Medical Myths: From 64 Ounces of Water Per Day to “Healthy” Low Cholesterol

I started Psychiatry Redefined in an effort to address the challenges present in mainstream psychiatry’s approach to patient care. Considering the poor efficacy of a one-size-fits-all, medication-based treatment for patients, I knew there had to be a better way to approach mental illness.

Having been aware of the research on nutrient interactions with mental health, my own journey led me to functional medicine and functional psychiatry, where treatment determined by laboratory testing for the underlying factors contributing to a patient’s symptoms.

Patients are unique, with numerous components that can all contribute to mental health, including nutrient deficiencies, hormonal imbalances, gut flora problems, toxicities, chronic infections, genetic factors and personal history. Recognizing the uniqueness of patients and providing a more comprehensive assessment and treatment is the foundation of functional psychiatry.

Some of the questionable strategies in modern medicine derive from medical myths—ideas that aren’t based on the most up-to-date research, and are repeated often enough that people begin to believe they are true. Recently, I was reminded of one of those myths when I was forwarded a video on how much water we should consume on a daily basis.

While most people recommend eight, eight ounce glasses of pure water per day, a total of 64 ounces, the recommendation is a misunderstanding of the original 1945 recommendation from the U.S. Food and Nutrition Board. The board originally recommended that individuals should consume 1 milliliter of water per calorie of food. For a 2000 calorie diet, this works out to about 64 ounces of water per day (Stookey 2020).

However, this 64 ounces is equates to water consumed from all food and beverages combined, not a recommendation for pure water. In reality, we can meet a large portion of our daily water needs from our food and other beverages, including coffee, milk, juice and tea.

Another common health myth is that low cholesterol is healthy.

For decades the cholesterol hypothesis has dominated our approach to heart disease. And while it is true that highly elevated cholesterol levels increase the risks for heart disease, the data doesn’t show that low cholesterol is always better.

In fact, a recent analysis found the levels of low density lipoprotein cholesterol (LDL) under 70 mg/dl had a 45% higher risk for all cause mortality, a 60% increase in cardiovascular mortality and a whopping four times higher risk for stroke mortality. For high LDL levels above 190 mg/dl, they found a 49% higher risk of cardiovascular mortality and 63% increase in coronary heart disease mortality, with no change in stroke risk or all-cause mortality (Rong 2022).

In summary, low LDL increased the risk of death MORE in some categories, including all-cause mortality, than high LDL.

Some of the strongest data comes from older patients. A systematic review found the opposite of what was expected (Ravnskov 2016). For most individuals over age 60, higher LDL cholesterol was protective—it reduced the risk of death from any cause.

For heart disease there was either no association or reduced risks for cardiovascular mortality with high LDL cholesterol, depending on the research cohort examined. The author’s state that the findings clearly question the validity of the cholesterol hypothesis as an underlying cause of atherosclerosis and heart disease.

As for mental health outcomes, the data on low cholesterol also raises serious concerns. Initial research in the 1990s started to uncover a link between low cholesterol and suicide, especially violent suicide.

Low cholesterol is known to lower serotonin function, potentially leading to increased aggressive, impulsive and even violent behaviors (Fiedorowicz 2010).

The latest meta-analyses only appear to confirm the findings. In major depressive disorder, both low total cholesterol and low LDL cholesterol were associated with suicide risk (Li 2020).

For schizophrenia, a separate analysis found low total cholesterol associated with suicide attempts (Sankaranarayanan 2021). An earlier meta-analysis of risk factors and suicide found significantly lower total cholesterol, LDL and HDL in suicidal patients as compared to healthy controls. However, the authors caution that the included studies had a high degree of variability (Wu 2016)

Considering the increased risks for suicide combined with other major health concerns associated with low cholesterol, it starts to bring up valid questions as to our lower-LDL-cholesterol-at-all-costs strategy for treating heart disease. In fact, in depressed or suicidal patients with low cholesterol, I recommend supplemental cholesterol as a strategy to help mitigate suicide risks.

Approximately 46,000 people per year die from suicide in the United States. This works out to one person every eleven minutes. Unfortunately, the tragedy of suicide affects both young and old. Between the ages of 10 and 34 years, suicide is the second leading cause of death. For all age groups, suicide is the 10th leading cause (Stone 2021).

Preventing suicides should be a moral imperative, and yet it often feels ignored by mainstream medicine.

Ready to use nutritional and functional strategies to help your patients with mental illness? Enroll now in our comprehensive Fellowship! Book a 1:1 call with Dr. James Greenblatt to learn more.