Joi Ito's Web

Joi Ito's conversation with the living web.

I talked to a physician about my blood tests from yesterday. I will have the complete results soon, but the preliminary results are very interesting. I had 2 tests that were in or approaching the "red zone" a month ago. The levels are now well within the "healthy" range.

However, the physician was very concerned that my blood cholesterol was "too low". It was 132 mg/dL. He said that this means that I don't have enough energy and that it was dangerous. The problem with this for me is that I have more energy than I've ever had and have no signs of depression or anything like that.

In "The China Study" Campbell and Campbell explain the amazingly low rates of cancer, heart disease, liver disease and other "diseases of the affluent" in counties in China eating whole, plant-based foods. They tested the blood levels of the super-healthy Chinese. On page 106, they say:

As I mentioned earlier, the time when the China Study was begun, a blood cholesterol range of 200-300 milligrams per deciliter (mg/dL) was considered normal, and lower levels were suspect. In fact, some in the scientific and medical communities considered cholesterol levels lower than 150 mg/dL to be dangerous...

But when we measured the blood cholesterol levels in China, we were shocked. They ranged from 70-170 mg/dL! Their high was our low and their low was off the chart you might find in your doctor's office!

[...] We too often have come to the view that the U.S. values are "normal" because we have a tendency to believe that the Western experience is likely to be right.

So my question is... the diet that I am on has significantly improved all measurable indicators of a formerly much more unhealthy body. The one level that is "out of range" is blood cholesterol which is too low by Western standards. A quick google search shows various warnings about low cholesterol, but there appear to be a number of reports stating the opposite. Does anyone know of a resource to better understand the overall opinion of the medical community on the risks of low blood cholesterol?

I'm also going to try to talk to some of my friends in medical research about this.


Eat a couple sticks of butter and fuggedabout it!

That or bacon. Mmmmm... bacon.

I don't have any real medical knowledge. However, I am vegan, as are many of my friends. I tend to be rather untrusting of Western standards of health that are derived from a meat-based diet.

I think the important thing is how you feel. If you are feeling strong, fit, and energetic.. then you're doing something right. Many of my friends who have been vegan for 15-20 years don't look a day over 30, have beautiful skin, are very fit and show no signs of arthritis or other age-related annoyances.

Remember that ultimately you are the best judge of your own health, not a science that relies heavily on testing animals then trying to adapt those results to humans.

When I lived in Japan I'd get flagged for having too little (ie. below average) LDL (ie. "bad) cholesterol on my yearly kenkoshindan checkup through work... I laughed it off as my HDL levels were always dead on normal.

I've never been vegetarian, but I eat a ton of raw vegetables and fruit every day, and when I lived in Japan I had red wine practically every night. (Red wine supposedly lowers blood cholesterol...)

BTW, it doesn't surprise me that the national averages for cholesterol level for Japan would be high; even though the Japanese diet is recognized as being healhier than the average Western diet, a lot of the cuts of meat and prepared food in Japan are very high in fat compared to what you'd find in North America (with the possible exception of bacon!).

I just came across the term biomarkers of aging in relation to calorie restricted diets producing remarkable longevity in mice. Two of the biomarkers of aging that were detected to be remarkably improved were low levels of blood insulin and lower core body temperature. As you are sharing your body chemistry with us, I was wondering what your insulin levels will be like.
I have no idea how core body temperature is measured, but that might be interesting too.
Interesting discussion about the cholestorel. The world stumbles forward trying to figure out what it should be worried about.

Cholesterol level alone is not even a good indicator of cardiovascular disease risk. The ratio of bad/good cholesterol LDL/HDL ratio (where LDL is Low Density/Bad Cholesterol and HDL is High Density/Good Cholesterol) is a much better predictor of cardiovascular disease risk.

A Vegan (low fat) diet will lower both good and bad cholesterol, as cholesterol is essentially fat circulating on your blood, fat tied to a protein -apolipoprotein- that helps to transport the fat in your blood. On a vegan diet you don't get a lot of fat, so the amount of fat transported on you blood goes down

When there is a lot of LDL cholesterol on you blood, it is easier for it to stick to your arteries and give you cardiovascular disease. HDL on the other hand tends to "pick up" excess fat from your arteries, so HDL is good and LDL in excess (or when there is low HDL) can be bad.

So total cholesterol is not a good indicator, it is best to look at the components that make Cholesterol: HDL, LDL and VLDL.

