Is my cholesterol really “too low,” what to do if so?

January 12, 2019 7:23 PM

Every year for 4 years, the doc at my yearly health evaluation tells me my LDL cholesterol is too low and to “eat more eggs.” Have you been told this before?

Ooo, it’s my first health question. YANMD, and I do intend to ask another doctor in passing the next time I’m in. I am a woman and in my early 30s, and I know that I am lucky not to have the opposite problem.

I live in Japan. Every year, we get a health exam through our workplace. This means being herded through a series of tests at the local hospital. Blood test, urine test, x-ray, vision/hearing, the works. At the end, we meet a doctor to review the results. Every year for four years, I’ve had the same doctor. He always tells me I have a clean bill of health, EXCEPT that my LDL cholesterol (“bad cholesterol”) is too low and to eat more fatty fish and eggs. He says that I exercise a lot (usually true?) and that lowers my LDL cholesterol, so I need to eat more of these foods than regular people.

I’ve got a sheet with my results on it. This year, my LDL cholesterol is listed as 58 mg/dL, which is marked as “low,” with the lower normal value at 70 and the higher at 139. (My HDL is 53, marked as normal, normal ranges 40-89) I don’t remember my LDL levels the previous years perfectly but I do know I’ve never made it to 70.

I have been mostly inclined to ignore what health test doctor says about this, because I dislike him personally and don’t totally trust him. Every year he tries to engage me in an unpleasant, long and mumbly conversation about what country I am from, and every year I have to tell him that I will only engage with him about my health results, because given the opportunity he will drone on and on about foreign countries even though they make us fast from the night before and I have had no coffee and no breakfast at this point, and I would also prefer to be at work. He hands me the same handmade sheet about cholesterol each year, which makes me suspect this is just a pet theory of his. Furthermore, our local hospital has a short supply of doctors and is probably just hanging on to anything with a pulse for dear life at this point.

On the other hand, I do wonder if my cholesterol is really too low and if there’s anything I could do about it. I don’t eat a TON of meat (it’s expensive here), and a middling number of eggs (maybe 1-2 a day), and not a lot of dairy anymore (prefer soy milk), but I do have my share of like, pudding cups and potato chips and fried chicken. Butter is my very good friend!

I have already consulted the internet in both English and Japanese about this and various sources counseled me that maybe low cholesterol could cause me to be depressed and anxious, or visa versa. Some sources say I should eat more foods high in cholesterol, others that there’s no point in changing my diet because dietary cholesterol is not important.

Anyway, how low is too low? Has anyone ever told you your cholesterol is too low, and did they elaborate on what you should do about it?

posted by sacchan to Health & Fitness (7 answers total)

IANAD, but as it’s been explained to me, the general consensus at this point the most important measure of cholesterol is the ratio of HDL to LDL - if your HDL is normal, so should your LDL in order to maintain the optimal ratio. If your LDL is too low (or your HDL too high) it increases your risk of developing issues.

The fact that he’s never explained this or told you why it matters (or how to accomplish the increase) certainly supports your theory that he’s perhaps not the best, or at least most communicative, doctor.
posted by scrute at 7:42 PM on January 12, 2019 [1 favorite]

My last two LDL measurements were 54 and 65, and no one has said that’s too low. I’m in the US, and the form from my medical provider says optimal is below 100, but does not give a minimum.

I’ve also recently started taking a cholesterol-lowering medication for other reasons. When I asked my doctor if there was any problem with it further lowering my already low cholesterol, he said no.

I attribute my low LDL to a vegan diet. Before I went vegan, it was 113. I mention this because it might make a difference in whether my low cholesterol is pertinent to your situation.
posted by FencingGal at 7:52 PM on January 12, 2019 [1 favorite]

Mayo Clinic says there is the possibility of increased risk of disease if your LDL is below 50 but that is not confirmed.
Harvard Health Newsletter says 60 is better than 90 for heart health and predicts that the new recommendation might be 50-70.
Here is a research article that defines LDL-C
My non-expert conclusion would be that (a) your levels aren't that low and (b) there are probably heart benefits from having them lower rather than higher.
posted by metahawk at 8:30 PM on January 12, 2019 [1 favorite]

Also most current science says that eating lots of eggs won't raise your blood cholesterol anyway. I would try to find another doctor.
posted by Umami Dearest at 8:51 PM on January 12, 2019 [8 favorites]

You may have a genetic variation called Gilbert's syndrome. It's fairly common (affecting about 5% of people) and it causes higher bilirubin which in turns causes lower cholesterol (in which case, congratulations, you have a significantly lower risk of coronary disease). Is your bilirubin slightly higher than normal? It will often be on the same test results.
posted by rada at 9:28 PM on January 12, 2019 [1 favorite]

Response by poster: OK! Thank you everybody. This makes me feel much better about my levels. I'll just keep on doing what I'm doing! Another doc has asked to see my test results at next appointment for another reason, so that'll be a perfect chance to mention it and see if other doc has anything to add.
My preliminary tests don't have bilirubin on it, but I should get a more detailed report in a little bit. Will keep an eye out!
posted by sacchan at 11:30 PM on January 12, 2019 [1 favorite]

I've been told this exact thing before. (M, 30s, USA.) I also have an intolerance of eggs, so the proposed solution doesn't actually work for me. My other test results have always been normal, so I just keep doing what I'm doing and get by with low LDL. It doesn't seem to matter.
posted by kevinbelt at 3:40 AM on January 13, 2019