Adv Chol Resources

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Medical Heresy: Low Cholesterol is Dangerous!

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James Greenblatt, MD

Misleading Messages: What is the Truth about Cholesterol?
The cultural dogma is that cholesterol is an evil villain that needs to be eradicated for true health.  Given the unflagging efforts of the United States medical establishment over the last few decades to lower cholesterol and corresponding media saturation of food and drug promotions boasting cholesterol-lowering effects, it is understandable that most consumers are not concerned about having cholesterol levels that are too low.  Clinical practices appear to uphold the belief that “lower is better”, regardless of significant evidence to the contrary.  Opposing reports from aggressive cholesterol-lowering methods suggest that, for many patients, the potential cardiovascular benefits may come with unforeseen risks to mental health and behavior.  As a matter of fact, in 2012 the FDA was compelled to require black-box warnings on statins as a result of clinical trial outcomes indicating dangerous effects on cognition and psychological symptoms. Further research suggests that while statin drugs and other cholesterol-lowering agents have improved mortality rates for cardiovascular disease, total mortality has not experienced similar reductions, reflecting a rise in death by suicide or other consequence of mental disorders (Sahebzamani, 2013).  A prospective six-year cohort study of approximately 500 older adults provided startling data that individuals with lower serum total cholesterol (less than 6 mmol/L) had a higher risk of dying, independent of health or disease status (Tuikkala, 2010).

Cholesterol is a critical component of human biochemistry; indeed, it is so important that it is regularly synthesized by the liver and other organs throughout the body and is continuously recycled.  As a key structural constituent of cell membranes, cholesterol is essential for intracellular transport and communication, including signaling between neurons.  Synthesis of several hormones and Vitamin D also depend on cholesterol, providing additional clues to the connection between cholesterol and brain health.  In addition to other lipid molecules, cholesterol contributes to the approximately 60% dry weight of the brain composed of fat.  The brain relies heavily on lipids during growth and development and for optimal daily function, drawing on dietary and endogenous sources to fuel its extreme demands for energy.  The increased demand for cholesterol during adolescent brain development underlies the greater risk for psychopathology in teens and young adults.  Concurrent anatomical and neurotransmitter changes beginning in childhood persist until roughly age 21, a critical time when psychiatric disorders often erupt (Gogtay, 2004).

Clinical cholesterol panels measure blood lipid levels comprising triglycerides, low-density lipoprotein (LDL), high-density lipoproteins (HDL), and total cholesterol, which is a function of all three.  Normal values stretch from 125 to 200 mg/dl, and healthy levels vary by age, gender, race, health status, and family medical history.  Although recent media reports dismissed the contribution of high dietary cholesterol to serum status, the debate is far from over and the National Institutes of Health (NIH) continues to recommend dietary restriction of high-cholesterol foods (NIH, 2018).  Despite decades of clinical research and practice, experts still do not agree on “optimal” levels for LDL, HDL, or total cholesterol.  Medical treatment targets vary from lowering LDL, lowering total cholesterol, or raising HDL, leaving the public more confused than ever and creating a general fear of cholesterol.  And while consumers attempt to alter serum cholesterol through dietary and other lifestyle changes, data continue to accumulate showing the detrimental physical and psychological outcomes of fat avoidance. 

Like many health paradigms, a reductionist perspective on cholesterol as related only to cardiovascular health has neglected the extensive utility of these important molecules throughout the body.  Lipids including cholesterol play fundamental roles in human metabolism, and “healthy” levels can vary widely between individuals based on a complexity of factors.  David Horrobin, an ardent medical researcher who devoted much of his career to the relationship between lipids and mental health, developed a substantial hypothesis for the role of dietary fats in human anthropology.  He proposed that rapid advances in human evolution that enabled higher intellect and creativity occurred due to increases in fat storage in humans.  Focusing on schizophrenia, Horrobin suggested that the genetic factors influencing the severity of schizophrenia symptoms were the same markers that “made us human” (Horrobin, 1998).

Cholesterol’s Role in Mental Health
A significant connection between low cholesterol and poor psychiatric health has been emphasized through decades of observational and retrospective research studies.  Correlations with substance abuse, eating disorders, depression, and suicide strongly imply that cholesterol status influences mood and behavior.  Inadequate cholesterol levels may represent a shared etiological factor between these conditions and explain the overlapping continuum of pathology.  Low cholesterol reduces the function of serotonin, a neurotransmitter responsible for the regulation of emotion and decision-making.  Abnormal brain volumes, neural connectivity, and neurotransmitter function are present in patients with depression and eating disorders (Travis, 2015).  In Anorexia-Nervosa patients, low serum cholesterol significantly predicts depression, self-injury, and suicidal ideation (Favaro, 2004).  Research also suggests that anti-depressant medications may further lower serum cholesterol, counteracting any beneficial mechanisms (Sahebamani, 2003).  Lack of impulse control associated with drug addiction may also be attributed to poor cholesterol status.  An assessment of cocaine addicts following hospital discharge revealed that lower cholesterol values predicted relapse at each follow-up, suggesting that recovery requires an adequate supply of dietary lipids (Buydens, 2003).

Aggression can describe both physical and psychological behaviors directed towards the self or others, yet each of its manifestations has been linked to cholesterol status.  Violent conduct has been related to low cholesterol levels in patients ranging from adolescents with attention-deficit hyperactivity disorder (ADHD) to war veterans with post-traumatic stress disorder (PTSD) (Vilibic, 2014; Virkkunen, 1984).  While different genetic and biological mechanisms may be at play, cholesterol’s influence on hormones and neurotransmitters may provide at least one explanatory link (Hillbrand, 1999).  Imbalanced neurotransmitters inhibit the normal stress response, triggering expressions of fear at the root of aggressive actions.  A 3-month naturalistic observation of pre- and post-discharge psychiatric patients found significant associations between HDL cholesterol levels and violence, building upon more numerous data related to total cholesterol and highlighting HDL as a potential biomarker for risk of violence.  The authors reported strong evidence that insufficient cholesterol reduces the transportation capacity of serotonin in the central nervous system, interfering with the limbic brain’s affective and impulse responses (Eriksen, 2017). 

One of the most disturbing demonstrations of self-aggression is suicide.  A tragically growing public health issue, deaths by suicide are at their highest levels in three decades, increasing 24% between 1999 and 2014 to become the tenth leading cause of death in the United States (Curtin, 2016).  Attempts at self-harm and suicide are also rising in the adolescent population, with data suggesting a 65% increase in girls age 13 to 18 and reports of self-injury ranging from 15 to 30% of middle-, high-school, and college age students (Twenge, 2017).  Low cholesterol status again emerges as a common thread in otherwise healthy suicidal patients and those with depression and eating disorders, showing associations with abnormal brain volumes and Vitamin D concentrations (Grudet, 2014).  In spite of biomarker data obtained from clinical research, suicide prevention through biological strategies remains elusive. 

An Integrative Perspective on Cholesterol
Cholesterol levels should be monitored in all patients evaluated for depression, self-injury, and suicidal ideation.  With the number of prescriptions to anti-depressants and cholesterol-lowering drugs continuing to rise in patients young and old, it is imperative for clinicians to be aware of the undeniable influence of cholesterol status in both the etiology and treatment of mental health disorders.  Based on decades of clinical experience in my integrative psychiatry practice, genetic heritability and dietary cholesterol intake are highly predictive of mental health risk.  A family history of aggression, violence, or substance abuse may indicate a heritable metabolic defect affecting normal synthesis and recycling of serum cholesterol and suggesting a need for greater dietary intake.  Furthermore, a personal history of trauma, chronic stress, or eating disorders are flags for potential influences on cholesterol metabolism.

While consumption of high-cholesterol foods continues to be vilified in the battle against cardiovascular disease, inadequate dietary cholesterol is often overlooked.  Consensus on what represents low total serum cholesterol varies, but the normal range identified by the NIH suggests that levels above 125 mg/dL are adequate in most men and women (NIH, 2018).  While many clinicians recommend total cholesterol remain below 150 mg/dL, my concern is triggered in psychiatric patients with levels below 130 mg/dL, particularly in those with restrictive diets or with symptoms of irritability, lack of impulse control, or reckless behavior.  In these patients, gradually increasing total serum cholesterol over a period of three to six months has produced clear improvements in mood along with decreases in aggressive tendencies and any drug cravings.

The treatment protocol I have adopted in my integrative psychiatry practice for safely and effectively optimizing total cholesterol levels typically includes a recommendation to increase consumption of organic eggs, one of the richest sources of dietary cholesterol accompanied by protein, B-vitamins, choline, and other nutrients associated with brain health.  I also prescribe the use of digestive enzymes that contain lipase to enhance intestinal lipid digestion and absorption.  As a second-tier treatment strategy or for patients who avoid or are allergic to eggs, I recommend a supplemental form of cholesterol at a dose based on the individual’s cholesterol status.  New Beginnings Nutritionals’ Sonic Cholesterol delivers 250 mg of pure cholesterol per capsule, equivalent to the amount found in a single egg.  In addition to symptom monitoring, monthly cholesterol screening is necessary to adjust recommendations and prescriptions as blood levels improve.

It may be medical heresy to advocate for raising cholesterol, but only because of widespread ignorance and stubborn adherence to outdated information and methodology.  The World Health Organization predicts that by 2020, the global rate of suicide will increase to a death every 20 seconds, doubling the rate estimated in 2014.  This alarming societal epidemic highlighted by recent high-profile deaths and substantial data supporting the prevalence of low cholesterol among mental health patients provides an opportunity to expose a major, potentially preventable risk factor and a simple, straightforward treatment model that may save thousands of lives.  As knowledge of the link between diet and the brain grows, now is the time to reverse cholesterol’s erroneous reputation and recognize this essential nutrient as a critical component for mental health.

References:

  1. Buydens-Branchey, L., & Branchey, M. (2003). Association between low plasma levels of cholesterol and relapse in cocaine addicts. Psychosomatic medicine, 65(1), 86-91.

  2. Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States, 1999-2014.

  3. Eriksen, B. M. S., Bjørkly, S., Lockertsen, Ø., Færden, A., & Roaldset, J. O. (2017). Low cholesterol level as a risk marker of inpatient and post-discharge violence in acute psychiatry–A prospective study with a focus on gender differences. Psychiatry research, 255, 1-7.

  4. Favaro, A., Caregaro, L., Di Pascoli, L., Brambilla, F., & Santonastaso, P. (2004). Total serum cholesterol and suicidality in anorexia nervosa. Psychosomatic Medicine, 66(4), 548-552.

  5. Gogtay, N., Giedd, J. N., Lusk, L., Hayashi, K. M., Greenstein, D., Vaituzis, A. C., ... & Rapoport, J. L. (2004). Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National academy of Sciences of the United States of America, 101(21), 8174-8179.

  6. Grudet, C., Malm, J., Westrin, Å., & Brundin, L. (2014). Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology, 50, 210-219.

  7. Hillbrand, M., & Spitz, R. T. (1999). Cholesterol and aggression. Aggression and violent behavior, 4(3), 359-370.

  8. Horrobin, D. F. (1998). Schizophrenia: the illness that made us human. Medical hypotheses, 50(4), 269-288.

  9. National Institutes of Health. (2018). Cholesterol Levels: What You Need to Know. Medline Plus Website. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html#. Accessed 09 June 2018.

  10. Sahebzamani, F. M., D'Aoust, R. F., Friedrich, D., Aiyer, A. N., Reis, S. E., & Kip, K. E. (2013). Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism. Journal of clinical lipidology, 7(3), 208-216.

  11. Travis, K. E., Golden, N. H., Feldman, H. M., Solomon, M., Nguyen, J., Mezer, A., ... & Dougherty, R. F. (2015). Abnormal white matter properties in adolescent girls with anorexia nervosa. NeuroImage Clin. 9, 648–659.

  12. Tuikkala, P., Hartikainen, S., Korhonen, M. J., Lavikainen, P., Kettunen, R., Sulkava, R., & Enlund, H. (2010). Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up. Scandinavian journal of primary health care, 28(2), 121-127.

  13. Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

  14. Vilibić, M., Jukić, V., Pandžić-Sakoman, M., Bilić, P., & Milošević, M. (2014). Association between total serum cholesterol and depression, aggression, and suicidal ideations in war veterans with posttraumatic stress disorder: a crosssectional study. Croatian medical journal, 55(5), 520-529.

  15. Virkkunen, M., & Penttinen, H. (1984). Serum cholesterol in aggressive conduct disorder: a preliminary study. Biological Psychiatry.

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The Implications of Low Cholesterol in Depression and Suicide

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James M. Greenblatt, M.D.

For the last quarter century, we have been told that cholesterol is dangerous for our health and were advised to avoid it in order to live a healthier life. However, cholesterol is essential in maintaining good mental health. The brain is the most cholesterol-rich organ in the body, and depriving the brain of essential fatty acids and cholesterol can lead to detrimental health problems. Lower levels of cholesterol in the blood are associated with a heightened risk of developing major depressive disorder, as well as an increased risk of death from suicide. A study published in the Journal of Psychiatric Research found that depressed men with low total cholesterol levels (less than 165 milligrams per deciliter [mg/dL]) were seven times more likely to die prematurely from unnatural causes such as suicide and accidents.

Most recently, the continued allegation that cholesterol is dangerous came under scrutiny. A meta-analysis published in the March 2014 issue of Annals of Internal Medicine found that there's not enough evidence supporting the claim that saturated fat increases the risk of heart disease. After reviewing 72 different studies, researchers did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Researchers came to the conclusion that instead of avoiding fats, which are essential to maintaining brain health, scientists are identifying the real villains as sugar and highly processed foods.

Low Cholesterol and Depression

Several studies have linked low cholesterol levels to an increased risk of developing depression. Consider the following examples:

  • A 1993 paper published in the Lancet reported, "Among men aged seventy years and older, categorically defined depression was three times more common in the group with low total plasma cholesterol . . . than in those with higher concentrations."

  • A 2000 study published in Psychosomatic Medicine, researchers compared cholesterol levels to depressive symptoms in men ranging in age from forty to seventy. They found that men with long-term, low total cholesterol levels "have a higher prevalence of depressive symptoms" compared to those with higher cholesterol levels.

  • Women with low cholesterol levels are also vulnerable to depression. In 1998, Swedish researchers reported the results of their examination of cholesterol and depressive symptoms among 300 healthy women, ages thirty-one to sixty-five, in and around Stockholm. Women in the lowest cholesterol group (the bottom tenth percentile) suffered from significantly more depressive symptoms than did the others.

  • A 2001 study published in Psychiatry Research looked at primary care patients in Ireland, finding that low levels of cholesterol were linked to higher ratings on depression rating scales.

  • Italian researchers measured the cholesterol levels of 186 patients hospitalized for depression and found an association between low cholesterol and depressive symptoms.

This research is supported by other studies, including a 2008 meta-analysis, which found that higher total cholesterol was associated with lower levels of depression. A 2010 study published in The Journal of Neuropsychiatry & Clinical Neurosciences looked at the levels of HDL in depressed people and found that low levels of HDL were linked to "long-term depressive symptomatology."

Low Cholesterol and Suicide

Suffering through a depressive episode can be very difficult, and one of the great fears is that someone in the throes of depression does not see any point in continuing to live.

Early evidence of a link between low cholesterol and suicide came from the Multiple Risk Factor Intervention Trial study, a large-scale, long- term look at various health factors involving hundreds of thousands of volunteers. Data from the study was analyzed by researchers from the University of Minnesota, who found that people with total cholesterol levels lower than 160 mg/dL were more likely to commit suicide than those with higher cholesterol levels. Other studies are equally alarming:

  • A 2008 study looked at forty men who were hospitalized due to bipolar disorder. Twenty had attempted suicide at some point in the past, and the other twenty had not. Both cholesterol and blood fat levels were lower, on average, among those who had attempted suicide.

  • A paper published in the Journal of Clinical Psychiatry in the same year reported the results of an examination of cholesterol levels in 417 patients who had attempted suicide at some point, 155 hospitalized psychiatric patients who had not, and healthy controls. Results of the study suggest that low cholesterol may be associated with suicide attempts.

  • The suicidal method of choice, self-inflicted fatal gun wound versus pills, for example, may also be related to cholesterol levels. A2008 study published in Psychiatry Research compared nineteen people who had attempted suicide using violent methods to sixteen who had attempted to kill themselves nonviolently, as well as to twenty healthy controls. The researchers found that "violent suicide attempters had significantly lower total cholesterol and leptin levels compared with those with nonviolent suicide attempts."

The connection between low cholesterol and suicide is highlighted in a 2004 study, which concluded that a low total cholesterol level can be used as an indicator of suicide risk. This study, involving suicide attempters with major depressive disorder, nonsuicidal depressed patients, and normal controls, found significant differences in cholesterol levels among the various groups.

The average total serum cholesterol level was 190 mg/dL among the normal controls, 180 mg/dL in nonsuicidal depressed group, and 150 mg/dL among the suicidal depressive patients. This study showed that the total cholesterol level can be used to gauge possible suicide risk (less than 180 mg/dL) and probable risk (150 mg/dL and lower).

Suicide is not the only type of violence associated with lower cholesterol levels. Homicide and other violence committed against others is also associated with low cholesterol. Swedish researchers compared one-time cholesterol measurements on nearly eighty thousand men and women, ranging in age from twenty-four to seventy, to subsequent arrests for violent crime. The researchers reported that "low cholesterol is associated with increased subsequent criminal violence."

What's the Cholesterol-Depression Link?

There is strong scientific evidence indicating that low cholesterol and suicide, particularly violent suicide, are linked. The vast majority of studies linking low cholesterol to depression, suicide, and violence looked at the serum cholesterol level. But what about the amount of cholesterol in the brain?

Canadian researchers were the first to examine this question in their 2007 study published in the International Journal of Neuropsychopharmacology. The researchers measured and compared the cholesterol content in various parts of the brains of forty-one men who had committed suicide and twenty-one men who had died of other, sudden causes that had no direct impact on the brain. The results were intriguing: When the suicides were categorized as violent or nonviolent, those who had committed violent suicide were found to have less cholesterol than the others in the gray matter of their brains. This was seen specifically in the frontal cortex, a part of the brain that handles "executive functions," including processes involved in planning, cognitive flexibility, abstract thinking, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information. The frontal cortex essentially controls the ability to make good decisions.

Cholesterol is a critical precursor to many essential physiological molecules in the human body that directly and indirectly affect our moods and optimal brain function. Some researchers theorize that low levels of cholesterol alter brain chemistry, suppressing the production and/or availability of the neurotransmitter serotonin. Cholesterol is essential for the synthesis of all steroid and sex hormones, including DHEA, testosterone, and estrogen. Cholesterol is also needed in the synthesis of vitamin D.

Clinically low cholesterol is a significant variable in the treatment and recovery from mood disorders. A simple blood test looking at total cholesterol can reflect multiple factors influencing treatment. In my clinical practice for the past 20 years, I have found that low cholesterol (<130) has significant implications for what is referred to as "treatment-refractory" depression. This refers to patients who have failed to recover from traditional antidepressant medications. Treatment-refractory patients often struggle with intense suicidal ideation and aggressive behavior. Often, we are able to determine that low cholesterol is genetic, as there are other members in the family who also have low cholesterol levels, despite eating a diet rich in cholesterol and saturated fats. For individuals with low cholesterol, a diet with adequate cholesterol and saturated fats is highly recommended in order to replenish cholesterol levels, although supplemental cholesterol may also be needed for many.

New Beginning's Sonic Cholesterol supplement provides 250 milligrams of cholesterol per capsule. Individuals with low cholesterol levels may take between two to six capsules per day in order to restore adequate cholesterol levels for optimal brain function. Cholesterol repletion is often slow and can take many months. Once cholesterol levels are normalized, we often see an improvement in symptoms and a decreased dependency on medications. It is quite striking to consistently witness the high correlation between cholesterol levels and behavioral and mood symptoms.

For information about cholesterol supplementation, contact New Beginnings Nutritionals.

Conclusion

There is a growing amount of research looking at the use of essential fatty acids, particularly omega-3's in psychiatry, but we often overlook cholesterol. Low levels of cholesterol and essential fatty acids are intimately linked to depression. Understanding the consequences of deficiencies in essential fats and cholesterol is important for the effective treatment of depression. Whether it is drug induced, genetic, or a result of dietary patterns, low cholesterol impairs optimal brain function and often prevents successful recovery from chronic depression.

Clinical References:

  • 1. Hediger ML, England LJ,Molloy CA, Yu KF, Manning-Courtney P, Mills JL. Reduced bone cortical thickness in boys with autism or autism spectrum disorder. J Autism Dev Disord. 2008;38(5):848–856

  • 2. Coleman, M. Clinical presentations of patients with autism and hypocalcinuria. Develop. Brain Dys. 7: 63-70, 1994

  • 3. Caudarella R, Vescini F, Buffa A, Stefoni S. Citrate and mineral metabolism: kidney stones and bone disease. Front Biosci. 2003 Sep 1;8:s1084-106.

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Cholesterol Balance – A Major Factor in Many Chronic Disorders

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William Shaw, PhD

Cholesterol Balance – Deficiency & Excess

Low cholesterol has been connected to depression, anxiety, bipolar disorder and statistically higher frequency of violent behavior, suicide, Parkinson’s disease, and cancer mortality. Susceptibilities to tuberculosis and gastrointestinal infections are also associated with lower cholesterol levels. Most significantly, the death rate is doubled in older adults with lower total cholesterol and stroke and cataracts rates are higher.

Cholesterol is a sterol essential to life and is found in every animal cell. Cholesterol is part of our cellular structure and protects our tissues. Many people fear and focus on high cholesterol levels, yet never focus on low cholesterol levels, which can have negative health effects. Like everything in nature, balance is the key.

High cholesterol is statistically associated with greater risk of cardiovascular disease (CVD), but less well known is the association of low cholesterol with poor health and many chronic disorders. Recent studies have suggested strongly that lower cholesterol does not guarantee a long life or high quality of life.

The Great Plains Laboratory, Inc. (GPL) offers the Advanced Cholesterol Profile. This profile is used to determine whether a cholesterol deficiency is present or if cholesterol is elevated. This profile also determines if the body is eliminating potentially toxic homocysteine and determines risk factors for vascular disease and/or neurological disease.

Benefits of Cholesterol

Cholesterol serves several important roles in metabolism: it is a key constituent of all cell membranes and provides the structural framework of vitamin D and adrenal and sex hormones, as well as for bile acids which help digest fat and increase absorption of fat soluble vitamins. Most cholesterol is made in the liver and is so crucial to metabolism that, if necessary, it can be synthesized from either fatty acids or glucose. 

The Brain is the Most Cholesterol-Rich Organ in the Body

Cholesterol synthesized in the brain is the primary component of the myelin that surrounds each nerve cell as a protective sheath. Loss of myelin from disease or injury inevitably causes neurological damage. Both neurons and glial (support) cells in the central nervous system (CNS) contain unbound cholesterol as an integral part of their cell membranes.

Cholesterol & Cardiovascular Disease

High cholesterol may be associated with the onset of CVD, but cholesterol may be deposited as a “patch” on inflamed or injured blood vessels, particularly coronary arteries. Macrophages scavenge cholesterol along with other cell debris and may become “foam cells” which accumulate in artery walls and cause atherosclerotic streaks. Assessments of inflammation such as C-reactive protein (test available at GPL) or homocysteine level have been suggested as better predictors of CVD risk.

Homocysteine (Hcy) is a non-protein, non-structural amino acid that is generated by metabolism of methionine, an essential amino acid. Homocysteine can be recycled back to methionine with folic acid and vitamin B-12 as co-factors.

Low Cholesterol Associated with Mental Disorders & Mortality in Elderly

Understanding the health consequences of lower cholesterol has been aided by studying serious genetic disorders that prevent cholesterol synthesis in the body. Low choles-terol has been connected to greater risks of suicide, accidents, violence, and mood disorders, such as depression.

Cholesterol levels may influence serotonin activity in the brain. Serotonin is the neurotransmitter associated with mood, and low serotonin is associated with depression and violent and anti-social behavior. Several theories about how cholesterol levels are related to serotonin levels have been proposed. The simplest effect may be that if cholesterol in the nerve cell membrane is deficient, serotonin cannot properly bind to its receptor. Cholesterol also stabilizes receptors for the social-bonding hormone oxytocin.

In the elderly, studies over several decades have pointed to increased risk of death in the population with the lowest cholesterol. Falling cholesterol in the elderly is a sign of increasing morbidity, with controversy over whether it is a sign of underlying chronic disease or a cause of disease. 

Testing Cholesterol with The Great Plains Laboratory, Inc.

The Advanced Cholesterol Profile is useful for adults whose low cholesterol may put them at risk for mood disorders or infectious disease. Medical historians have noted that tuberculosis has been uncommon in the USA since the Great Depression, during which high cholesterol foods were unavailable to many because of financial hardship. Vegetarians also have a much higher incidence of tuberculosis than meat eaters. Pregnant women with low cholesterol are twice as likely to have premature babies or babies with small heads.

In addition to total cholesterol, the Advanced Cholesterol Profile includes Apolipoprotein A-I and Apolipoprotein B, Lipoprotein (a) , and Homocysteine.

Lipoproteins are enclosures of protein carrying water-insoluble fat (cholesterol and triglycerides) for transport in the bloodstream and through cellular and mitochondrial membranes. Apolipoproteins have a detergent-like structure that allows them to interface on the outside with aqueous blood and with the lipids bound to the inside. These specialized proteins also serve as enzyme co-factors and receptor ligands (receptor interactions control cholesterol synthesis, transport, and metabolism).

Total Cholesterol

Total cholesterol is the same measure in all lipid panels. Low values (generally values less than 4.14 mmol/L* ; 160 mg/dL*) are associated with genetic diseases of cholesterol metabolism. 
In China, where mean cholesterol is much lower than in the Western world, chronic hepatitis B virus infection is ubiquitous. Chronic carriers of hepatitis B, but not individuals with eradicated hepatitis B, have significantly lower total cholesterol than non-carriers, suggesting a cause-effect relationship. Inflammation and higher cholesterol levels are hypothesized to increase the risk of cardiovascular disease (CVD). Genetic diseases of cholesterol and lipid metabolism have been strongly associated with increased CVD.

Apolipoprotein A-I (Apo A-I)
The main protein component of HDL (high density lipoprotein, the so-called “good cholesterol”) accounts for approximately 65% of the total protein content of HDL. Apo A-I triggers the esterification or binding of free cholesterol with long-chain fatty acids. This is the form in which cholesterol can then be transported back to the liver, metabolized, and excreted in bile. Values of Apo A-I have been shown to decrease during infection.

Apolipoprotein B (Apo B)
The main protein component of LDL (low density lipoprotein, the so-called “bad cholesterol”) accounts for approximately 95% of the total protein content of LDL. Apo B is necessary for the reaction with LDL receptors in the liver and on cell walls and is thus involved in transporting cholesterol from the liver to the cells. Recently, the Mind Institute found that low values of Apo B are associated with autism, with the lowest values being found in low-functioning autism. LDL has been found to have protective effects against endotoxins from deadly staphylococcus bacteria.

Lipoprotein (a) (Lp (a))
Lp (a) is a modified version of LDL containing Apo B and a unique protein, apolipoprotein (a) linked by a disulfide bridge. High values have been implicated as a risk factor for cardiovascular disease, Alzheimer’s disease, Crohn’s disease, and rheumatoid arthritis. Low values have also been found in those with autism who have higher levels of Apolipoprotein E epsilon-4 gene variants that are associated with increased risk of Alzheimer’s disease. Lipoprotein (a) is biochemically unrelated to Apolipoprotein A.

Homocysteine (Hcy)
Homocysteine (Hcy) is a sulfur-containing amino acid that is converted back to methionine in a cycle that required B12 and folic acid. Although the role of homocysteine in atherosclerosis is still being studied, high Hcy levels suggest supplementation with folic acid and vitamin B12 may be protective. The genetic disorder homocystinuria is known to cause massive atherosclerosis in younger people, although the mechanism by which homocysteine promotes narrowing and hardening of arteries is unknown. Abnormally high values have been reported in stroke, cardiovascular disease, and in Alzheimer’s disease. The Advanced Cholesterol Profile includes an Hcy level, which is usually a separate blood test.


The Advanced Cholesterol Profile uses FDA-approved diagnostic laboratory reagents, which assures quality results.

* Some countries (Canada, Europe, Middle East, and others) report cholesterol levels using mmol/L while the U.S. and Latin America use mg/dL.