I have very low cholesterol (124) but I still try to keep it very low, because genetically I tend to have extremely low HDL, and I can move LDL down (with diet and/or medication) but it is very hard to make HDL go up in any meaningful way, as HDL is determined mostly by genetics.

I would as the doctor about the levels of HDL and LDL, and not worry much about cholesterol alone.

If for any reason you feel you need to increase your cholesterol level, just add some fat to your diet and that should increase your cholesterol levels. You can try to find more vegetable oils if you want to try to stick to a began diet.
. Disclaimer... I am not a Doctor, so listen to the experts.


I just walked 2 hours to work and now I'm eating a bag of walnuts. Maybe eating more nuts will help my cholesterol. ;-)

Interesting Jorge. I'll try to get more detail on HDL, LDL and VLDL.

Looking at my recent blood test report, the acceptable range it gives here for total colesterol is 120-219mg/dl. This is for a test administered in Japan, and probably reflects the consensus medical opinion regarding appropriate total cholesterol levels for Japanese people.

Acceptable HDL range is given as 40-70 (for men) and 45-75 for women. Acceptable LDL range is given as 65-139. (all units mg/dl)

HDL/LDL are usually measured as a matter of course, and your doctor should be able to give you those numbers.

As Jorge writes, LDL/HDL ratio is an important indicator also.

Also, bear in mind that low total cholesterol and low HDL are both thought to be significant risk factors associated with stroke. - significantly enough that the Japanese government guidlines for cholesterol levels was increased back when the findings were published. I believe it was Takashi Shimamoto, et al. Trends for Coronary Heart Disease and Stroke and Their Risk Factors in Japan, Circulation 1989; 3:503 based on a quick search.

Anecdotally, as Japanese diet has transitioned to a more western style higher fat diet, incidence of strokes has decreased on a statistically significant level. (Though the pendulum has probably swung too far the other way now as far as fat intake is concerned)

Other suggested potential risks of low total cholesterol and HDL also include Alzheimers and psychological conditions such as anxiety and depression, both of which seem compatible with the current understanding of cholesterol's role in brain chemistry.

Furthermore, in a very recent study, low absolute levels of LDL have been suggested as a potential risk factor in Parkinson's disease. (the medical consensus regarding this recent finding appears to be that the risks are associated with long term levels of LDL, and should not discourage patients who are on statins to reduce their blood cholesterol levels)

Having written this much, although some of the information above is based on a conversation I had with my uncle who is a cardiovascular surgeon, I am not a medical doctor, so get a registered physician's advice.

I dunno if my comment was lost because of the problem you mention in your latest post, anyhow I'll re-submit.

My point basically was: don't be too much obsessed by food from a diet point of view. Eating it's not something you do just for sustain yourself in terms of energy, it's something where you express a lot more and where you may gain a lot more than the nutrients you are eating.

I'm Italian and one of the things I enjoy most of my cultural heritage is our rich and various cousinne and the love for good (in terms of quality) food I developed. I like almost everything, if it's cooked well and with love. I strongly believe that while it may be true that eating a Fiorentina (high t-bone, rare cooked, salt, pepper and a little of fresh oil) with grilled veg and some glasses of wine may be less healty than a strictly vegan diet I'm quite sure that I'm feeding my soul too that way. Fat problems? Eat *less*, but always *good*.

My 2eurocent: don't damn yourself with nutrient statistics, living longer must be worth of it. Eating is one of the pleasure that differentiate us evoluted apes from other earthly beings, and it's a shame to not enjoy it.

Take a close look at your testosterone levels. Low fat consumption causes increase of the SHGB (sex hormone binding globulin), which means one thing – less free testosterone. It is considered that monounsaturated fats play an important role in testosterone levels and bioavailability.

dasnake - you are making me hungry, and your advice is very good indeed

And by the way Joi - my dad has had a quad bypass (and is about 25 years older than you are) and had similar low cholesterol levels in a recent blood test .. because he was supplementing his regular cholesterol pills with some quack herbal pills (ganoderma / rei shi mushroom based stuff) a friend gave him, that were supposed to be good for general health, "toning up the cardio vascular system" etc.

He was also on an enforced low fat diet (he's already lacto + vegetarian, and has been all his life, but now he was on lots of boiled veg, lower amounts of starchy food - and south india having a rice based diet that means cutting down on rice, very very little oil, salt and spices if at all..) so that the mushroom stuff he took on started causing some funny swings in his cholesterol level.

