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
I find it chilling knowing that your videos NOW will probably wind up saving my life when I turn 60.
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.
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.
This is becoming my favorite nutrition channel.
I appreciate your dedication to digging into this important issue.
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!
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.
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.
Excellent presentation. Thank you.
So crystal clear and to the point and brilliantly put! Thank you for this!
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
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.
Bravo - Love how you explain complicated issues in a way that makes them easy to understand.
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!
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.
As a physician for 35 years, this presentation is eye opening. Medical disease prevention criteria now seem backwards!
man, you nailed it. Beautiful, thank you. Love clear explanations of scientific realities.
Just popping in to say thanks for the great video!
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
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?
Thank u Sir. In depth understanding leaves no confusiom.
I like your cholesterol paradox resolution from the epidemiological point of view. Very well explained Gil, with your excellent structured multimedia presentation.
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)
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
Love your work. Thank you!!!
Excellent explanations. Finally, some proper medical interpretation of this phenomenon.
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 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.
Wonderful explanation and clears up a lot of confusion.
Beautifully conveyed. 💯
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!
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 ?
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!
Fantastic explanation. Thank you.
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 info as always, Doc! Thanks!
Well presented doc.
Thank you! This video is useful
Always great content Gil! I'm so happy that your channel is flourishing as more people discover this gem.
I wouldn’t get so fixated on micro biological mechanisms. Outcome studies are what matter.
Great Video!!! Thanks Dr Gil!!
Great video - perfect way to teach this topic
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.
Great video.
thank you very well presented info
Nice! Always looking for good evidence to continue taking care of myself!
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."
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?
@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.
@jamest1103 - 2024-02-15
Lipoprotein levels have only been shown as a marker of disease, it's why we're on the 10th iteration of the hypothesis.