Treatment of Hypocholesterolemia - How Low is too Low?

Hypertension is one of the prevalent diseases in the Philippines and across the globe. Risk factors for hypertension include family history, being overweight, and having high cholesterol. While doctors and health experts recommend that we all watch our diet and reduce our cholesterol intake, it is possible to have the opposite problem. Low cholesterol is not often talked about, however, it presents its own set of health issues. Read on to discover the causes and treatment of hypocholesterolemia.

What is considered normal cholesterol?

Firstly, cholesterol and fat have a bad reputation, but that does not mean they are not essential. In fact, our bodies need cholesterol to maintain our cells and synthesize important hormones like testosterone and estrogen.

Additionally, the so-called good cholesterol or high-density lipoprotein (HDL) is necessary to scavenge more harmful cholesterol. Saturated fats and low-density lipoprotein are the main culprits when it comes to cardiovascular disease.

There is no specific value for lipids that is normal for everyone. Instead of a single value, there are ideal ranges based on age and sex. For people younger than 20 years, total cholesterol should be less than 170 mg/dL. People over 20 years should aim for a total cholesterol level of 125 to 200 mg/dL. Additionally, HDL in women should be ≥40 mg/dL while men should have ≥50 mg/dL.

Because hypocholesterolemia is less common, there are no clear cut-off values. However, an LDL measurement of less than 40 to 50 mg/dL can be an indicator. Low HDL alone is not an indicator of hypocholesterolemia.

How does hypocholesterolemia happen?

Compared to hypercholesterolemia, not much research has been done on low cholesterol. Before we can talk about the treatment of hypocholesterolemia, it is important to know the possible causes. Very low cholesterol seems to be an issue for patients who are critically ill or have a genetic mutation of LDL-C. Secondary or acquired causes of low cholesterol include cancer, severe anemia or blood loss, hyperthyroidism, and malnutrition.

Genetic problems are fairly rare. Therefore, doctors only consider these when there is family history and other causes are ruled out. Genetic abnormality is determined by conducting a full patient history, physical exam, and lipid profile.

Treatment of hypocholesterolemia

After doing a lipid panel to determine the amount of LDL, HDL, and triglycerides, low cholesterol can be spotted. Your doctor will conduct a complete physical exam and patient interview to determine possible causes.

Low cholesterol due to cancer or chronic malnutrition typically requires supplemental feeding. Appetite stimulants may be given to encourage eating. Blood transfusion along with supplementation are necessary for severe blood loss and anemia.

Patients with genetic mutations such as familial hypobetalipoproteinemia may have steatorrhea (oily stools), trouble absorbing vitamins A, D, E, and K, and depression. Limiting dietary fat and taking fat-soluble vitamin supplements can reduce symptoms and nutritional deficiency. Unfortunately, there is no known cure for these genetic abnormalities.

Some studies show that low cholesterol can increase the chance of depression and suicidal thoughts. The exact mechanism is unknown, however, researchers believe that low cholesterol affects serotonin levels.

Less serotonin results in mood disorders, anxiety, and sleep disturbances. Medications and psychiatric therapy are available as treatment.

Key takeaways

In summary, treatment of hypocholesterolemia involves adjusting your diet and supplementing with fat-soluble vitamins. If the underlying cause is due to a treatable disease or condition such as anemia or malnutrition, these should be addressed first.

Cholesterol levels will likely improve once managed. However, genetic mutations of LDL are incurable and can present with different symptoms.

Learn more about managing your cholesterol, here.