Follow dasnake's advice - and dont go pure vegan, or any other sort of fad diet. Eat healthy (less fat, cooked well), eat small meals, chew your food.. remember everything your grandmother used to tell you? well, she was right.

I am currently on a hardcore vegan diet right now, which I think was a good thing. It increased my appreciation for fruits and vegetables in a way that I don't think I would have ever gained from just "increasing fruits and vegetables" and not eliminating meats and oils. I may return to eating small amounts of meats, but I'd much rather do it after having experienced these 6 weeks without them.

I am extremely fussy about eating and I've told many people that eating is one of the most enjoyable things in my life. Having said that, experimenting with eating is also very exciting. I am greatly enjoying myself right now including eating fruits and vegetables. I don't see it as a chore or a pain. I view this more as exploring MORE eating, not as limiting something. I always have a choice to go back to eating various foods.

On the other hand, I am very concerned about health risks and if I can happy with a diet that I believe is healthier, I'm not sure why I should force myself to eat things that I believe are unhealthy.

Also, the cultural heritage of Japan is a mostly vegan diet very similar to what I'm eating now. ;-)

The cultural heritage of japan is a mostly vegan diet WITH seafood, often lightly cooked or raw. Dont forget the seafood .. that is about the one thing that makes a typical japanese diet healthier than most [e&oe food poisoning, minamata from mercury contaminated fish etc but careful shopping can avoid that].

The huge assortment of pills you're currently swallowing (omega-3 supplements etc) are quite likely to be derived from fish liver oils so no, your diet is not as vegan as you think it is.

Why not something you'll probably like? Go "traditional japanese" in diet. And combine it with t'ai chi or something similar?

Scrap the vegan diet, Joi. You're in Japan, and Japanese cuisine is healthy. To raise your HDL, just eat more fish. Get some sanma in, for example. Here's a decent webpage: Fishoil FTW.

What is the damage of having low testosterone levels? I'm just curious. Seems like we have too much testosterone in the world already. ;-P

I'm not sure why I should "scrap my vegan diet" just because you assert the "You're in Japan, and Japanese cuisine is healthy." I'm enjoying myself and there is plenty of interesting food right now with the diet that I am on. I also have more energy than I've ever had before. Unless someone convinces me that what I'm doing right now is an actual health risk, I don't see why I should change. I'm not asking other people to eat what I eat.

There is significant evidence that eating the amount of fish that many Japanese eat IS bad for you. Many fish contain high mercury levels and many Japanese diets exceed the recommended amount by far. Fish are basically the top of the food chain and contain lots of chemicals that end up getting dumped into the sea. Also, I can get plenty of fats including omega-3 from things like flaxseed which I enjoy.

I think the Japanese diet USED to be quite healthy, but deaths from "Western diseases" are increasing as the diet "globalizes" and animal proteins and refined starches increase.

Having said that, after I finish this 6th week of the 6 week program, I will begin experimenting with adding more variety to my diet including small amounts of oil, fish, meat, etc. I will try to keep my total calorie intake from non-whole plants to 10% or so. I primarily want to experiment with how my sense of taste has changed. I'm also curious about whether my body will reject certain foods.

Thanks for the link Adriaan. It looks like I can increase HDL from soy products which I eat almost every day and onions which I eat several times a week. But I'll wait until I get the actual detailed blood test back since I'm not even sure it was HDL that my doctor was talking about. Right now I'm doing a "let my body tell me" thing eating as much of whatever I feel like eating and am trying to see how well it ends up balancing in the end.

Found a few comments jammed in the filter... Sorry.

Shin: Thanks for your post. I will try to dig up the sources, but The China Study tries to debunk some of the arguments against low cholesterol. I'll try to read sources from both sides and report back if I figure something out. Has the incidence of stroke really decreased in Japan with increased fat intake? The data I gleaned from various studies that I've skimmed seemed to be asserting the opposite. I'll go back and compare this as well.

Suresh, the omega-3 supplements I'm taking are made from sunflower seeds.

Having said that, I'm not a vegan because of religion and I don't mind taking nutritionally insignificant amounts of animal products. I'm being strict for these first six weeks, but I don't plan on rejecting flavors or animal stock.

