Hypocholesterolemia

Hypocholesterolemia is a very low amount of cholesterol in your body. With this condition, total cholesterol and/or LDL (low-density lipoprotein) is lower than that of more than 9 out of 10 people. People with this condition have a total cholesterol level of less than 116 milligrams per deciliter. Your LDL (“bad” cholesterol) may be less than 50 mg/dL.

You can inherit this condition or develop it from infections or other medical conditions.

A healthy level of total cholesterol is below 200. For LDL, a healthy level is below 100.

Symptoms of hypocholesterolemia

Often, people don’t have low cholesterol symptoms. But if you have a genetic condition that causes low cholesterol, you may have symptoms from that. These may include diarrhea, poor muscle control, and problems with growth and development.

Hypocholesterolemia causes

Some people get this condition from a genetic problem they inherit from a biological parent. These rare conditions may make it hard to absorb nutrients. Some genetic syndromes that cause hypocholesterolemia include abetalipoproteinemia and Smith-Lemli-Opitz syndrome. But for most people, the causes of hypocholesterolemia aren’t genetic.

Causes of this condition that aren’t genetic include:

• Addison’s disease (adrenal insufficiency)
• Alcohol use disorder
• Cancer
• Chronic pancreatitis
• Crohn’s disease and other conditions that cause poor nutrient absorption in your GI tract
• Hyperthyroidism
• Kidney failure
• Liver disease
• Malnutrition
• Protein loss (protein-losing enteropathy)
• Sepsis, HIV or other infections

Complications

Hypocholesterolemia may lead to mild liver dysfunction or fatty liver disease. You may also have problems with your eyes, brain, liver, muscles or bones. This comes from not having enough vitamin A, D, E or K in your body. These are vitamins your GI tract absorbs with the help of fats in your food.

How doctors diagnose this condition

A healthcare provider can diagnose this with a blood test that measures cholesterol levels. A different blood test can tell you if you have a genetic disorder that causes hypocholesterolemia. If you do have a genetic issue, you may have other tests, like a liver ultrasound or bone density scan. These tests check for related problems.

How is it treated?

Treatment of hypocholesterolemia may include taking high doses of vitamins A, D, E and K if you have low levels of them. Your healthcare provider may also tell you to keep your fat intake low or ensure that you get enough essential fatty acids. Your provider will also treat the condition that causes hypocholesterolemia.

Researchers are studying the use of steroids (corticosteroids) to raise cholesterol levels.

When should I see my healthcare provider?

You’ll need regular physical exams with your provider. They may track height and weight for children and compare those numbers to growth charts.

Contact your provider about any problems you’re having from the condition that caused hypocholesterolemia.

Questions to ask your provider may include:

• Did I inherit hypocholesterolemia?
• Do I need more testing?
• Do any of my family members need testing?
• What’s the best treatment for me?
• How often do I need follow-up visits?

What can I expect if I have hypocholesterolemia?

Hypocholesterolemia may be a sign that you have an infectious disease or a severe illness. Healthcare providers see this condition as a sign of poor prognosis, especially in people who have sepsis.

This isn’t the case if you inherited a condition that causes hypocholesterolemia. You can expect to work with a dietitian to make sure you’re getting the nutrients you need. One benefit is that people with hypocholesterolemia are at low risk for plaque buildup in their arteries and conditions it causes (like heart attacks).