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The Dangers of Low Cholesterol As We Age

Cholesterol myths abound.  If you are a savvy practitioner, you already know that cholesterol isn’t an undesirable “evil” in the body.  It’s a critical, life-giving substance that the liver makes (much more than we would ever eat) to help the body to respond to the environment we ask it to thrive in each day.  Cholesterol has many key roles…as a critical part of our immune system, as the core raw material for all steroid hormones, and as s key component of all tens of trillions of cell membranes in our body.  Whew:  that’s a big job!  No wonder low cholesterol as we age increases the risk of many diseases and death itself.

Most media attention is put on warning patients about high cholesterol, but too often, that guidance is not balanced by the equally dramatic risks of pushing cholesterol too low as we age.  In fact, low cholesterol is an excellent predictor of earlier death in seniors and the elderly.  Our clients and patients need education and empowerment on this topic!  Especially when they are choosing unknowingly to use cholesterol-lowering medication that might be overly-suppressing their cholesterol production.

One study found that seniors (age 65 or older) with total cholesterol in the lowest quartile had more than twice the risk of death of those in the highest quartile.  This was true even when the data was adjusted to reflect an array of chronic diseases including Type 2 diabetes, hypertension, and existing cardiovascular disease.  The study found that total cholesterol levels below 189  increased the risk of death!

Another study of over 100,000 people found that low cholesterol was predictive of mortality with statistical significance in both women and men from age 50 and older.   In particular, this included death from cancer, liver disease, and mental illnesses.   A more recent study of those 80 years of age and older has shown the same result.  This article brings the past decade of research into a poignant clinical question about the overt value of lowering cholesterol.

The risk of infections that require hospitalization (and infections overall) is also inversely related to total cholesterol.  This makes sense as LDL is a key component of the immune system (pull it all together:  that is why LDL is attracted to damaged or inflamed arteries – as a defensive, healing response – just as your immune system would do if you cut yourself on your arm.)

Another study found a 1500% (yes, 15X) higher risk of developing cancer in those individuals with LDL cholesterol below 70.

As far as high cholesterol is concerned, protecting ourselves from heart disease is largely about keeping our bodies free from chronic inflammation – and thus our arteries largely un-inflamed and not attracting an immune system reaction or the build-up of plaque.  Inflammation makes arteries “sticky”.  If arteries are healthy a person can have relatively high levels of LDL cholesterol (supported with ample HDL levels as well) with no issues.  This is evidenced by clear data that those who are in the hospital actually having had a heart attack are just as likely to have low-normal cholesterol as they are to have high levels.  Beyond this, people with low cholesterol get just as atherosclerotic as those with high cholesterol (and here).

The key, of course, is to treat each unique patient as an individual and assess what can uniquely best serve them at this point in their health journey vs. defaulting to a “standard operating procedure”.   Medications can be life-saving interventions; they can also be disease-worsening defaults.  LDL and HDL are neither inherently “good” nor “bad”.  To practice comprehensively, we must be willing to trade our assumptions for careful consideration of each unique case with a “beginner’s mind”.  We must consider the environment in which LDL and HDL are functioning and look for specific insights as to how a unique person’s body is thriving (or not) at present.

Want to know more?  In the SAFM Cardiovascular Myths and Truths, we do a deep dive into what really matters for CVD risk and what doesn’t.  Very specific guidance for patients and clients.  Detailed supplement recommendations.  Addressing hypertension.  Labwork assessment (which ones matter and which ones don’t) and case study practice.  Science has learned much in the past decade about the higher value of LDL particle count and size and also the Triglycerides:HDL ratio (vs. just the total amount measured of LDL-C, the typical “bad” lipid).

I hope this information supports you in your work to educate, inspire, and empower your patients and clients.

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11 Questions for “The Dangers of Low Cholesterol As We Age”

  1. 6
    John Etcheverry says:

    Hi-
    Thank you so much for these very interesting topics and tips!

    I am 58, MWM, and have always had LOW cholesterol. Fluctuates between 70-98 and never any higher. I was always told by the allopathic docs that I was in excellent health and never had to worry about any cardiac events. They even said eat all you want, fried foods, etc…. So, being a devoted patient, I did…and ended up pre-diabetic, 100lbs overweight, depressed, etc…
    In the years, I’ve changed my diet, exercised, etc and lost the weight and 60% of depression.
    However, in the past 5 yrs, I have terrible insomnia. I’m wondering if there’s a connection between insomnia and depression with low cholesterol?

  2. 5
    betty mcdonald says:

    I’m curious about Lipoprotein Lp(a) where higher LDL cholesterol could drive the small particle level higher and increase the risk of stroke. What is your approach to the one in five people who are genetically engineered for this dangerous particle?