Sorry for the long string of comments. I realize I'm rambling. I blame it on my spam filter ;-)

I did set up a meeting with a well known medical researcher and I'll try to grill him for information and other researchers that I can talk to. The problem I'm having with some of the physician's that I'm talking to is that their advice seems to be based on "standard practice" which isn't reviewed that actively. They also seem to assume that it is impossible for anyone to be happy on a vegan diet. I'd rather make the "matter of taste" part of the decision myself.

I realize that the natural tendency is to suggest that everything should be done in moderation. The thing is, there is lots and lots of data about totally vegan populations that are healthy and in most cases live longer than modern populations. I don't think "going vegan" is really that extreme.

Having said that, I do appreciate the input and I will continue to experiment and possibly even go back to a more balanced omnivorous diet. I am just reacting negatively to people assuming that I'm "missing out" on something when I'm enjoying life, including my meals, more than I ever have.

For Japanese, hemorrhagic strokes are a much more significant cause of death than for westerners. Stroke incidences are much higher, and hemorrhagic strokes occur much more frequently than for westerners, where 80-90% of strokes are ischemic strokes.

For westerners, lowering cholesterol levels reduces risk of both cardiovascular disease and (ischemic) strokes.

For Japanese, (whose cholesterol levels are mostly very low/low/normal by western standards anyway), reduction in cholesterol levels reduces risk of cardiovascular disease, but may increase the risk of hemorrhagic strokes at a rate which makes the slight reduction in CV disease moot. One study (H Tsuji et al 2005) showed low cholesterol levels tripling the risk of hemorrhagic stroke.

I'd recommend that, as you are of Japanese genetic makeup, you look into Japanese studies of Japanese patients as there is a significant difference in the cause of death distribution between Japanese and western patients (and "normal" cholesterol levels mean quite different things in Japanese and Western circles as well....).

Good advice. Thanks.

What is the damage of having low testosterone levels? I'm just curious. Seems like we have too much testosterone in the world already. ;-P

Less erections :P

My 73 year old dad has better cholesterol than you and eats more meat in a week then most people do in a month.

His favorite: Pork

Why is he so healthy? He prepares all his meals, lots of vegetables, lots of garlic, lots of wine. I can't emphasize the wine enough, our house easily goes thru a bottle a day.

Don't blame the meat on your unhealthy self, blame the food you stick in your body.

From 10 years of vegetarianism with many stretches of veganism detox within, i can give you this following advice:

When it comes to Vegetarian/Vegan lifestyles, your doctor is either a well known authority or 100% clueless about the nutritional / body impact. There is abolutely no middleground. This has no bearing on their intelligence or ability to be a doctor - its just not taught in medical schools, and people create beliefs on hearsay.

You'll meet doctors who will tell you that you are going to die if you don't eat meat. You'll meet ones who will tell you that your body can't run without at least dairy. You'll also meet ones who will tell you variatins of the above while wholly believing it themselves.

In any event, LDL and HDL have a lot to do with the foods you eat and your genetic makeup. An ex gf and I once did a test. We got our cholestorol checked, ate the same food for a month (mainly delicious mexican smothered in cheese), and got it checked again- I went up 2%. She went up 20%. Some people just have good genes - my heritage is luckily from european areas where i can stuff myself with fats and oils and it will barely influence my numbers.

In my experience on vegan detox, cutting out dairy for 3 months can lower LDL from ~180 - 120. eating balaced food , moderate soy ( there's the estrogen issue ), and subbing in olive oil, can raise HDL from 35 - 50.

The Eat To Live diet seems very marketing oriented. If you haven't seen it before, I'd suggest looking into the McDougall program. McDougall's diet - widely used for many years , is a strict lowfat vegan diet. Its based on health studies of long-living indigenous populations. There are a series of books on Amazon - some are health oriented, others are weight loss orieted. 12 days to dynamic health is probably the best. There's also the new flashy website:

Having gone through the same motions of you several times a year, I can also suggest this:

The Low-Fat Cookbook from the Moosewood Cookbook can be your new bible.
There are TONS of great vegan recipe resources online - has a ton of their own, and lists many blogs/links across it as well.
When you transition out of veganism, should you decide to, a really good intermediary diet is the mediteranean. the only fat is generally from olive oils, it correlates to a largely healthy culture of people, and its absolutely delicious.

"I'm also curious about whether my body will reject certain foods."

I was vegan for 5 years (mostly for moral/political reasons), and then I went back to eating meat/cheese/etc. for a month in an effort to fix my perspective and reevaluate (I blogged about it here: ).

