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:

Vitamin C for Male Infertility and Lead Poisoning?

What is the clinical relevance of vitamin C among lead-exposed infertile men? Compared to controls, lead battery industry workers given 1,000 mg of vitamin C every workday for three months experienced “a significant increase in sperm motility and sperm count, as well as decrease in abnormal sperm,” and “a significant reduction in the incidence of sperm DNA fragmentation,” that is, damaged sperm DNA. Okay, but the ideal endpoint would be bouncing baby boys and girls. Enter this extraordinary little study from the University of Texas from more than 30 years ago.

Twenty-seven men with fertile wives had been trying to have kids for years to no avail. Twenty of them were given 1,000 mg of vitamin C a day for two months, and 7 acted as controls and didn’t get any vitamin C. The researchers followed up at the end of the 60 days. By then, every single one of the wives of each of the 20 men who had gotten the vitamin C had became pregnant—20 out of 20! After years of frustration, boom: 100-percent pregnant. What’s more, not a single one of the wives of men in the control group got pregnant. Rarely does one see these kinds of black-and-white results in the medical literature for any intervention.

Is the vitamin C lowering the oxidative stress from the lead, or is it actually lowering the level of lead? Sure, antioxidant supplementation can have antioxidant effects, but it may fail to actually lower lead levels in the blood. Now, this was in a group of workers who were breathing lead day in and day out, and the way vitamin C may work is by simply blocking the “intestinal absorption of lead.” An earlier study showed vitamin C supplementation apparently cut lead levels by a third within six months, but that was with a whopping dose of 2 g with added zinc. Another small study found the same 30 percent drop with just 500 mg a day, no zinc, and in only one month. But neither of those studies had a control group of subjects who didn’t take anything, so we don’t know if their levels would have fallen anyway.

Similarly, there is an almost too-good-to-be-true study on the role of vitamin C in scavenging lead toxicity from “biosystems,” by which they meant children. They got 250 to 500 mg a day of vitamin C for a few months, and shaved hair samples every month saw up to a 69 percent decline in lead levels. Researchers repeated it in two other small groups of kids and saw the same amazing kind of drops in every single child. But maybe lead levels were just dropping throughout the whole community during that time? Without measuring lead levels in a control group of kids not taking vitamin C, we can’t be sure.

As I illustrate from 3:17 in my video Yellow Bell Peppers for Male Infertility and Lead Poisoning?, with eight weeks of vitamin C, lead levels dropped in the blood and rose in the urine. One could conclude that the vitamin C was pulling lead out of the body, but the same thing happened in the placebo group: Blood levels dropped, and urine levels rose. So, it had nothing to do with the vitamin C at all. That’s why it’s always important to have a control group.

The same applies with studies that appeared to show no benefit. For example, 36 battery manufacturing workers were studied. Each was given vitamin C, yet there was no change in their lead levels. But, maybe their co-workers suffered a big increase in lead levels during that same time period, and the vitamin C was actually successful in keeping the subjects’ levels from rising. You don’t know without a control group.

That’s why studies like “The effects of vitamin C supplementation on blood and hair levels of cadmium, lead, and mercury” are so important. Vitamin C versus an identical-looking sugar pill placebo. The result? The vitamin C failed to help, which really put a damper on enthusiasm for using vitamin C for lead poisoning until a now-famous study was published in 1999 that showed that vitamin C supplementation could lead to a decrease in blood levels. As you can see at 4:32 in my video, after four weeks of taking a placebo, not much change occurred in blood lead levels in the control group, which is what we’d expect. In contrast, the vitamin C group started out at about the same blood lead level as the control group, but within one week of taking 1,000 mg of vitamin C a day, lead levels dropped 81 percent. So, supplementation of vitamin C “may provide an economical and convenient method of reducing blood-lead levels, possibly by reducing the intestinal absorption of lead.”

The urine lead levels didn’t change, so it’s not as if the subjects were excreting more lead in their urine to bring down their blood levels. However, most of the lead in our blood is in the red blood cells, which are recycled in the liver and discharged through the bile into the gut where the lead could just get reabsorbed—unless, perhaps, you’ve got a lot of vitamin C in there to block the re-absorption. But 1,000 mg is a lot of vitamin C. Would something like 200 mg, which is just about how much vitamin C you’d get in an orange and a cup of broccoli or strawberries, work? The researchers tested that, too. The 200 mg group started out the same as the control and the 1,000 mg group, but blood lead levels didn’t really budge. Bummer! So, 1,000 mg seemed to work, but 200 mg didn’t. Isn’t 1,000 mg of vitamin C a bit unnatural, though? The RDA is only 60 mg. Well, actually, we may have evolved for millions of years getting closer to 600 mg a day—ten times the current RDA—because we were eating so many fruits and greens. Okay, but could you reach 1,000 mg of vitamin C without having to take pills? Yes! That’s the amount of vitamin C, for example, that can be found in three yellow bell peppers.


Other videos in my series on lead include:

Note that there is nothing special about yellow bell peppers—other than their extraordinary vitamin C content, that is. I just used them as a practical way to get 1,000 mg of vitamin C in whole-food form. They’re certainly easier than eating ten oranges!

Though, remember my video Peppers and Parkinson’s: The Benefits of Smoking Without the Risks? So, one would expect to get all the benefits of the 1,000 mg of vitamin C with benefits. Why not just take vitamin C supplements? See Do Vitamin C Supplements Prevent Colds but Cause Kidney Stones?.

If hundreds of milligrams a day of vitamin C sounds like a lot, check out What Is the Optimal Vitamin C intake?.

You may be interested in my vitamin C and cancer series:

Finally, for more on male fertility, 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:

How to Treat Bacterial Vaginosis

Vitamin C is pitted head-to-head against antibiotics for bacterial vaginal infections.

A study published in 1999 raised the exciting possibility that “cheap, simple, innocuous and ubiquitous vitamin C” supplements could prevent a condition known as preeclampsia, but after a decade of research, we realized that was merely a false hope and that vitamin C supplements appear to play little role in women’s health. But this was in regard to oral vitamin C, not vaginal vitamin C, which has been found to be an effective treatment for bacterial vaginosis, an all too common gynecological disorder characterized by a foul-smelling, watery, gray discharge, which I discuss in my video Treating Bacterial Vaginosis with Vaginal Vitamin C.

Bacterial vaginosis “can best be described as an ‘ecological disaster’ of the vaginal microflora.” The good, normal, lactobacillus-type bacteria get displaced by an army of bad bacteria. Probiotics may help, repopulating the good bacteria, but the reason the bad bacteria took over in the first place was that the pH was off. I’ve talked before about the role diet may play in the development of the condition. (See my video Bacterial Vaginosis and Diet for more.) For example, saturated fat intake may increase vaginal pH, allowing for the growth of undesirable bacteria, so why not try to re-acidify the vagina with ascorbic acid, otherwise known as vitamin C? This isn’t just plain vitamin C tablets but specially formulated silicone-coated supplements that release vitamin C slowly, so as to not be irritating. How well do they work? One hundred women suffering from the condition were split into two groups, and the vaginal vitamin C beat out placebo. But how does vitamin C compare with conventional therapy, an antibiotic gel?

This is an important question. “Although perceived as a mild medical problem,” bacterial vaginosis may increase the risk of several gynecological complications, including problems during pregnancy, when you want to avoid taking drugs whenever possible. The vitamin C appeared to work as effectively as the antibiotic. So, vitamin C can really help, especially in the first trimester of pregnancy when you really don’t want to using drugs like topical antibiotics. And for women with recurrent episodes, using vitamin C for six days after each cycle appears to cut the risk of recurrence in half, as you can see at 2:36 in my video.


Another way to get vitamin C into the body is by dripping it directly into the vein. Does that actually do anything? See:

For those of us who prefer to get vitamin C the old-fashioned way, through the mouth and in foods rather than supplements, the question becomes What Is the Optimal Vitamin C Intake?

 If you’re considering taking oral vitamin C in supplements instead, make sure to watch this video first: Do Vitamin C Supplements Prevent Colds But Cause Kidney Stones?.

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: