Can Your Cholesterol Be Too Low?

Some people, when they follow a low-fat vegan diet or a low-fat RAW vegan diet, come back with interesting blood test results, with cholesterol levels so low that their doctor is puzzled and even worried. They’ve just never seen any patient with levels that low.

I’m talking about levels way below 150 mg/dl. For example, as low as 120 mg/dl, and sometimes lower.

I’ve personally never had that “problem,” as I think I have a tendency for higher cholesterol, which I keep in check with my current regimen. (My cholesterol hovers between 155 and 165.)

Before we look at how low cholesterol levels can be, we have to look at the role of blood cholesterol in the development of heart disease, because I think this is where the “debate” lies. I put the word debate in quotes because it only appears to be a debate on the Internet and with diet gurus, but not with the vast majority of scientists.

Why the Contrarian View on Cholesterol is Wrong

When I started looking at this a few years ago, I had an open mind and wanted to find out the truth. Were the vegans right? Were the paleo folks right? What would be the right approach when it comes to preventing heart disease, and consuming animal products?

I was prompted to get down to the bottom of this issue when my dad died of a heart attack, and my own cholesterol readings did not put me in the healthiest range according to the vegan doctors.

The “contrarian” thing to say would be that cholesterol has nothing to do with heart disease, and in fact prevents heart disease (such a claim is made by the Weston Price Foundation).

But this contrarian view is WRONG. Dead wrong.

Heart disease can be caused by a number of factors, but elevated LDL levels is the most important factor of all. It’s almost impossible to develop atherosclerosis if one smokes, has hypertension, and doesn’t exercise… as long as LDL levels are under 80 mg/dl (some people say 70 mg/dl).

This has been shown countless time both in animal models (every mammal reacts the same way, including primates) and epidemiological studies.

Some people try to blame heart disease on other factors, like sugar, but it’s quite ludicrous because it’s only been associated with heart disease as a relationship factor in epidemiological studies, but not proven by other models.

(There is a model in which sugar can cause heart disease. It’s because elevated blood sugar levels damage LDL particles, making everything stickier, just like when sugar water is dropped on a table. However, this model alone is not sufficient to cause heart disease and animal studies have disproven it.)

What’s Unique About LDL Cholesterol and Heart Disease

There are other risks factors other than LDL; however, one cannot deny the primordial role of elevated LDL levels in the development of heart disease. This is because it can be a unique cause, as opposed to the other factors, which work in conjunction with each other.

This is the main point: there are many causes to heart disease, but only one main factor that alone is sufficient to cause it. This factor is elevated LDL levels. I have many sources for this:

“There are many risk factors to cardiovascular disease but elevated cholesterol levels alone are enough to drive the disease.”1

“Among the many genetic and environmental risk factors that have been identified by epidemiological studies, elevated levels of serum cholesterol are probably unique in being sufficient to drive the development of atherosclerosis in humans and experimental animals, even in the absence of other known risk factors. In humans, the majority of serum cholesterol is carried by LDL particles.”2

“In contrast to feeding cholesterol and/or saturated fat, it is not possible to produce atherosclerotic plaques in herbivores by raising the blood pressure chronically, by blowing cigarette smoke in their faces for their entire lifetimes, or by somehow raising the blood glucose levels without simultaneously feeding them an atherogenic diet.”3

William C. Roberts.

A Few Interesting Facts About Genetic Disorders

Some people are affected by familial hypercholesterolemia; a genetic disorder. They have very high cholesterol levels and have to be treated with medications. One in a million people is affected by familial hypercholesterolemia in both chromosomes, and those people can die of heart disease in their 20s, with no other risk factor.4

On the other hand, another genetic anomaly is hypocholesterolemia, which is just the opposite: abnormally low levels of blood cholesterol. However, these people tend to live longer than their peers because this defect protects them from heart disease.

“Expectations of life for males and females (with this condition) were 9 and 12 years longer (…) than otherwise expected.”5

How Much Cholesterol do we Need?

Humans need cholesterol to perform important functions. What we need is in the range of 25-60 mg/dl for LDL, and total cholesterol of 110 to 150 mg. 6

From the Same Source:

Other mammals without heart disease have LDL generally less than 80 mg/dl.
LDL level in newborn humans is around 30 mg/dl (total cholesterol around 72
born from mothers with total cholesterol of 297 mg/dl and LDL of 162).
In humans raised on a low-fat diet, LDL stays around 50 to 80 mg/dl.
LDL of 100 mg/dl and above is customary in rich societies with high intakes of animal foods.7

Official Recommendations (Mayo Clinic) for LDL Cholesterol:

Below 70 mg for people at very high risk of heart disease
Below 100 mg for people at risk of heart disease

How Much Cholesterol Do We Actually Need? (Continued)

Because some people have a genetic defect for very high LDL levels, some research has been done to determine how low their cholesterol can be lowered with medication. Because hypercholesterolemia is a serious disease with life-threatening consequences if left untreated, researchers have tried to answer this question. Here’s information from some research I found:

“Lowering plasma cholesterol levels does not decrease intracellular cholesterol levels (…) so much that even at plasma LDL cholesterol concentrations of 10 mg/DL, the LDL receptors in peripheral tissues would still be at 50% saturated and uptake would continue unabated.”  Daniel Steinberg, MD.8

(Notes from Fred: essentially, he’s saying that LDL levels can be pretty low and still perform its function in the body.)

Steinberg says: “LDL cholesterol levels can be 9

People claim that cholesterol is necessary for the body to perform essential functions. That is true, but the amount we need is very low. Other mammals have LDL levels well below 42 mg/DL and do just fine.

Infants and Cholesterol Levels

Infants have cholesterol levels of 50-90 mg. 10

What are Ideal Cholesterol Levels?

Optimal for LDL seem to be 50 to 70 mg/dl. Lower is generally better and physiologically normal.

- Loren Cordain, promoter of the paleo diet, says that optimal levels of LDL should be between 50 and 80 mg/dl. (I found an interesting study he co-authored that I will reference below.)

- Hunter-gatherers have low cholesterol, generally about 70 to 140 mgl/dl (35-70 mgl of LDL).

Here’s an interesting table from the study I’m about to reference:

Cholesterol in Native Populations and Wild Mammals (Total mg/dl) 11

Inuit: 140 mg

Hazda: 110 mg

Pygmy: 106 mg



Wild Primates



Baboon: 110 mg

Howler monkey: 105 mg



Wild Mammals:



Horse: 140 mg

Boar: 70 mg

African Elephant: 110 mg



Adult American: 208 mg (LDL 130 mg)

Quotes from The Study:

“The normal low-density lipoprotein (LDL) cholesterol range is 50 to 70 mg/dl for native hunter-gatherers, healthy human neonates, free-living primates, and other wild mammals (all of whom do not develop atherosclerosis). Randomized trial data suggest atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to 12

“Atherosclerosis development is a complex process influenced by a myriad of risk factors, although the LDL level is among the most important.” 13

“Atherosclerosis progression varies directly with low-density lipoprotein (LDL) cholesterol. This regression line indicates that atherosclerosis does not progress when LDL is 67 mg/dl or below.” 14

“Cholesterol is an essential component of the cell membrane and an obligate precursor for bile acid, steroid hormone, and vitamin D synthesis. Consequently, it is likely that a physiologically ideal range of blood cholesterol exists above and below which adverse health consequences might be expected. Although individuals with serious chronic illnesses, such as cancer, often develop depressed LDL levels as a result of malnutrition, epidemiological studies show that people with naturally low LDL levels are associated with improved longevity.” 15

“People with heterozygous hypobetalipoproteinemia have total cholesterol levels as low as 80 mg/dl and LDL cholesterol levels as low as 30 mg/dl (30). This condition is associated with longevity (31), presumably due to the absence of atherosclerosis, but the lack of other adverse effects that might have accompanied a low LDL level suggests that such low levels of LDL are safe.” 16

Why do Hunter-Gatherers Have Low Cholesterol Levels?

It’s a bit of a paradox that societies with a relatively high intake of animal products have low cholesterol levels, while people following a paleo diet nowadays have a high cholesterol level.

It seems to be that parasites eat up excess cholesterol, and parasitic infections are common in those societies. 17

Even malaria (parasites) lowers cholesterol.

Also, a number of disease cause cholesterol to be lower. So, that’s why people have lower cholesterol at the end of their lives. Sometimes, this is why low cholesterol levels are associated with some diseases, like depression, when it’s possibly this reverse causation effect.

For the hunter-gatherer societies, other explanations include food scarcity and genetic adaptation.

Should we aim at LDL levels of 80 mg/dl or less? If one is at a high risk for heart disease, yes.

If one exercises and does all of the right things, then overall risk of heart disease is lower, because some of these things will prevent the disease (in part). But I still think looking at LDL levels or total cholesterol is a good idea. About 25% of heart attacks occur in people in the cholesterol range considered “normal.”

What About You: Do You Check Your Cholesterol? 

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1 SOURCE: (Arteriosclerosis, Thrombosis and Vascular Biology. 1987:7:612-619 – “Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake”)

2, 3 SOURCE: (Cell, Vol. 104, 503-516, February 23, 2001 Christopher K. Glass and Joseph L. Witztum Specialized Center of Research on Molecular Medicine and Atherosclerosis Other source: book called “Nutritional and Metabolic Bases of Cardiovascular Disease”)

4 Source: (Familial hyperalaphalipoproteinamia J Lab Clin Med, 1976, Dc,88(6)-941-57)



5 Source: (The Johns Hopkins Textbook of Dyslipidemia) – Peter O. Kwiterovich, Jr., MD)

6, 7 Source: (“A Receptor-Mediated Pathway for Cholesterol Homeostasis” – Nobel Lecture, 9 December, 1985 by Michael S. Brown and Joseph L Goldstein)

8, 9 SOURCE: (“Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia” – Circulation, 2008; 118:672-677)

10 SOURCE: (Serum Cholesterol Concentration in New-Born African and European Infants and Their Mothers) – American Journal of Clinical Nutrition, Vl 4, No. 8, 1962)

11-16 SOURCE: (James H O’Keefe, MD*; Loren Cordain, PhD†; William H Harris, PhD*; Richard M Moe, MD, PhD*; Robert Vogel, MD‡ J Am Coll Cardiol. 2004;43(11):2142-2146. doi:10.1016/j.jacc.2004.03.046 http://content.onlinejacc.org/article...)

17 SOURCE: (“Role of cholesterol in parasitic infections” – Lipids in health and disease 2005,4:10)

Note: thanks to PlantPositive for inspiring this article.