Hypocholesterolemia: Understanding Abnormally Low Cholesterol Levels

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What Is Hypocholesterolemia?

Hypocholesterolemia is a condition in which total cholesterol falls below 116 mg/dL or LDL cholesterol falls below 50 mg/dL, levels lower than those of more than 9 out of 10 people. [1] It can be inherited through genetic syndromes or acquired through illness, malnutrition or liver disease. [1] Unlike high cholesterol, low cholesterol is often a sign of another problem.

What the research says

• Low cholesterol on ICU admission goes with a higher risk of death. A meta-analysis of 24 prospective studies (2,542 participants) found that people who died had lower levels than survivors on the first day of intensive care: HDL cholesterol was 7.06 mg/dL lower (95% CI 4.91 to 9.21), total cholesterol 21.86 mg/dL lower (95% CI 12.49 to 31.23) and LDL cholesterol 8.79 mg/dL lower (95% CI 3.83 to 13.74). The studies were observational, so this shows a link, not a cause (Taylor et al., EBioMedicine, 2024) [2].

• Very low LDL from cholesterol-lowering drugs has not shown excess side effects in trials. A meta-analysis of 10 randomized trials (38,427 patients with LDL below 40 mg/dL on treatment vs 70,668 controls, median follow-up 28.8 months) found similar rates of non-cardiovascular death (odds ratio 1.13; 95% CI 0.87 to 1.45), cancer (1.02), hemorrhagic stroke (0.89) and neurocognitive disorders (0.97), and fewer major cardiovascular events (0.82; 95% CI 0.72 to 0.94). This concerns low LDL reached with treatment, not the disease itself (Patti et al., European Heart Journal – Cardiovascular Pharmacotherapy, 2023) [3].

Key Takeaways

Defining Low Cholesterol Levels

Cholesterol is a waxy substance the body uses to build cell membranes, make hormones and make vitamin D. Public health messages usually focus on lowering high cholesterol to protect the heart, but the body still needs some. A healthy total cholesterol is generally below 200 mg/dL and a healthy LDL is below 100 mg/dL. [1] In hypocholesterolemia, the numbers fall far below that range.

Recognizing the Signs and Symptoms

Most people with hypocholesterolemia have no symptoms from the low cholesterol itself. Symptoms usually come from the condition that caused it. [1] When the cause is inherited, difficulty processing fats can lead to noticeable physical problems.

Possible Signs Linked to Low Cholesterol

• Digestive problems: diarrhea or fatty stools (steatorrhea) from poor absorption of fats.

• Growth and development: problems with growth and development in children. [1]

• Muscle control: poor muscle control. [1]

• Vision and other vitamin-related problems: eye problems from severe vitamin deficiencies. [1]

Possible Complications

Hypocholesterolemia may lead to mild liver dysfunction or fatty liver disease. [1] You may also have problems with your eyes, brain, liver, muscles or bones. These come from not having enough of the vitamins A, D, E or K. [1]

Common Causes of Hypocholesterolemia

Hypocholesterolemia is either genetic (inherited) or acquired. Genetic forms are rare, and for most people the cause is not genetic. [1]

Genetic and Inherited Conditions

Rare genetic syndromes can make it hard for the body to absorb nutrients. [1] Examples include abetalipoproteinemia and Smith-Lemli-Opitz syndrome. [1] Reviews describe that when lipoproteins carrying apolipoprotein B are completely absent, as in abetalipoproteinemia and homozygous hypobetalipoproteinemia, people develop digestive problems and severe vitamin deficiencies that affect the nerves, muscles, eyes and blood. Milder genetic forms usually have a milder course and protect against atherosclerotic cardiovascular disease, although people with heterozygous hypobetalipoproteinemia may have a somewhat higher risk of liver disease (Gill and Hegele, Expert Review of Endocrinology & Metabolism, 2023) [4].

