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Is there a concern about reducing cholesterol too much?

When asked, my doctor told me that "there is no such thing as too low" when it comes to either LDL or total cholesterol. While I believe this about the former, I am skeptical of the latter claim as I have read some sources online that disagree with this. Google searches result in many articles stating that low cholesterol is thought to possibly cause problems, especially to the brain in the form of memory loss and depression. These sources don't have a lot of numbers, though, so I don't know how low is "too low" in this regard.

In particular, I am interested in whether one can over-compensate using statin medication and lifestyle changes to a point where they swing the numbers too far in the other direction.

I'd like to know if there is something like "too low cholesterol" and if that might be a potential danger to consider.

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  • Statins lower cholesterol and some have been shown to increase stroke risk. Commented Aug 10, 2018 at 0:09

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Some doctors think there is not enough evidence that low cholesterol levels are harmful.

Ask the doctor: Is my LDL cholesterol too low? (Harvard.edu, 2012)

There really isn't evidence of harm from driving your LDL too low. In the past, some scientists worried that extremely low LDL levels could result in blood vessel ruptures and perhaps increase the risk of getting certain types of cancer. Those concerns have faded after neither occurred in large clinical trials that involved reducing people's LDL to very low levels.

Still, taking larger doses of atorvastatin...increases the risk of statin side effects, which include muscle and liver damage. For that reason, moving to a lower dose is a good idea.

Can your total cholesterol level be too low? (Mayo Clinic)

Although the risks are rare, very low levels of LDL cholesterol may be associated with an increased risk of:

  • Cancer
  • Hemorrhagic stroke
  • Depression
  • Anxiety
  • Preterm birth and low birth weight if your cholesterol is low while you're pregnant

The potential risk of lowering LDL cholesterol to very low levels has not been confirmed, and its association with certain health risks is still under debate.

Still, according to some studies, there might be some risks of too low cholesterol levels (usually caused by taking statins).

Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults (PubMed)

Groups with the lowest group having TC < 160 mg/dL as well as the highest group having >= 240 mg/dL were associated with higher cardiovascular disease mortality...Based on the results of this study, caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk in Korean adults.

Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case–control study (PubMed, 2012)

This study confirms an increased risk of primary intracerebral hemorrhage associated with low cholesterol both in men and women, especially in older individuals.

One who has very low cholesterol levels can discuss with a doctor about adjusting the dose or statins or even stopping them.

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  • Sounds like opinions are quite varied at this point. Commented Aug 2, 2018 at 12:16
  • Yes, they are and I hope my answer shows this.
    – Jan
    Commented Aug 3, 2018 at 7:47

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