Cholesterol, Low 

What Is Low Cholesterol?

[dropcap]L[/dropcap]ow cholesterol found in blood indicates an abnormal blood level of this essential lipid (fat) that is characterized by decreased production of steroid hormones and bile.

Cholesterol is a soft, fat-like substance found in the bloodstream and is an essential structural component in all body cells. It is required for membrane fluidity and permeability of cells. Within the cell membrane, cholesterol also functions in intracellular transport, cell signaling and nerve conduction.

Cholesterol is required for these essential body processes:

1. Cholesterol is converted to bile by the liver and stored in the gallbladder until needed for digestion of fats in the small intestine.  
2. Cholesterol is used by the adrenal glands to produce the steroid hormones cortisol and aldosterone.
3. Cholesterol is used by the sex glands to make progesterone, estrogen, and testosterone and their derivatives.
4. Cholesterol is needed for the production of vitamin D.

Q: What makes cholesterol bad for you?

A: There are different forms of cholesterol that can be bad or good depending on the level. In blood vessels, low-density lipoprotein (LDL or ‘bad’) cholesterol can abnormally join with fats and other substances to build up in the inner walls of arteries. The arteries can become clogged and narrow, and blood flow is reduced. This is atherosclerosis which can lead to stroke, heart attack and thrombosis.

High-density lipoprotein (HDL or ‘good’) carries harmful cholesterol away from the arteries and helps protect from heart attack and stroke.¹

What Is Low Cholesterol In Celiac Disease and/or Gluten Sensitivity?

• A low cholesterol blood test result is a common feature of untreated celiac disease.
• In the reverse, it is suggested that celiac disease should be screened in children and adolescents with low cholesterol and mental disorders.²

Lower cholesterol concentration is a frequent finding in children with malabsorption and steatorrhea due to celiac disease. Moreover, low plasma cholesterol has also been found in celiac disease without signs of overt malabsorption, and cholesterol levels in the normal-to-high range have been shown to have a high predictive power to exclude celiac disease.

On the other hand, it is well known that low cholesterol maybe associated with mental disorders. In particular, a statistically significant association has been shown between low cholesterol and aggressive behaviors among non-African American children from a national sample of non-institutionalized, school-age children. Low cholesterol has also been associated with the onset of conduct disorder during childhood among male criminals.³

How Prevalent Is Low Cholesterol In Celiac Disease and/or Gluten Sensitivity?

• Low cholesterol is a common serology result in 17.9% of untreated celiac disease patients.⁴
• A study of 100 anemic celiac disease patients found that all patients had plasma cholesterol less than 156mg/100ml.⁵
• Cavallaro et al. found that patients with prolonged PT (prothrombin) had significant lower values of cholesterol.⁶

What Are The Symptoms Of Low Cholesterol?

• Low cholesterol in celiac disease is marked by impaired hormone production with inadequate production of bile, adrenal hormones, sex hormones, and vitamin D.

How Does Low Cholesterol In Celiac Disease and/or Gluten Sensitivity Develop?

Low cholesterol and low-density cholesterol levels in celiac disease result from these mechanisms:

• Low cholesterol absorption.
• Enhanced cholesterol synthesis.
• Diminished production resulting from liver impairment.
• High removal and transport rate of LDL apo B.⁷

Does Low Cholesterol Respond To Gluten-Free Diet?

Yes. Gluten free diet enhances HDL (good) cholesterol levels without change in LDL levels.⁸,⁹

6 Steps To Improve Low Cholesterol In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both low cholesterol and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹⁰
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹¹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹¹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹¹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹¹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹¹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain medications deplete cholesterol that can cause abnormally low serum cholesterol. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

LAXATIVES

•  Psyllium powder (Metamucil® and others) binds cholesterol in the gut.

CHOLESTEROL DRUGS

• Lipitor®, Crestor®, Zocor®, and others interfere with the production of Cholesterol.
• Colestid® and Questran® bind Cholesterol in the gut.

WEIGHT LOSS DRUGS THAT BIND FAT ALSO BIND CHOLESTEROL 

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Low Cholesterol In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Change in lipid profile in celiac disease: beneficial effect of gluten-free diet.” This study investigating the effect of a gluten-free diet on the lipid profile in patients with celiac disease found that diagnosis of celiac disease and its treatment with a gluten-free diet resulted in improvement in the lipoprotein profile, which included an increase in HDL and a decrease in the LDL/HDL ratio. Researchers identified 132 patients with celiac disease who adhered to a gluten-free diet and had lipid profiles performed before and after a median of 20.5 months on the diet. The patients lacked diseases that may affect serum lipids.

There were significant increases in total cholesterol and high-density lipoprotein (HDL) cholesterol (P < .0001) but not low-density lipoprotein (LDL) cholesterol (P=.06). The LDL/HDL ratio decreased by 0.36+/-0.7 (P < .0001). Both men and women had a significant increase in total cholesterol and HDL and a significant decrease in the LDL/HDL ratio. Only men had increases in LDL (P=.02). The greatest increase in lipid values was seen in those with the lowest initial values. The largest increase in HDL was seen in subjects with more severe disease as indicated by low albumin level and presence of total villous atrophy.¹²

“Prevalence and clinical associations of prolonged prothrombin time in adult untreated coeliac disease.” This study investigating prolonged prothrombin time (PTT) in celiac adults demonstrated that patients with prolonged PT had significant lower values of cholesterol.⁶

“Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia.” This study defining the correlates of Celiac Disease in 100 anemic adults without overt malabsorption demonstrated that among patients with hypochromic anemia, plasma cholesterol in the high-to-normal range could be used to exclude the presence of Celiac Disease. Compared to anemic patients without Celiac Disease, anemic patients with Celiac Disease had significant or borderline significant differences for plasma cholesterol, albumin, and body mass index but not for blood hemoglobin, mean corpuscular volume, plasma iron, and ferritin. All anemic Celiac Disease patients had plasma cholesterol less than 156mg/100ml.⁴

“Metabolism of cholesterol and apolipoprotein B in celiac disease.” This study investigating the association of cholesterol malabsorption with cholesterol and lipoprotein metabolism by determining low-density lipoprotein (LDL) apolipoprotein (apo) B kinetics simultaneously with measurements of cholesterol absorption and synthesis before and during the gluten free diet, demonstrated that cholesterol absorption, cholesterol synthesis, hepatic B/E receptor activity, and LDL apo B transport rate are closely associated with each other and that their levels can change markedly with no detectable change in serum levels of LDL cholesterol or apo B.

The baseline condition was characterized by low cholesterol absorption, enhanced cholesterol synthesis, and high removal and transport rate of LDL apo B. The Gluten Free Diet markedly improved cholesterol absorption and decreased intestinal reflux of cholesterol, fecal neutral steroids, and cholesterol synthesis. Only plasma high-density lipoprotein (HDL) was enhanced by the gluten free diet proportionately to cholesterol absorption. The plasma LDL apo B level remained unchanged because of simultaneous decreases in the fractional catabolic rate (FCR) and transport of LDL apo B. As cholesterol absorption was improved by gluten free diet, the FCR and transport rate for LDL apo B was decreased, which reductions were closely related to the decrease in synthesis.⁷

Sources:

1. http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=hdlldl [↩]
2. Mascitelli L, Pezzetta F, Goldstein MR. Low Cholesterol and Mental Disorders in Children and Adolescents With Celiac Disease. Psychosomatics 50:300-301, May-June 2009. doi: 10.1176/appi.psy.50.3.300 [↩]
3. Mascitelli L, Pezzetta F, Goldstein MR. Low Cholesterol and Mental Disorders in Children and Adolescents With Celiac Disease. Psychosomatics 50:300-301, May-June 2009. doi: 10.1176/appi.psy.50.3.300 [↩]
4. Ciacci C, Cirillo M, Giorgetti G, et al. Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia. American Journal of Gastroenterology. Jul 1999;94(7):1888-91. [↩] [↩]
5. Ciacci C, Cirillo M, Giorgetti G, et al. Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia. American Journal of Gastroenterology. Jul 1999;94(7):1888-91. [↩]
6. Cavallaro R, Iovino P, Castiglione F, et al. Prevalence and clinical associations of prolonged prothrombin time in adult untreated coeliac disease. European Journal of Gastroenterology and Hepatology. Feb 2004;16(2):219-23. [↩] [↩]
7. Vuoristo M, Kesaniemi YA, Gylling H, Miettinen TA. Metabolism of cholesterol and apolipoprotein B in celiac disease. Metabolism: Clinical and Experimental. Nov 1993;42(11):1386-91 [↩] [↩]
8. Vuoristo M, Kesaniemi YA, Gylling H, Miettinen TA. Metabolism of cholesterol and apolipoprotein B in celiac disease. Metabolism: Clinical and Experimental. Nov 1993;42(11):1386-91. [↩]
9. Brar P, Kwon GY, Holleran S, Bai D, Tall AR, Ramakrishnan R, Green PH. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med. 2006 Sep;119(9):786-90. [↩]
10. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
12. Brar P, Kwon GY, Holleran S, Bai D, Tall AR, Ramakrishnan R, Green PH. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med. 2006 Sep;119(9):786-90. [↩]