cholesterol? Well, it’s not only involved in the formation of atherosclerotic plaque, as I discuss in my video, Cholesterol Crystals May Tear Through Our Artery Lining. What about fluffy versus dense cholesterol? I cover that in Does Cholesterol Size Matter?. But can’t you just take cholesterol-lowering statin drugs? I encourage you to see The Actual Benefit of Diet vs. Drugs. When should we start monitoring cholesterol? As it turns out, Heart Disease May Start in the Womb.

For more on this concept of being at normal risk and dying from all the normal diseases, watch my video, When Low Risk Means High Risk. I continue questioning the patronizing paternalism of authorities in Optimal Diet: Just Give It To Me Straight, Doc. Finally, check out my latest heart disease overview, How Not to Die from Heart Disease.

Michael Greger, M.D.

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