Hypocholesterolemia is a condition in which cholesterol levels are too low. It can cause health complications, such as a higher risk of bone fractures, and may have a link to depression.

Hypocholesterolemia is less common than hypercholesterolemia, which involves cholesterol levels that are too high and may lead to stroke or heart attack.

People may develop hypocholesterolemia for many reasons. Possible causes include certain underlying health conditions and an inherited condition.

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Hypocholesterolemia occurs when a person’s cholesterol levels are too low. While people are typically concerned about having high cholesterol, low cholesterol can also be a cause for concern.

For most people, the ideal level of low-density lipoprotein (LDL) cholesterol — sometimes called “bad” cholesterol — is less than 100 milligrams per deciliter (mg/dL)Trusted Source.

A person’s level of high-density lipoprotein (HDL) cholesterol, or “good” cholesterol, should ideally be 60 mg/dL or higher. The HDL level is low if it is less than 50 mg/dL in women or less than 40 mg/dL in men.

When both the LDL level and the total cholesterol level are in the bottom 5%Trusted Source range of the worldwide population, doctors diagnose hypocholesterolemia. When addressing cholesterol levels, doctors also factor in a person’s sex and age.

Learn more about cholesterol levels.

Hypocholesterolemia has many possible causes, including the use of statins or PCSK9 inhibitors to treat high cholesterol. In some cases, taking these drugs can cause cholesterol levels to drop too low. However, people rarely develop hypocholesterolemia as a result of taking medications.

Genetics

People who have a family member with familial hypobetalipoproteinemia or another inherited genetic condition, such asTrusted Source abetalipoproteinemia or Anderson’s disease, may have a higher riskTrusted Source of developing hypocholesterolemia.

Learn more about low cholesterol.

Medical conditions

People with liver disease may have difficulty maintaining optimal cholesterol levels. The liver regulates cholesterol levels, and a health condition such as hepatitis or chronic liver disease may interfere with typical liver function. A 2020 studyTrusted Source suggests a link between low cholesterol levels and severe liver conditions.

Malabsorption syndromes may also contribute to hypocholesterolemia since these conditions prevent the body from efficiently absorbing nutrients from food, including lipids such as cholesterol. People can develop malabsorption as a result of health conditions such asTrusted Source:

Hyperthyroidism, a condition that causes the thyroid gland to produce too many hormones, can increase the breakdown of lipids, including cholesterol, and may cause hypocholesterolemia over time.

A 2019 studyTrusted Source reported that sepsis, a severe and potentially life threatening infection, may contribute to a drop in cholesterol levels, leading to hypocholesterolemia.

Certain types of anemia may reduce the concentration of cholesterol in the blood. However, a 2016 study in mice found opposite results, with higher cholesterol levels in mice with a B12 deficiency. For this reason, more research is needed to understand the role of anemia in hypocholesterolemia.

Read about pernicious anemia.

Like people with high cholesterol, those with hypocholesterolemia typically do not experience any specific symptoms until a major event occurs. For this reason, people should ask healthcare professionals to check their cholesterol levels regularly with a blood test.

A 2018 studyTrusted Source found that people with hypocholesterolemia may sometimes experience symptoms such as:

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However, other research has found opposite evidence without being able to replicate the results of the 2018 study. More research is needed.

Doctors can diagnoseTrusted Source hypocholesterolemia with a blood test called a lipid profile. A healthcare professional will collect a blood sample and send it to a laboratory for analysis.

This test can determine a person’s total cholesterol levels. It typically includes four measurements, one for each type of lipid:

  • HDL level
  • LDL level
  • triglyceride level
  • total cholesterol level

Based on the results of the lipid profile, a doctor can diagnose hypocholesterolemia. However, they may order other tests if the results are not clear or if they suspect another underlying health condition.

The treatment for hypocholesterolemia depends on the underlying cause of the low cholesterol. Lifestyle changes that may help with low HDL include:

  • avoiding or quitting smoking
  • getting more physical activity
  • making efforts to reach or maintain a moderate body weight

If hypocholesterolemia is linked to an underlying condition or a genetic disorder, treating or managing that condition may help improve cholesterol levels. For example, a person may take supplements and vitamins that help improve the absorption of lipids.

People with hypocholesterolemia may have a higher riskTrusted Source of developing cardiovascular disease over time.

Other possible complications includeTrusted Source:

  • depression
  • more fragile bones and bone fractures
  • suicidal thoughts
  • increased risk of infections
  • mood changes

However, because hypocholesterolemia is rare, research on the condition is limited. More scientific evidence is needed to confirm the long-term effects associated with low cholesterol levels.

What happens if cholesterol is too low?

People with cholesterol levels that are too low may have a higher riskTrusted Source of developing cardiovascular disease.

Is total cholesterol of 100 too low?

A total cholesterol of 100 mg/dL may be too lowTrusted Source. The optimal LDL level is less than 100 mg/dL, and the optimal HDL level is 60 mg/dL or more. An HDL level of less than 50 mg/dL in women or less than 40 mg/dL in men is too low.

How to treat hypocholesterolemia?

The treatment of hypocholesterolemia depends on the root cause of the low cholesterol levels. In certain cases, treating the underlying condition that causes hypocholesterolemia can improve cholesterol levels. In other cases, a person may need to make some diet and lifestyle changes.

Cardiovascular health resources

Visit our dedicated hub for more research-backed information and in-depth resources on cardiovascular health.

Hypocholesterolemia is a condition involving low cholesterol levels. It is not as common as hypercholesterolemia (high cholesterol levels). These conditions may not cause any symptoms, and either condition can lead to health complications over time, such as cardiovascular disease.

A blood test called a lipid profile can detect a person’s cholesterol level to help healthcare professionals diagnose hypocholesterolemia. The treatment that healthcare professionals recommend for this condition depends on the underlying cause.