From my experience, my body handled every animal product I threw at it with grace. Digestively, I had no difficulty with creams, cheeses, meats, whatever. But taste-wise, I found many non-vegan foods to be unappetizing. Even mild cream cheeses seemed to have way too much "cheesiness" to them. Creamy dressings were unpleasant additions to sandwiches. I was surprised by how pervasive animal products are in US markets - which I had mostly ignored in the previous five years, but only started noticing when I finally considered them edible.

One thing I did find, however, was a return in cravings for some things (like cheese or ice cream) which I hadn't experienced in years, and recalled being tough cravings to kick, initially.

While I'm still confused on the moralistic grounds for veganism, I'm back on a vegan diet for its convenience and healthiness. I wish you the best of luck with your health and choices.

I'm totally engrossed in reading about your Vegananism experiment and all the fabulous comments. I've been Vegan for about 7 years, and it's long been completely second nature. It's also opened up my life to so many great new things: Nutrition, Botany, Cooking, Herabalism, Philosophy etc.

When I first converted I read all the books I could about it, and one of the more interesting one's was Cardiologist Dean Ornish's Program for Reversing Heart Disease which is just 40 cents used, at least on America's Amazon.

Here's a link where he specifically adresses the issue of low-fat vegan cholesterol levels:
Jump down about half way to "After a heart attack eight months ago"

Also, I couldn't agree more with Jonathan's advice "When it comes to Vegetarian/Vegan lifestyles, your doctor is either a well known authority or 100% clueless about the nutritional / body impact."

As for energy, it is my understanding that Carl lewis became vegan purely for athletic reasons:

I've got about 7 years worth of advice I want to share, but I'll restrain myself.

I look forward to reading about your progress!

funny, this topic, like something from the 70's, better late than never i suppose,

What is regarded as a 'normal' range for cholesterol is based on what *most* of the population already have. While this may be a good way to calculate what is 'normal', it is not a good way to calculate what is a *healthy* range. In fact, considering the 'normal' diet is extremely high fat - and we consume more meat today than ever in history - then you should celebrate if your cholesterol level is 'sub-par'.

Since the conversation is on cholesterol, one aspect of cholesterol metabolism that most of us don't realize is happening is that some biotoxins - mycotoxins and other low-molecular-weight toxins from toxinogenic molds, shellfish, lyme disease bacteria, spider bites etc, tend to collect in the bile and recirculate, along with cholesterol, between the liver and small intestine.

In toxic environments, etc, especially with some people, they can accumulate at a rate faster than they can be excreted without help. This buildup leads to biotoxin illness and it can cause metabolic chaos.

The best way to get them out of the body is to use the anti-cholesterol drug cholestyramine, which removes them from enterohepatic recirculation.

I found this out the hard way when I was sickened by mold in the walls of my apartment building. Cholestyramine helped me quite a bit - and of course, I moved, but I'm still sick with lots of health issues.

Something to watch out for and remember!

Regarding low cholesteral levesls, Reuters recently ran a story reporting a study that associated drop-offs of total cholesterol levels with future (15 years later) dementia.

It does suggest that whatever is causing the drop in cholesterol maybe the cause of dementia. But trust news on the Internet to make you nervous about anything.

Also, somewhere above there is a comment about what is wrong with low levels of testosterone. My father went through a treatment which surpresses all testosterone in order to stop/delay the spread of prostate cancer throughout the body. Although one might say he was mellower, the lack of energy and ability to rebuild muscle was not something that you want to face. Still that was a n extreme case.

I don't think either of these apply to you, and in the end the body is probably too complex for an individual experimenting with himself to be able to understand all the implications. But feeling good and being energetic sound like good signs - although I can get that for a couple of days from some of the strong coffee that is served in Japan.

What total crap. "Your cholesterol is too low." Too low for your doctor to make money, that is!!

Mine is 130. I've been vegan for seven years. I skate marathons. I'm training to run a half marathon. I do lots of exercise and generally bounce around happily all day. the last thing anyone would ever accuse me of is too little energy.

Listen to your body. Does it feel good? Is it responding well? It will tell you what it needs.

Dr. Weil wrote about low cholesterol a couple times on his site:

My total colesterol was 324,HDL 58, LDL 275, Triglyceride
256. After taking 40 mg Zocor for tree monts, my total colesterol 1s 13o, HDL 50, LDL 57, TRYg.115.
I think I have been overmedicated! Am I in danger. I am 73 years old.