What White Blood Cell Count Should We Shoot for?

At the start of my video What Does a Low White Blood Cell Count Mean?, you can see what it looks like when you take a drop of blood, smear it between two pieces of glass, and view at it under a microscope: a whole bunch of little, round, red blood cells and a few big, white blood cells. Red blood cells carry oxygen, while white blood cells are our immune system’s foot soldiers. We may churn out 50 billion new white blood cells a day. In response to inflammation or infection, that number can shoot up to a 100 billion or more. In fact, pus is largely composed of: millions and millions of white blood cells.

Testing to find out how many white blood cells we have at any given time is one of the most common laboratory tests doctors order. It’s ordered it hundreds of millions of times a year. If, for example, you end up in the emergency room with abdominal pain, having a white blood cell count above about 10 billion per quart of blood may be a sign you have appendicitis. Most Americans fall between 4.5 and 10, but most Americans are unhealthy. Just because 4.5 to 10 is typical doesn’t mean it’s ideal. It’s like having a “normal” cholesterol level in a society where it’s normal to die of heart disease, our number-one killer. The average American is overweight, so if your weight is “normal,” that’s actually a bad thing.

In fact, having excess fat itself causes inflammation within the body, so it’s no surprise that those who are obese walk around with two billion more white cells per quart of blood. Given that, perhaps obese individuals should have their own “normal” values. As you can see at 2:06 in my video, if someone with a 47-inch waist walks into the ER with a white blood cell count of 12, 13, or even 14, they may not have appendicitis or an infection. That may just be their normal baseline level, given all the inflammation they have in their body from the excess fat. So, normal levels are not necessarily healthy levels.

It’s like smoking. As you can see at 2:31 in my video, if you test identical twins and one smokes but the other doesn’t, the smoker is going to end up with a significantly higher white cell count. In Japan, for example, as smoking rates have steadily dropped, so has the normal white count range. In fact, it’s dropped such that about 8 percent of men who have never smoked would now be flagged as having abnormally low white counts if you used a cut-off of 4. But, when that cut-off of 4 was set, most people were smoking. So, maybe 3 would be a better lower limit. The inflammation caused by smoking may actually be one of the reasons cigarettes increase the risk of heart attacks, strokes, and other inflammatory diseases. So, do people who have lower white counts have less heart disease, cancer, and overall mortality? Yes, yes, and yes. People with lower white blood cell counts live longer. Even within the normal range, every one point drop may be associated with a 20 percent drop in the risk of premature death.

As you can see at 3:39 in my video, there is an exponential increase in risk in men as white count goes up, even within the so-called normal range, and the same is found for women. The white blood cell count is a “stable, well-standardized, widely available and inexpensive measure of systemic inflammation.” In one study, half of the women around 85 years of age who had started out with white counts under 5.6 were still alive, whereas 80 percent of those who started out over 7 were dead, as you can see at 4:05 in my video—and white blood cell counts of 7, 8, 9, or even 10 would be considered normal. Being at the high end of the normal range may place one at three times the risk of dying from heart disease compared to being at the lower end.

The same link has been found for African-American men and women, found for those in middle age, found at age 75, found at age 85, and found even in our 20s and 30s: a 17 percent increase in coronary artery disease incidence for each single point higher.

As you can see at 5:00 in my video, the higher your white count, the worse your arterial function may be and the stiffer your arteries may be, so it’s no wonder white blood cell count is a useful predictor of high blood pressure and artery disease in your heart, brain, legs, and neck. Even diabetes? Yes, even diabetes, based on a compilation of 20 different studies. In fact, it may be associated with everything from fatty liver disease to having an enlarged prostate. And, having a higher white blood cell count is also associated with an increased risk of dying from cancer. So, what would the ideal range be? I cover that in my video What Is the Ideal White Blood Cell Count?.

