Can LDL Cholesterol be Too Low

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We all know that high cholesterol levels are bad for heart health, but can cholesterol be too low? When we ask this we really mean the low density lipoprotein, LDL, cholesterol. That is the one that is commonly referred to as “Bad” cholesterol.

Is “Bad” LDL Cholesterol Really Bad?

The answer to that is pretty straight forward, inasmuch, if your LDL cholesterol count is too high you are at risk of developing heart disease. However, cholesterol is not all bad. That said, can cholesterol be too low? Strange as it may seem, especially in light of all the publicity it receives, cholesterol has many important functions in the human body. It forms the lining of every cell wall in the body as well as forming a protective coat (myelin sheath) around each of your peripheral nerves. Cholesterol is also the substrate from which the hormones testosterone, estrogen and cortisone are made. It is so important to our survival that our livers manufacture it. In fact, 75% of the cholesterol in our blood stream comes from the liver.

Some of the reasons why cholesterol is important:

10 to 20% of the brain is composed of cholesterol.
Essential substances like the sex hormones and vitamin D are also constructed of cholesterol.
Clinical studies have shown that when LDL cholesterol level is low, you will get ill sooner.
Very low cholesterol levels are also bad for the liver and the brain.
Low cholesterol levels have also been associated with depression (the lower the cholesterol the more aggressive the depression).

Can cholesterol be too low concerning heart health?

As mentioned above, it is known that the higher the level of LDL cholesterol in your blood stream the higher the risk of developing heart disease. But what about the other side of the coin:

Can you get LDL cholesterol levels too low?

This very question has recently been answered by two of the biggest names in modern cardiology on the website of the American College of Cardiology. In fact, the question: “Can you get LDL concentrations too low?” was put to Cristopher P. Cannon, M.D. F.A.C.C., Associate Professor of Medicine, Brigham and Women’s Hospital, Cardiovascular Division and Valentin Fuster, Past President of the American Heart Association, current President of the World Heart Federation (2005-2006). Here are their replies:

Dr. Cannon:
Probably not, that we’ve seen so far. In another presentation, that exact question was asked. We looked at the outcomes of people who got their LDL to 60, which was actually the average in the atorvastatin 80 mg group, or 40-60 or even less than 40, and the clinical outcomes tended to even be better still, the lower the LDL. But, importantly, the safety variables that we worried about—liver function tests, CK, myalgias, or even ophthalmologic issues—none of those were any worse in the less-than-40 group versus the new standard of 70 or thereabout.
Dr. Fuster:
If you look at the history of LDL, it’s interesting that in developing countries, in some of the Oriental countries, the LDL was at the level of 40 about three decades ago when, in fact, the incidence of heart attacks was extremely small. And as it has gone from 40 to 90, and 120 now, the incidence is increasing in the developing world. So, I think we have to realize that we have to go back to the primitive. And I think the lowest LDL should be, I don’t mean zero, but a reasonable number, maybe 40 or 50. I’m just talking genetically about what is going on in the developing countries at this time.

The view of the experts concerning heart disease seems quite clear: whatever LDL levels are, get them down; at least to reasonable levels.

One thing is probably certain regarding cholesterol levels and heart health; a well balanced healthy diet, regular exercise and “normal” levels of LDL cholesterol will probably add years to your life and help to protect you from heart disease and stroke. So, can cholesterol be too low? It seems for protective measures against heart disease, no. However, perhaps other health problems may be susceptible to cholesterol levels that are too low.

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