Acquired and Non-Genetic Causes

• Infections: sepsis, HIV and other infections. [1]

• Organ problems: liver disease, kidney failure and chronic pancreatitis. [1]

• Hormone problems: hyperthyroidism and Addison's disease (adrenal insufficiency). [1]

• Nutrition: malnutrition, protein loss from the gut (protein-losing enteropathy) and alcohol use disorder. [1]

• Other chronic illness: cancer, Crohn's disease and other conditions that cause poor absorption of nutrients. [1]

Diagnosis and Clinical Testing

A healthcare provider can diagnose hypocholesterolemia with a blood test that measures cholesterol, often found during a routine checkup. If total cholesterol is below 116 mg/dL, further tests may be needed to find the cause.

Diagnostic Procedures

1. Blood tests: a lipid panel measures total cholesterol, LDL, HDL and triglycerides.

2. Genetic testing: a different blood test shows whether a genetic disorder is the cause. [1]

3. Liver ultrasound: checks for fatty liver disease or other liver problems.

4. Bone density scan: checks for bone loss related to low vitamin D.

Treatment and Management Strategies

The main goal is to treat the underlying cause and to prevent problems from low levels of fat-soluble vitamins. Providers also track growth in children, and you will need regular physical exams. [1]

Standard Treatment Approaches

• Vitamin supplements: high doses of vitamins A, D, E and K if your levels are low. [1]

• Dietary guidance: a dietitian can make sure you get enough essential fatty acids, and some genetic forms need a low-fat diet. [1] [4]

• Treating the primary condition: such as the infection, thyroid problem or digestive disorder behind the low cholesterol. [1]

• Experimental therapies: in critically ill patients, glucocorticoid (steroid) treatment was linked to higher HDL and LDL cholesterol, but in septic mice it came at the cost of impaired adrenal function, suppressed muscle regeneration and greater loss of body mass, so it is not a treatment for low cholesterol (De Bruyn et al., Critical Care, 2024) [5].

Outlook and Long-Term Prognosis

The outlook depends heavily on the cause. Hypocholesterolemia can be a sign of an infectious disease or severe illness, and providers see it as a sign of poor prognosis, especially in people with sepsis. [1] For inherited forms, the long-term outlook is manageable with steady nutritional support and regular follow-up with a dietitian. [1] One advantage of low cholesterol is a low risk of plaque buildup in the arteries and of the conditions it causes, such as heart attacks. [1]

Conclusion

Hypocholesterolemia is a useful clue to overall health. It offers some protection against plaque in the arteries, but the risks of poor nutrient absorption and vitamin deficiency need careful attention. If a lab result shows abnormally low cholesterol, the next step is to talk with your healthcare provider about finding any underlying medical condition.

Frequently Asked Questions

Is low cholesterol always a bad thing?

Not necessarily. Very low levels can be a sign of illness or malnutrition, but people with genetically low LDL have a low risk of plaque buildup in the arteries and of heart attacks. A healthcare provider needs to look at the cause.

Can I inherit low cholesterol?

Yes. Rare genetic conditions such as abetalipoproteinemia and Smith-Lemli-Opitz syndrome can be passed down from a biological parent and can make it hard to absorb nutrients. [1]

What vitamins are affected by low cholesterol?

Vitamins A, D, E and K. They are fat-soluble vitamins, so the gut absorbs them with the help of fats, and low levels can cause problems with the eyes, brain, liver, muscles or bones. [1]

Does diet cause hypocholesterolemia?

Severe malnutrition can. For most people, though, the cause is a medical condition or a genetic problem rather than ordinary dietary choices.

How is hypocholesterolemia diagnosed?

With a simple blood test that measures cholesterol, called a lipid panel. A different blood test can show whether a genetic disorder is the cause. [1]

Can infections cause my cholesterol to drop?

Yes. Sepsis, HIV and other infections can lower cholesterol, and low cholesterol can be a sign of a serious infection or illness. [1]

What are the risks of untreated hypocholesterolemia?

It may lead to mild liver dysfunction or fatty liver disease, and to problems with the eyes, brain, liver, muscles or bones caused by low levels of vitamins A, D, E and K. [1]

Is there a cure for genetic low cholesterol?

There is no cure for the genetic changes themselves, but the condition can be managed with a tailored diet, vitamin supplements and regular follow-up. Early treatment gives the best outlook in the severe forms. [4]

Should I take supplements if my cholesterol is low?