A higher white blood cell count may be an important predictor for cardiovascular disease incidence and mortality, decline in lung function, cancer mortality, all-cause mortality, heart attacks, strokes, and premature death in general. This is no surprise, as the number of white blood cells we have circulating in our bloodstreams are a marker of systemic inflammation. Our bodies produce more white blood cells day to day in response to inflammatory insults.

We’ve known about this link between higher white counts and heart attacks since the 1970s, when we found that higher heart attack risk was associated with higher white blood cell counts, higher cholesterol levels, and higher blood pressures, as you can see at 0:53 in my video What Is the Ideal White Blood Cell Count?. This has been found in nearly every study done since then. There are decades of studies involving hundreds of thousands of patients showing dramatically higher mortality rates in those with higher white counts. But why? Why does white blood cell count predict mortality? It may be because it’s a marker of inflammation and oxidation in the body. In fact, it may even be a biomarker for how fast we are aging. It may be more than just an indicator of inflammation—it may also be an active player, contributing directly to disease via a variety of mechanisms, including the actual obstruction of blood flow.

The average diameter of a white blood cell is about seven and a half micrometers, whereas our tiniest vessels are only about five micrometers wide, so the white blood cell has to squish down into a sausage shape in order to squeeze through. When there’s inflammation present, these cells can get sticky. As you can see at 2:20 in my video, a white blood cell may plug up a vessel as it exits a small artery and tries to squeeze into a capillary, slowing down or even momentarily stopping blood flow. And, if it gets stuck there, it can end up releasing all of its internal weaponry, which is normally reserved for microbial invaders, and damage our blood vessels. This may be why in the days leading up to a stroke or heart attack, you may find a spike in the white cell count.

Whether white count is just a marker of inflammation or an active participant, it’s better to be on the low side. How can we reduce the level of inflammation in our body? Staying away from even second-hand smoke can help drop your white count about half of a point. Those who exercise also appear to have an advantage, but you don’t know if it’s cause and effect unless you put it to the test. In one study, two months of Zumba classes—just one or two hours a week—led to about a point and a half drop in white count. In fact, that may be one of the reasons exercise is so protective. But is that just because they lost weight?

Fitness and fatness both appear to play a role. More than half of obese persons with low fitness—51.5 percent—have white counts above 6.6, but those who are more fit or who have less fat are less likely to have counts that high, as you can see at 3:47 in my video. Of course, that could just be because exercisers and leaner individuals are eating healthier, less inflammatory diets. How do we know excess body fat itself increases inflammation, increases the white count? You’d have to find some way to get people to lose weight without changing their diet or exercise habit. How’s that possible? Liposuction. If you suck about a quart of fat out of people, you can significantly drop their white count by about a point. Perhaps this should get us to rethink the so-called normal reference range for white blood cell counts. Indeed, maybe we should revise it downward, like we’ve done for cholesterol and triglycerides.

Until now, we’ve based normal values on people who might be harboring significant background inflammatory disease. But, if we restrict it to those with normal C-reactive protein, another indicator of inflammation, then instead of “normal” being 4.5 to 10, perhaps we should revise it closer to 3 to 9.

Where do the healthiest populations fall, those not suffering from the ravages of chronic inflammatory diseases, like heart disease and common cancers? Populations eating diets centered around whole plant foods average about 5, whereas it was closer to 7 or 8 in the United States at the time. How do we know it isn’t just genetic? As you can see at 5:38 in my video, if you take those living on traditional rural African diets, who have white blood cell counts down around 4 or 5, and move them to Britain, they end up closer to 6, 7, or even 8. Ironically, the researchers thought this was a good thing, referring to the lower white counts on the “uncivilized” diet as neutropenic, meaning having too few white blood cells. They noted that during an infection or pregnancy, when more white cells are needed, the white count came right up to wherever was necessary. So, the bone marrow of those eating traditional plant-based diets had the capacity to create as many white cells as needed but “suffers from understimulation.”

