Cholesterol: The Misunderstood Molecule

For decades, cholesterol has been vilified as the enemy of heart health, with dietary guidelines and medical advice often focusing on lowering cholesterol levels at all costs. However, cholesterol is essential for many vital functions in the body, and emerging research suggests that low cholesterol may actually increase the risk of dementia and overall mortality.

In this article, we’ll explore why cholesterol is so important, the risks of having levels that are too low, and what you can do to support your health with a balanced approach.

Cholesterol is a waxy, fat-like substance found in every cell of your body. It is not inherently bad – in fact, it plays critical roles in multiple biological processes, including:

1. Brain Health & Cognitive Function

• Your brain is made up of about 60% fat, and cholesterol is a key component of brain structure.
• It is essential for forming synapses (connections between neurons), which are crucial for learning and memory.
• Low cholesterol has been associated with an increased risk of dementia and cognitive decline.

📖 Research: A study published in Frontiers in Aging Neuroscience found that lower total cholesterol levels in older adults were linked to poorer cognitive performance and a higher risk of dementia (Lu, Y., et al., 2020).

2. Hormone Production

• Cholesterol is the precursor for steroid hormones such as:
  • Oestrogen and progesterone (important for reproductive health)
  • Testosterone (important for muscle maintenance, libido, and overall vitality)
  • Cortisol (helps regulate stress and inflammation)
• Very low cholesterol levels can lead to hormonal imbalances, affecting energy levels, metabolism, and mood.

3. Vitamin D Synthesis

• Your body requires cholesterol to produce vitamin D when exposed to sunlight.
• Vitamin D is essential for immune function, bone health, and mental wellbeing.

4. Cell Membrane Integrity

• Cholesterol helps maintain the structure of cell membranes, ensuring that cells can communicate and function properly.
• Without enough cholesterol, cells become weak and prone to damage.

5. Bile Acid Production & Digestion

• Cholesterol is needed to produce bile acids, which are necessary for digesting and absorbing dietary fats and fat-soluble vitamins (A, D, E, K).

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While high LDL cholesterol is often associated with an increased risk of heart disease, low cholesterol (particularly low LDL) has been linked to several health risks, including:

1. Increased Risk of Dementia & Neurodegenerative Diseases

• Studies have found that people with low cholesterol levels are at a higher risk of Alzheimer’s disease and dementia.
• Cholesterol is critical for synapse formation, and without adequate cholesterol, neurons struggle to function properly.

📖 Research: A large-scale study in the journal Neurology reported that low LDL cholesterol was associated with an increased risk of dementia in elderly individuals (Kjeldsen et al., 2021).

2. Higher Overall Mortality Risk

• Research suggests that people with very low total cholesterol levels (below 160 mg/dL or 4.1 mmol/L) may have an increased risk of early death.
• A meta-analysis published in The BMJ found that low cholesterol was linked to higher rates of mortality from non-cardiovascular causes, including cancer and infections (Ravnskov et al., 2016).

3. Mental Health Issues (Depression & Anxiety)

• Low cholesterol has been associated with higher rates of depression, suicidal tendencies, and anxiety.
• Since cholesterol is essential for neurotransmitter function, very low levels may impair mood regulation.

📖 Research: A study published in The Journal of Psychiatric Research found that low cholesterol was associated with a higher risk of suicide in men (Partonen et al., 1999).

4. Increased Risk of Haemorrhagic Stroke

A study in the Journal of the American Heart Association found that people with very low LDL cholesterol had a significantly higher risk of haemorrhagic stroke (Sun et al., 2019).

While high cholesterol is often linked to an increased risk of ischemic stroke (caused by blood clots), low cholesterol levels have been linked to a higher risk of haemorrhagic stroke (caused by brain bleeds).

Many people are told to focus on lowering their LDL cholesterol, but
cholesterol alone is not a reliable marker of heart disease risk. What’s more important?
Inflammation and triglycerides.

2️⃣ Triglycerides: A Better Indicator of Metabolic Health

Triglycerides are a type of fat in your blood. High levels can indicate poor metabolic health and insulin resistance, which are much stronger predictors of heart disease than LDL alone.

✅ The best predictor of heart health?
A low triglyceride-to-HDL ratio (ideally below 2:1).

Instead of focusing solely on lowering cholesterol, the goal should be to maintain optimal levels that support overall health. Here’s how:

✔️ Eat Healthy Fats (olive oil, avocados, nuts, fatty fish)
✔️ Prioritise Protein & Nutrient-Dense Foods (eggs, grass-fed meat, full-fat dairy)
✔️ Reduce Processed Carbs & Sugar
✔️ Exercise Regularly
✔️ Check Metabolic Markers (Triglycerides, CRP, and fasting insulin)
✔️ Work with a Nutritional Therapist

Cholesterol is not the enemy – it is an essential molecule for brain function, hormone production, immune health, and longevity. Instead of fearing cholesterol, focus on a balanced, nutrient-dense diet and lifestyle to achieve optimal wellbeing.

👉 Need guidance on cholesterol and metabolic health?
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References:

Lu, Y., et al. (2020). “Low Cholesterol Level Linked to Reduced Semantic Fluency Performance in Healthy Elderly.” Frontiers in Aging Neuroscience, 12, 57.
🔗 https://www.frontiersin.org/articles/10.3389/fnagi.2020.00057/full

Kjeldsen, E. W., et al. (2021). “Low-density lipoprotein cholesterol and risk of dementia – a prospective cohort study including 86,000 individuals.” Neurology, 96(18), e2272.
🔗 https://www.atherosclerosis-journal.com/article/S0021-9150(21)00641-9/abstract

Ravnskov, U., et al. (2016). “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.” The BMJ, 353, i1246.
🔗 https://bmjopen.bmj.com/content/6/6/e010401

Partonen, T., et al. (1999). “Association between low serum cholesterol and major depression: A systematic review.” Journal of Psychiatric Research, 33(3), 231-242.
🔗 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/association-of-low-serum-total-cholesterol-with-major-depression-and-suicide/088101E2369B85EEEB13F2088D0F7BBB

Sun, L., et al. (2019). “Associations of Low-Density Lipoprotein Cholesterol Levels With Risk of Hemorrhagic Stroke in a Chinese Prospective Cohort Study.” Journal of the American Heart Association, 8(10), e012379.
🔗 https://pmc.ncbi.nlm.nih.gov/articles/PMC6428094/

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