Only take high-dose vitamins under the supervision of a healthcare provider after your vitamin levels have been tested. Fat-soluble vitamins can build up in the body if you take too much.

Does hyperthyroidism affect cholesterol?

Yes. An overactive thyroid speeds up how quickly the body clears cholesterol and can lead to low levels. Hyperthyroidism is a recognized non-genetic cause of hypocholesterolemia. [1]

What is the normal range for total cholesterol?

A healthy total cholesterol level is generally below 200 mg/dL, and a healthy LDL is below 100 mg/dL. [1]

Is hypocholesterolemia common?

By definition, it means your cholesterol is lower than that of more than 9 out of 10 people. [1] The inherited forms are rare, and most cases are caused by another illness. [1]

Can alcohol affect my cholesterol levels?

Yes. Alcohol use disorder is one of the non-genetic causes of abnormally low cholesterol. [1]

Why does the liver matter for cholesterol?

The liver makes and processes much of the body's cholesterol, so liver disease can disrupt cholesterol levels.

Can low cholesterol cause fatty liver?

It can. Hypocholesterolemia may lead to mild liver dysfunction or fatty liver disease [1], and in some genetic forms the body cannot move fat out of the liver properly.

What is LDL?

LDL stands for low-density lipoprotein, often called “bad” cholesterol because high levels contribute to plaque buildup and heart disease.

What LDL level is seen in hypocholesterolemia?

LDL is typically below 50 mg/dL, and total cholesterol is below 116 mg/dL. [1]

Are there medications to raise cholesterol?

There are no standard medicines used to raise cholesterol. Researchers are studying corticosteroids for this purpose, mainly in critical illness.

How often should I have my cholesterol checked?

Your healthcare provider will decide based on your overall health. If your level is very low, you will usually need regular follow-up tests and physical exams.

Does low cholesterol affect brain health?

Low cholesterol itself usually does not, but the low vitamin levels that can come with it may cause problems with the brain, nerves and eyes.

Can children have hypocholesterolemia?

Yes. Children can inherit genetic forms, which may affect growth and development, so providers track height and weight against growth charts. [1]

Is hypocholesterolemia the same as being healthy?

Not always. It lowers the risk of artery plaque, but it can also be a marker of a severe underlying illness or malnutrition.

What is Smith-Lemli-Opitz syndrome?

It is a rare genetic developmental disorder that affects the body's ability to make cholesterol.

Can kidney failure cause low cholesterol?

Yes. Kidney failure is one of the recognized medical causes of hypocholesterolemia. [1]

What is a dietitian's role in treatment?

A dietitian helps make sure you get the fats, essential fatty acids and fat-soluble vitamins you need, and can tailor your diet to the cause of your low cholesterol.

Can cholesterol levels tell me about sepsis?

Low cholesterol on admission to intensive care is linked to a higher risk of death in sepsis and critical illness (Taylor et al., EBioMedicine, 2024) [2]. It is a marker of how sick someone is, not a test for diagnosing sepsis.

Does low cholesterol affect bone density?

It can indirectly. Low cholesterol may come with low vitamin D, which is needed for bone health, so a bone density scan may be used to check for related problems.

Are there specific foods to eat?

There is no single food list. A dietitian can tailor your intake of essential fatty acids and fat-soluble vitamins to the cause, and some genetic forms need a low-fat diet.

Can Crohn's disease cause low cholesterol?

Yes. Crohn's disease and other conditions that cause poor nutrient absorption in the gut can lower cholesterol. [1]

Is hypocholesterolemia a lifelong condition?

If it is genetic, yes. If it is caused by an infection or another treatable condition, it may improve once that problem is treated.

What is abetalipoproteinemia?

It is a rare inherited disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food.

Does hypocholesterolemia cause muscle pain?

Muscle pain is not a typical symptom. Poor muscle control can occur in some genetic forms, especially when vitamin levels are very low.

Can I prevent hypocholesterolemia?

You cannot prevent genetic forms. Managing chronic health conditions and eating a nutritious diet can help prevent acquired forms.

Can I have low cholesterol and still be overweight?

Yes. Cholesterol levels reflect the fats in your blood, not your body weight.

What is Addison's disease?

It is a condition, also called adrenal insufficiency, in which the adrenal glands do not make enough of certain hormones. It is one of the causes of low cholesterol. [1]

Can low cholesterol affect pregnancy?

Any severe nutritional or metabolic problem should be monitored by an obstetric provider during pregnancy, so tell your provider if you have very low cholesterol.

Can exercise lower cholesterol too much?

No. Regular exercise is healthy and does not cause hypocholesterolemia.

Is there a specific age when it appears?

Genetic forms appear in childhood, while acquired forms can occur at any age depending on the cause.

What is a lipid panel?

It is a blood test that measures total cholesterol, LDL, HDL and triglycerides.

Can I live a normal life with hypocholesterolemia?

Most people can, especially with good management of nutrition and of any underlying condition.

What is “good” cholesterol?

HDL (high-density lipoprotein) is called “good” cholesterol because it helps carry cholesterol away from the bloodstream.

Does hypocholesterolemia affect HDL?

It is defined by low total cholesterol and low LDL, but HDL can also be low, for example in people who are critically ill.

What are essential fatty acids?

They are fats the body cannot make on its own and must get from food, such as omega-3 and omega-6 fatty acids.

Can cancer cause low cholesterol?

Yes. Cancer is one of the non-genetic causes of hypocholesterolemia. [1]

What is steatorrhea?

It is the passing of abnormal amounts of fat in the stool because the intestine does not absorb fat properly. It can be a sign of malabsorption.

Can cholesterol-lowering medicines cause very low LDL?

Strong lipid-lowering drugs can lower LDL to very low levels on purpose. A meta-analysis of 10 trials found no excess of serious side effects when LDL was driven below 40 mg/dL (Patti et al., 2023) [3]. Ask your doctor if you are worried about your results.

Can steroids raise cholesterol?

Researchers are studying corticosteroids as a way to raise cholesterol during critical illness. [5] They should only be used under a doctor's supervision.

Why do doctors look for another illness when cholesterol is low?

Because low cholesterol is often a sign of another problem, such as an infection, liver disease, an overactive thyroid or malabsorption, finding and treating the cause is a key part of care.

What should I do if my lab results show low cholesterol?

Discuss the results with your healthcare provider to decide whether further tests are needed to find an underlying cause.

Are there support groups for genetic cholesterol disorders?

Yes. Organizations for rare genetic disorders often offer resources and support for families dealing with inherited lipid conditions.

References

1. Cleveland Clinic. Hypocholesterolemia (Low Cholesterol): Causes and Treatment. Cleveland Clinic. Last updated January 27, 2026. https://my.clevelandclinic.org/health/diseases/hypocholesterolemia-low-cholesterol

2. Taylor R, Zhang C, George D, et al. Low circulatory levels of total cholesterol, HDL-C and LDL-C are associated with death of patients with sepsis and critical illness: systematic review, meta-analysis, and perspective of observational studies. EBioMedicine. 2024;100:104981. PMID 38290288. https://doi.org/10.1016/j.ebiom.2024.104981

3. Patti G, Spinoni EG, Grisafi L, Mehran R, Mennuni M. Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials. Eur Heart J Cardiovasc Pharmacother. 2023;9(2):138-147. PMID 36102667. https://doi.org/10.1093/ehjcvp/pvac049

4. Gill PK, Hegele RA. Low cholesterol states: clinical implications and management. Expert Rev Endocrinol Metab. 2023;18(3):241-253. PMID 37089071. https://doi.org/10.1080/17446651.2023.2204932

5. De Bruyn L, Téblick A, Van Oudenhove T, et al. Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function. Crit Care. 2024;28(1):295. PMID 39238038. https://doi.org/10.1186/s13054-024-05079-8

Disclaimer

This article is for informational purposes only and does not constitute medical advice. If you have a lab result showing very low cholesterol, talk to a qualified healthcare professional.