As you can see at 6:26 in my video, similar findings were reported in Western plant eaters, with an apparent stepwise drop in white count as diets got more and more plant based, but could there be non-dietary factors, such as lower smoking rates, in those eating more healthfully? What we need is an interventional trial to put it to the test, and we got one: Just 21 days of removing meat, eggs, dairy, alcohol, and junk affected a significant drop in white count, even in people who started out down at 5.7.

What about patients with rheumatoid arthritis who started out even higher, up around 7? As you can see at 7:03 in my video, there was no change in the control group who didn’t change their diet, but there was a 1.5 point drop within one month on whole food plant-based nutrition. That’s a 20 percent drop. That’s more than the drop-in inflammation one might get quitting a 28-year pack-a-day smoking habit. The most extraordinary drop I’ve seen was in a study of 35 asthmatics. After four months of a whole food plant-based diet, their average white count dropped nearly 60 percent, from around 12 down to 5, though there was no control group nor enough patients to achieve statistical significance.

If white blood cell count is such a clear predictor of mortality and is so inexpensive, reliable, and available, why isn’t it used more often for diagnosis and prognosis? Maybe it’s a little too inexpensive. The industry seems more interested in fancy new risk factors it can bill for.

I touch on the health of the rural Africans I discussed in How Not to Die from Heart Disease.


For more on fighting inflammation, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Chia Seeds vs. Flaxseeds

 

What effect do chia seeds have on weight loss, blood sugar, cholesterol, blood pressure, and inflammation?

We’ve been eating chia seeds for more than 5,000 years. Historically, they are one of the main crops grown in the Western hemisphere. They are exceptionally high in fiber and omega-3 fatty acids, though, like flaxseeds, it’s better to grind them up. As you can see at 0:26 in my video Which Are Better: Chia Seeds or Flaxseeds?, eating two tablespoons of whole chia seeds every day for ten weeks led to no change in omega-3 levels, but consuming the same amount of ground chia seeds did lead to a significant increase in blood levels of both short-chain and long-chain omega 3s. “Ingestion of…milled chia seed compared to whole chia seed or placebo… appeared to have no influence on inflammation or disease risk factors,” though. As well, there was no change in body fat, blood sugar, cholesterol, blood pressure, C-reactive protein, or any of the other markers of inflammation, as you can see at 0:47 in my video.

An earlier study purported to show a significant reduction in C-reactive protein levels (an indicator of systemic inflammation), compared to control. However, if you look closely at the data, you see that was only because there was a significant worsening in the placebo group who had been given a couple of tablespoons of wheat bran a day instead of chia. So it’s not that the chia group got significantly better; the control group just got significantly worse, as you can see at 1:22 in my video.

Whenever researchers appear to be exaggerating their results, that’s a red flag to check their funding source. In this case, they didn’t disclose any conflicts of interest. Five years later, however, the truth came out. The study was indeed funded by a chia company. Furthermore, the lead investigator had filed a patent to use chia seeds to treat diseases. Why wasn’t any of this disclosed when the study was originally published? Because the journal’s “conflict-of-interest policy did not specifically require the disclosure of such information.”

Regardless, the “patent has since been abandoned,” likely because subsequent studies found no significant benefits for weight loss, blood sugar, cholesterol, blood pressure, or inflammation after eating a quarter cup of chia seeds a day for three months, as you can see at 2:16 in my video. The original study, however, did show a significant drop in blood pressure, which was replicated by other researchers.

More potent effects have been found with ground flaxseeds, though. The primary reason I prefer flaxseeds over chia seeds is their lignan content, which averages about 15 times more than other seeds, including sesame and chia. This is thought to explain the anti-cancer effects of flaxseeds for both prevention and survival.

Still, chia seeds are certainly better than eggs and oil. By mixing one part chia seeds and nine parts water and letting it sit, you can create a chia gel that can be used as an egg or oil replacer in baked goods.

Who grinds chia seeds? Were you as surprised by that as I was?

