Nutrition Made Simple! - 2023-06-26
Are low cholesterol levels dangerous? Do they raise risk of death? A look at the evidence and its significance. Connect with me: Facebook: https://www.facebook.com/DrGilCarvalho/ Twitter: https://twitter.com/NutritionMadeS3 Animations: Even Topland @toplandmedia References: 1.https://www.nature.com/articles/s41598-018-38461-y 2. https://www.bmj.com/content/371/bmj.m4266 3. https://www.sciencedirect.com/science/article/pii/S0002916523050244 4.https://cardiab.biomedcentral.com/articles/10.1186/s12933-015-0179-2/figures/4 https://www.nature.com/articles/s41591-020-0785-8 5. https://www.sciencedirect.com/science/article/pii/S1050173819300684 6. https://www.jacc.org/doi/full/10.1016/j.jacc.2008.06.036 7. https://journals.lww.com/co-lipidology/Abstract/2018/08000/Acquired_low_cholesterol__diagnosis_and_relevance.8.aspx 8. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011737.pub3/full 9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437972/ 10. https://academic.oup.com/ije/article/44/2/604/753171 11. https://www.sciencedirect.com/science/article/abs/pii/S1462388905001080 12. https://aspenjournals.onlinelibrary.wiley.com/doi/abs/10.1177/011542650602100168 13. https://onlinelibrary.wiley.com/doi/full/10.1111/jdi.12698 14. https://www.sciencedirect.com/science/article/abs/pii/S1470204505701704 15. https://www.sciencedirect.com/science/article/abs/pii/S1525861017306746 Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!. #NutritionMadeSimple #GilCarvalho 0:00 Low cholesterol raises risk of death? 1:12 The U curve 2:20 BMI 3:09 Blood pressure 3:43 HbA1c 4:23 Disease lowers cholesterol 6:49 U curves are common 7:52 A thought experiment
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
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.
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.
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
As a physician for 35 years, this presentation is eye opening. Medical disease prevention criteria now seem backwards!
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.
I find it chilling knowing that your videos NOW will probably wind up saving my life when I turn 60.
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
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.
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)
Thank you for what you do. There’s so much misinformation about nutrition floating around on YouTube. 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!
man, you nailed it. Beautiful, thank you. Love clear explanations of scientific realities.
I appreciate your dedication to digging into this important issue.
Thank you! As a heart disease patient, this information is definitely of great importance.
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
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
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.
This is becoming my favorite nutrition channel.
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.
I've watched this video three times and read a lot of the comments, and I"m still not persuaded that optimums on cholesterol aren't actually the high levels.
Remove the people with cancers and other non-cardiovascular diseases, and we should see a linear effect, with those at relatively high levels still near the optimum.
The comparison to the BMI, BP, and HbA1c are not persuasive as two of them are not quadratic, and the other shows a tiny risk change across a wide range of BMIs.
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 YouTubers 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.
You deserve an award. Your fact-checking is as valuable as anything issued by the Surgeon General.
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.
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
Can you please start writing a book on nutrition and these related topics…
We need a voice like yours out there.
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.
Great video! Statins helped me but I stopped after 3 months. From there, diet and walking. Not so much diet as a lifestyle change. Meat was causing belly pain where my gallbladder area is and in my colon. Screw anymore surgeries, I went vegetarian 🥗. Best decision of my life.
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
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.
Excellent explanations. Finally, some proper medical interpretation of this phenomenon.
It's like losing weight. That happening for no reason (diet, exercise) is usually mentioned as a cancer symptom.
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
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.
You and Dr. Seheult are the only MDs on Youtube I trust.
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
Helpful as always. Well presented.
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!
As always, your videos are a great asset for understanding complex medical findings. Obrigado!
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."
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.
Excellent explanation! 🎉 thank you!
Thank u Sir. In depth understanding leaves no confusiom.
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?
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.
Just popping in to say thanks for the great video!
Hello Sir :) Which cholesterol levels are you discussing here ? The HDL ( the good one ) or the LDL ( the bad one ) ??
Excellent video. Very helpful in understanding so many YouTube channels that state there's little wrong with high cholesterol. Thank you.
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!
@paulholloway1599 - 2023-06-27
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.
@larryc1616 - 2023-06-27
It can be both just like high cholesterol can be due to diet/genetics or disease
@soniashapiro4827 - 2023-07-02
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.
@ScottLane-ud9tj - 2024-06-23
Dr. Atkins had a heart attack and a history of heart disease and he was overweight.