    • 5.1
      SAFM Team says:

      This is a great question, and we love the analogy of “the genes are bullets in the gun, but what we do on a daily basis is the finger that pulls the trigger” – in this vein, it is possible to align oneself with a lifestyle that will minimize the stroke risk even in the light of a genetic predisposition. This often requires, a specific diet low in easily digestible carbohydrates and rich in antioxidants and phytonutrients; stress management is often a key skill to master; regular exercise, sound sleep and low toxic load; sometimes there may be a set of supplements that help the body to thrive. The solutions WILL be based on each individual case.

  3. 4
    dianne says:

    If LDL is low, how do we raise it?

    • 4.1
      SAFM Team says:

      Great question! First one needs to think why LDL could be low and there can be several factors involved:
      – LDL synthesis is highly depended on fat digestion and absorption and formation of chylomicrons ( https://www.ncbi.nlm.nih.gov/books/NBK305896/ ) thus issues with this digestive process that leads to insuffcient raw materials for making LDL could be at play for low LDL levels. If that’s the case, focusing on gut health, improving gut microbial balance, healthy bile flow and production would be helpful
      – LDL synthesis requires specific raw materials, such as healthy dietary fats and B vitamins (B5 in particular, stimulates steroid pathways) – ensuring healthy fat sources and ample B vitamin supply would be a solution to that.
      – hyperthyroid state may lead to increased breakdown of LDL, thus working on the root causes of that would be the answer. This could involve, again gut health issues, toxicity, and/or stress. This is a good reference for a deeper dive into that: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109527/
      Hope this is helpful to you.

  4. 3
    Catherine Maria Pley says:

    I understand that homocysteine makes tiny cuts or nicks inside the arteries and this causes the body to produce plaque to cover these cuts. Unchecked homocysteine creates atherosclerosis. Cholesterol is a key component in plaque. The cholesterol has been mistakenly associated with atherosclerosis instead of low levels of folate (folic acid), B6 and B12 which creates high homocysteine levels in the blood. Making sure the person has the right amounts of these nutrients and in the right balance to each other, helps to check homocysteine free radical damage.

    I also understand that sugar creates LDL particles that are small and hard instead of the healthy LDL that is large and fluffy. So sugar consumption plays a key role in a healthy cholesterol profile.

    Therefore, as a health coach, I would look at certain nutritional deficiencies and sugar consumption of the patient/client for problems with cholesterol.

  5. 2
    stefanie Aring says:

    I know this is not what you specifically talked about in this post, but after watching the Disease Begins in the Gut 101 course, and then this little post, I am wondering if patients with high cholesterol levels on labs are more likely to have gall stones? What levels or numbers on a lipid panel would be more indicative of possibly developing gallstones or gallbladder problems? Thanks for all your great insight!!

  6. 1
    Lili Sannino says:

    The physician involved here said HDL is high but the rest is fine.

    Total Cholesterol 156 -RR less than 200
    Triglycerides 41 -RR less than 150
    HDL 87 – RR 30-85
    LDL 61 -RR 61
    Fasting glucose usually is in the 80’s some days it goes to 90-91. A1c is 5.4
    I eat lots of good fats, high quality 100%, grass-fed meats. I don’t eat any refined carbs and sugars at all. Intermittent fasting once or twice a week. Gluten and dairy free for years (100%), no grains. I actually have Hashimoto’s but I have no symptoms. My antibodies are pretty close to be under the normal range. No medications at all. I take 3 gr fish oil, Mg, Vit B12, Zinc and Vit D/K2.

    How can I increase my LDL if I need to?
    Thank you so much!

    • 1.1
      SAFM Team says:

      Alas, this type of format doesn’t allow us to give detailed, personalized guidance; it’s always key to consider the *entire* picture of a person’s health, not just an isolated subset of markers. Your low LDL may be interfering with steroid synthesis – or it may not be at all. You would need to explore hormone testing to know for sure e.g. DUTCH testing. This article is simply about provoking the question – and the investigation. I would use markers like the low LDL as a flag to inspire further investigation vs. something to counter on its own. If you feel fantastic, are seldom ill, have great energy and vitality, I wouldn’t worry about it. If you do decide upon further investigation that you wish to increase your LDL, I would consider increasing cholesterol via foods e.g. shellfish, egg yolks, ghee (assuming you tolerate it well). The body also needs ample B vitamins, especially B5, to stimulate steroid pathways. I would also consider the combination of low LDL and low triglycerides as a possible indication that your body experiences periods of hyperthyroid behavior. We often think of Hashimoto’s as necessarily driving *hypo*thyroid behavior, but in some cases, this can “swing” into hyperthyroid behavior. Low triglycerides is a common symptom of hyperthyroid function. The *slight* elevation in HDL may or may not be a concern at all; I would assess 8-OHdG as a marker of oxidative stress.

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