In his recently published book, "How Not to Age," Dr. Michael Greger questions the definition of normal cholesterol levels in today's society. According to Dr. Greger, average cholesterol values are considered normal based on a sick society where heart disease remains the leading cause of death.

Scientific consensus panels have long established the link between lowering LDL cholesterol and reducing the risk of heart attacks. Dr. Greger emphasizes that the evidence unequivocally demonstrates that LDL cholesterol is a major contributor to heart disease, our number one killer. This extensive evidence base is derived from numerous studies involving millions of people.

While there are multiple risk factors for atherosclerosis, Dr. Greger highlights that elevated cholesterol is the primary driver of the disease. Other factors such as smoking, high blood pressure, diabetes, inactivity, and obesity exacerbate the damage caused by high cholesterol.

The concept of having "normal" cholesterol levels is called into question. Dr. Greger argues that even individuals with so-called optimal risk factors, including normal blood pressure, blood sugars, and total cholesterol under 200, can still develop atherosclerotic plaques in their arteries. In fact, when ultrasound and CT scans were used to evaluate people with these "normal" numbers, 38% were found to have overt plaques. These findings suggest that what is considered normal by current standards may not be optimal for human health.

Dr. Greger suggests that an LDL cholesterol level should only be considered optimal when it no longer causes disease. Research involving over 1,000 individuals in their forties revealed that only those with LDL levels around 50 or 60 had no atherosclerotic plaques. This range coincidentally reflects the levels observed among our ancient ancestors before the dietary changes of today. The global adult population, historically, had LDL levels around 50 mg/dL.

According to Dr. Greger, an LDL cholesterol level in the range of 30 to 70 mg/dL (or 0.8 to 1.8 millimoles per liter) is considered normal for the human species. While this may seem excessively low by modern American standards, it aligns with the diet and lifestyle for which our ancient ancestors were genetically adapted.

Some experts argue for LDL levels under 70, but simply reducing intake of saturated and trans fats and dietary cholesterol may not be enough for most people to reach this target. However, those following completely plant-based diets have been found to achieve an average LDL as low as 70. Plant-based diets have also been scientifically proven to reverse the progression of coronary heart disease.

The question of how low LDL cholesterol levels should be lowered is an ongoing debate. While some experts argue for the lowest possible levels, the method of achieving lower levels matters. The use of pharmaceutical drugs, such as statins, comes with countervailing risks. Therefore, maximizing the benefits while minimizing the risk of side effects is crucial.

Dr. Greger's book challenges the medical community to not only focus on decreasing risk factors but also preventing the formation of atherosclerotic plaques altogether. While the ideal approach may vary, promoting healthy lifestyle changes and adopting plant-based diets can lead to significant reductions in cholesterol levels and a lower risk of heart disease and other related diseases.

As discussions continue on what truly constitutes optimal cholesterol levels, it is clear that a shift in perspective is needed to prioritize long-term cardiovascular health and wellness.