In the last post we established that cholesterol is actually a necessary component of every cell in your body. We briefly discussed some of the things your body uses cholesterol for- things like making vitamin D and various hormones. Now let's take the time to talk about the other side of the cholesterol tail- when your cholesterol is too low. We'll break it down by talking about some of the things you make out of cholesterol.
The sex hormones Estrogen, Testosterone, and Progesterone are all made from cholesterol. While the ovaries and the testes are more than capable of making their own cholesterol, the vast majority of cholesterol in the body is made by the liver(1). Thus, when you don't have enough of their precursor, cholesterol, it would be logical to think you might develop hormonal imbalances as a result.
The adrenal glands- also known as the suprarenal glands, are two triangular shaped glands that sit atop the kidneys. These tiny glands make a multitude of different hormones, most of which are derived from cholesterol. The most famous of these hormones is the so-called "stress hormone", cortisol. Cortisol and melatonin control the sleep-wake cycle, which is also called the circadian rhythm. When the adrenals don't have enough reserve to make cortisol, they can become exhausted. This is known as adrenal fatigue (more to come on this later) and can lead to things like chronic fatigue, trouble getting to sleep or staying asleep, trouble getting up, and gut and brain related symptoms.
Vitamin D is one of only two vitamins the human body is capable of making on it's own, and is incredibly important for gut healing(2), immune function(3), and most famously, calcium metabolism. Studies across the board have shown that vitamin D deficiency is the most common vitamin deficiency in the developed world, with as many as 40-90% of people being deficient(4). If you haven't gotten your vitamin D levels measured lately, it's well worth getting done. Luckily, vitamin D supplements are relatively inexpensive- but remember to take it with a meal with some fat. Vitamin D is a fat soluble vitamin, and will be best absorbed when eaten with other dietary fats so that the liver and gallbladder have a chance to emulsify it with bile salts.
Speaking of which, bile salts are another thing made from cholesterol. Bile is synthesized in the liver, which then is collected and concentrated in the gallbladder. I'll talk about the gallbladder and the consequences of removing it in a later post, but for now we will go over basic physiology. Bile is secreted from the gallbladder in response to the ingestion of dietary lipids (fat). Without bile acids, any fat you ingest would pass straight through the tubes and not be absorbed. I know that sounds like a good thing to a lot of people, but it's really not. Fat is a vitally important part of every cell in your body, particularly omega-3 fatty acids which are very anti-inflammatory.
As you can see, cholesterol is an extremely important part of your body. Because of this, most functional medicine doctors like to see cholesterol that is somewhere between 150-200. But now that we've covered what can happen as a result of low cholesterol, let's discuss some things that may cause low cholesterol.
Most commonly decreased cholesterol is seen in a pattern with other blood markers that are indicative of malabsorption. When you are unable to absorb the nutrients in your food, you can't make things like cholesterol, nor any of it's downstream metabolites. When this is the case, the most effective way to treat the patient with low cholesterol is often times a gut-healing protocol, which we will discuss in later posts. Conveniently enough, when you heal the gut it has a tremendous anti-inflammatory effect across the entire body.
Another interesting angle to look at is the debate about chronic infections and their impact on the body as a whole. In the article Mafia Wars(5) the author mentions that many critters (bacteria, namely) need cholesterol to stabilize their own cell membranes, and it is believed now that these bugs have the ability to steal our cholesterol. There has only been limited research on this so far, but it's an intriguing concept as the world learns more about infectious organisms such as H. Pylori, E. Coli, and Borrelia, the causative agent behind Lyme Disease.
Until next time,
(1) Guyton and Hall Textbook of Medical Physiology pp 847-848
(2) Juan Kong "Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier" Am J Phsiol Gastrointest Liver Physiol 294:G208-G216 October 2007
(3) Kamen, Diane. “Vitamin D and molecular actions on the immune system: Modulation of innate and autoimmunity” J Mol Med 2010 May; 88(5): 441-450