For an update about the potential of chia seeds for weight loss, check out Do Chia Seeds Help with Belly Fat?


You can learn more about flax seeds and cancer from my videos, including:

To find out more about what flax seeds can do, check out:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How to Increase Gut Bacterial Richness

We live in an “obesogenic environment,” with cheap junk food everywhere, thanks in part to subsidies going to the “‘food industrial complex,’ which manufactures obesogenic foods that foster addiction…The root causes…[may] make obesity difficult to escape,” but a lot of people do. If it were simply the external environment, why isn’t everyone obese?

“Some individuals seem to be more susceptible to the obesogenic environment…than others,” which suggests a genetic component, supported by studies of twins and adopted kids, but the genes that have been identified so far account for only 6 to 11 percent of the genetic variation in body mass index between individuals. Perhaps variation in our “other genome”—that is, all the different microbes that inhabit our body, known as the microbiome—may be playing a role. We have a hundred times more bacterial genes inside us than human genes.

As I discuss in my video Gut Microbiome: Strike It Rich with Whole Grains, a study found that people tend to fall into one of two groups: those who have lots of different types of bacteria in their gut (high “gut bacterial richness”) and those with relatively few types. Those with low bacterial richness had more overall body fat, insulin resistance, which is the cause of type 2 diabetes, high triglycerides, and higher levels of inflammatory markers, like C-reactive protein, compared to those with high bacterial richness. Not only did people with lower bacterial richness start out heavier, but the obese individuals with lower bacterial richness also gained more weight over time.

The question then becomes: Can a dietary intervention have any impact “A number of studies have associated increased microbial richness…with diets higher in fruits, vegetables, and fiber.”

Just giving fiber-type supplements doesn’t seem to boost richness, however, but the “compositional complexity” of a whole food, like whole grains, “could potentially support a wider scope of bacterial taxa,” types of bacteria, “thereby leading to an increase in diversity.” Human studies to investigate the effects of whole grains had been neglected, though…until now.

Subjects were given whole-grain barley, brown rice, or a mixture of both for a month, and all three caused an increase in bacterial community diversity. Therefore, it may take a broad range of substrates to increase bacterial diversity, and this can be achieved by eating whole plant foods.

Moreover, the alterations of gut bacteria in the study coincided with a drop in systemic inflammation in the body. We used to think that the way fiber in whole grains helped us was by gelling in our small intestine right off of our stomach, slowing the rate at which sugars were absorbed and blunting the spike in blood sugars one might get from refined carbs. We now know, however, that fiber is broken down in our colon by our friendly flora, which release all sorts of beneficial substances into our bloodstream that can have anti-inflammatory effects, as well. So, perhaps what’s happening in our large intestine helps explain the protective effects of whole grain foods against type 2 diabetes.

Interestingly, the combination of both barley and brown rice worked better than either grain alone, suggesting a synergistic effect. This may help explain “the discrepancy of the health effects of whole grains obtained in epidemiological [population-based] and interventional studies.”

Observational studies “strongly suggest” that those who consume three or more servings of whole grains a day tend to have a lower body mass index, less belly fat, and less tendency to gain weight, but recent clinical trials, where researchers randomized subjects to eat white bread rolls versus whole-wheat rolls, failed to provide evidence of a beneficial effect on body weight. Of course, whole grains are so superior nutritionally that they should continue to be encouraged. However, the “[i]nterventional trials might have failed to show [weight] benefits because they focused on a limited selection of whole grains, while in epidemiological trials [or the population studies], subjects are likely to consume a diverse set of whole grains which might have synergistic activities.”


Until recently, we knew very little about how powerfully our gut bacteria can affect our health. Catch up on the latest science with these related videos:

When it comes to rice, even white rice can be better than many choices, but brown rice is better and pigmented rice is probably the best. See my videos Kempner Rice Diet: Whipping Us Into Shape and Is It Worth Switching from White Rice to Brown? for more.

But what about the arsenic in rice? Learn more:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: