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Can My Cholesterol Be Too Low?

Cholesterol levels

Highlights

  1. Cholesterol is only properly diagnosed through a blood test.
  2. If you have an LDL cholesterol less than 50 mg/dL or your total cholesterol is less than 120 mg/dL, you have low LDL cholesterol.
  3. Risk factors for low cholesterol include family history, being on statins or other blood pressure treatment programs, and untreated clinical depression.

Cholesterol problems are usually associated with high cholesterol. That’s because if you have high cholesterol, you’re at a greater risk for cardiovascular disease. Cholesterol, a fatty substance, can clog your arteries and potentially cause a heart attack or stroke by interfering with blood flow through the affected artery.

It’s possible for cholesterol to be too low. However, this is much less common than high cholesterol. High cholesterol is strongly associated with heart disease, but low cholesterol may be a factor in other medical conditions, such as cancer, depression, and anxiety.

How can cholesterol affect so many aspects of your health? First, you need to understand what cholesterol is and how it functions in the body.

What exactly is cholesterol?

Causes

Despite its association with health problems, cholesterol is something the body needs. Cholesterol is necessary to make certain hormones. It’s involved in making vitamin D, which helps the body absorb calcium. Cholesterol also plays a role in making some of the substances required to digest food.

Cholesterol travels in the blood in the form of lipoproteins, which are tiny molecules of fat wrapped in protein. There are two major types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is sometimes referred to as “bad” cholesterol. This is because it’s the kind of cholesterol that can clog your arteries. HDL, or the “good” cholesterol, helps bring LDL cholesterol from the bloodstream to the liver. From the liver, the excess LDL cholesterol is removed from the body.

The liver plays another key role in cholesterol. Most of your cholesterol is made in the liver. The rest comes from the food you eat. Dietary cholesterol is found only in animal food sources, such as eggs, meat, and poultry. It’s not found in plants.

What are the dangers of low cholesterol?

Warning

High LDL levels may be lowered by medications, such as statins, as well as regular exercise and a healthy diet. When your cholesterol drops due to these reasons, there usually isn’t a problem. In fact, lower cholesterol is better than high cholesterol most of the time. It’s when your cholesterol falls for no obvious reason that you should take notice and discuss with your healthcare provider.

While the exact effects of low cholesterol on health are still being studied, researchers are concerned about how low cholesterol appears to negatively affect mental health.

An older Duke University study of healthy young women found that those with low cholesterol were more likely to have symptoms of depression and anxiety. Researchers suggest that because cholesterol is involved in making hormones and vitamin D, low levels may affect the health of your brain. Vitamin D is important for cell growth. If brain cells aren’t healthy, you may experience anxiety or depression. The connection between low cholesterol and mental health still is not completely understood and is being researched.

A 2012 study presented at the American College of Cardiology Scientific Sessions found a possible relationship between low cholesterol and cancer risk. The process that affects cholesterol levels could affect cancer, but more research is needed on the topic.

One other concern about low cholesterol involves women who may become pregnant. If you’re pregnant and you have low cholesterol, you face a higher risk of delivering your baby prematurely or having a baby who has a low birth weight. If you tend to have low cholesterol, talk with your doctor about what you should do in this case.

Symptoms of low cholesterol

Symptoms

For people with high LDL cholesterol, there are often no symptoms until a heart attack or stroke occurs. If there’s a serious blockage in a coronary artery, you may experience chest pain due to reduced blood flow to the heart muscle.

With low cholesterol, there’s no chest pain signaling a buildup of fatty substances in an artery.

Depression and anxiety can spring from many causes, including possibly low cholesterol. Symptoms of depression and anxiety include:

  • hopelessness
  • nervousness
  • confusion
  • agitation
  • difficulty making a decision
  • changes in your mood, sleep, or eating patterns

If you’re experiencing any of the above symptoms, see your doctor. If your doctor does not suggest a blood test, ask whether you should have one.

Risk factors for low cholesterol

Risk Factors

Risk factors for low cholesterol include having a family history of the condition, being on statins or other blood pressure treatment programs, and having untreated clinical depression.

Diagnosing low cholesterol

Diagnosis

The only way to properly diagnose your cholesterol levels is through a blood test. If you have an LDL cholesterol less than 50 mg/dL or your total cholesterol is less than 120 mg/dL, you have low LDL cholesterol. Total cholesterol is determined by adding LDL and HDL and 20 percent of your triglycerides, which are another type of fat in your bloodstream. An LDL cholesterol level between 70 and 100 mg/dL is considered ideal.

It’s important to keep track of your cholesterol. If you haven’t had your cholesterol checked within the last two years, schedule an appointment.

Treating low cholesterol

Treatment

Your low cholesterol is most likely being caused by something in your diet or physical condition. In order to treat low cholesterol, it’s important to understand that simply eating cholesterol-rich foods will not solve the problem. By taking blood samples and undergoing a mental health evaluation, suggestions for your diet and lifestyle may be made to treat your low cholesterol. If your cholesterol level is affecting your mental health, or vice versa, you may be prescribed an antidepressant. It’s also possible that statin medication has caused your cholesterol to drop too low. If that is the case, your prescription dose or medication may need to be adjusted.

Preventing low cholesterol

Prevention

Since having cholesterol that is too low is not something that most people worry about, it’s very rare that people take steps to prevent it. To keep your cholesterol levels balanced, get frequent checkups. Maintain a heart-healthy diet and an active lifestyle to avoid having to take statins or blood pressure medications. Be aware of any family history of cholesterol problems. And finally, pay attention to symptoms of anxiety and stress, especially any that make you feel violent.

Outlook and complications

Outlook

Low cholesterol has been linked to some serious health complications. It’s a risk factor for primary intracerebral hemorrhage, which typically happens in older adults. It also carries a risk for low birth weight or premature birth in pregnant women. Most notably, low cholesterol has been deemed a risk factor for suicide or violent behavior.

If your doctor notices that your cholesterol is too low, make sure you talk about whether you need to be concerned. If you’re feeling the symptoms of depression, anxiety, or instability, low cholesterol could be a factor. 

You asked, we answered

  • Which foods should I eat more of to get healthy fats without compromising my cholesterol level?
  • Foods that have healthy sources of fat, such as fatty fish (salmon, tuna, etc.) as well as avocado, nuts, and olives/olive oil, are good choices.

    - Timothy J. Legg, PhD, CRNP

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