Hypolipidemia: What You Should Know

Hypolipidemia: What You Should Know - Zizi

Medically Reviewed by Vincenta Faulkner, RD, CNSC, CCTD

When we hear the word cholesterol, we might think of its associations with poor health and heart attacks. Maybe you associate cholesterol with packaged snacks and salty junk food as opposed to healthy fats like avocados. Or, maybe you are not at all certain exactly what cholesterol is or how it impacts you.

High cholesterol is common, and most people can name at least one person in their life who has this diagnosis. More formally known as hypercholesterolemia, high cholesterol can lead to significant health risks down the line if left untreated.

However, contrary to what you might believe, hypercholesterolemia does not just mean that you have high cholesterol — it means that you have high levels of a specific type of cholesterol. This is because not all cholesterol is bad!

Cholesterol is a waxy substance our bodies produce naturally — it’s used for cellular structure and communication, hormone production, and vitamin D synthesis.

Hypercholesterolemia simply eludes to there being too much “bad” cholesterol in your blood — i.e. cholesterol that’s building up and risking a blockage.  

If there’s hypercholesterolemia, there must be hypocholesterolemia, too, right? How low is too low, and is there such thing as unhealthy cholesterol levels because they are too low?

Zizi is here to help answer some of these questions!

What Is Hypolipidemia?

Hypolipidemia means that you do not have enough cholesterol in your bloodstream.

Medical literature frequently interchanges the term “hypocholesterolemia” with “hypobetalipoproteinemia” and “hypolipidemia,” all of which generally describe the same condition.

A hypolipidemia diagnosis basically indicates that your total cholesterol levels are too low.

How Low Is Too Low for Cholesterol Levels?

Hypolipidemia is much less common than its counterpart, hyperlipidemia, affecting around 2-3% of healthy people and up to 6% of hospitalized or ill patients. Because hypolipidemia is rare, there is very little information about it, and healthcare providers are far less familiar with the diagnosis.

This does not mean that there are no studies or data on hypolipidemia, though. Rather, it unfortunately means that what few dozen studies do exist present data that lacks consistency and conclusiveness.

Total serum cholesterol (TC) can be a good laboratory indicator for cholesterol levels and the severity of any hypocholesterolemia cases. However, there is not yet a definitive, safe total cholesterol (TC) level concerning hypocholesterolemia — there is no consistency or universal guideline to the exact TC limit below which hypocholesterolemia becomes a diagnosis.

Some definitions refer to hypolipidemia as a disorder in which total serum cholesterol levels are lower than 160 mg/dL; others state the disorder’s cutoff level to be TC lower than 120 mg/dL.

In general, though, it is safe to say that if an individual has less than 40 mg of “bad” cholesterol (LDL) per dL of blood, this person has relatively low levels and is hypolipidemic.  

What Causes Hypolipidemia? How Can I Tell if I Have It?

Hypolipidemia is generally asymptomatic, so there are not always warning signs. Instead, this condition is detected on a lipid screening that either your doctor orders on routine or that you request your doctor to order.

As for etiology, you can separate causes for hypolipidemia into two categories: primary and secondary factors. Genetic mutations cause primary hypolipidemia and acquired factors such as infection, inflammation, and critical illness lead to secondary hypolipidemia.

Primary Hypolipidemia

Primary hypolipidemia is hypolipidemia due to genetic factors, namely gene mutations. Hypolipidemia is already rare in itself, but within this disorder’s etiologies, primary hypolipidemia is far rarer than secondary.

There are three primary disorders: abetalipoproteinemia, hypobetalipoproteinemia, and chylomicron retention disease. A gene involved in “bad,” or LDL, cholesterol’s absorption, biosynthesis, or metabolism pathway mutates in all primary types.

> Understanding Mutations

For example, with hypobetalipoproteinemia, a mutation in the APOB gene causes most cases, and typically results from family history and gene inheritance. The APOB gene has the blueprints and instructions for making two versions of a protein that helps comprise lipoproteins (the blood’s “transportation method” for cholesterol and fats).

When this gene mutates, it either shortens or obliterates both versions of the protein and thus affects the cell’s ability to transport fats and cholesterol. If the mutation completely omits the two versions, then severe hypobetalipoproteinemia results because dietary fat and cholesterol transportation is gone.

If the mutation slightly or moderately shortens the protein versions, then there is a decrease in fat and cholesterol transport, so the body becomes less capable of absorbing fats and fat-soluble vitamins.

> Symptoms

If the mutation shortens the protein versions only slightly, then it could be that no symptoms, or perhaps only very mild symptoms, appear. However, if the mutation obliterates both protein versions, more severe health problems will likely ensue.

While mild cases can result in abnormal fat buildups in the liver (called hepatic steatosis), more severe cases can cause hepatic steatosis to worsen, progressing to chronic liver disease.

Fortunately, inherited hypobetalipoproteinemia is very rare; data estimates that this disorder presents in one out of every one thousand to three thousand people.

Secondary Hypolipidemia

Compared to primary hypolipidemia, secondary hypolipidemia is more common.

Many factors and malignancies may sometimes lead to this secondary disorder, including anemia, acute or chronic infection, inflammation, sepsis, malabsorption, malnutrition, critical illness, hypothyroidism, liver disease, serious stress, and hospitalization.

In rare cases, individuals may also develop secondary hypolipidemia because they are on drug-induced statins to target and manage their hyperlipidemia.

I Have Hypolipidemia. How Will This Affect Me?

Just as there is little conclusiveness for what cholesterol levels really indicate hypolipidemia, there is also little conclusiveness as to possible consequences of it.

Again, because this disorder is so rare, there is very little information about it, and healthcare providers are generally less familiar with it as a cholesterol diagnosis. Scientists are still trying to test and develop more consistent and telling data regarding the connections between hypolipidemia and health risks.

Hypolipidemia may mean cell membrane lipid changes or impairment in the body’s ability to absorb and transport fats, which may or may not lead to presentable signs and symptoms. Hypolipidemia may link to a more significant number of associated diseases, meaning longer hospitalization periods and increased re-hospitalization rates.

Data indicates that hypolipidemia is commonly associated with critically ill and post-operative patients and largely associated with increased mortality. Some medical literature relays that hypolipidemia could act as a prognostic marker for cancer patients, and other literature relays that this disorder is a prognostic marker during sepsis or a predisposing factor for infection from some conditions.

In rare cases, hypolipidemia may increase a critically ill patient’s risk for sepsis, adrenal failure, hemorrhagic stroke, depression, anxiety, or other mental disorders. As such, severe hypolipidemia can be a serious disorder associated with many different diseases or other adverse effects.

Heart Health Made Easy With Zizi

Cholesterol levels are not a one-way road or a one-sided spectrum whose only threat to your health lies in high levels. Just as bad or total cholesterol levels can be harmful if too high, cholesterol levels that are too low can also pose a risk to your health.

Even though hypolipidemia is not as common as hyperlipidemia and does not always exhibit noticeable symptoms or effects, it can still be a serious diagnosis. It might be an indicator that there is another underlying medical problem.

If you are hypolipidemic, you should always address your diagnosis, its possible cause, strategies to combat its potential health effects, and ways to consistently monitor your cholesterol levels.

At Zizi, we know that better healthcare starts with better access, which is why we want to give you the means to improve your health without leaving your house.

With our Heart Health Reset Program, you have access to monthly cholesterol testing to monitor your levels among other resources.

If you have or think you might have hypolipidemia, Zizi is with you every step of the way. We’ve got your best heart at interest.


Hypolipidemia: A Word of Caution | NCBI

Familial hypobetalipoproteinemia | MedlinePlus Genetics

Cholesterol level: Can it be too low? | Mayo Clinic

Hypocholesterolemia: A Neglected Laboratory Finding | Acta Medica

High Cholesterol (Hypercholesterolemia) | Harvard Health

Hypolipidemia: A Word of Caution | NCBI

Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts in-hospital mortality in critically ill patients with diffuse peritonitis | NCBI  

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