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Commentary
High cholesterol may be associated with decreased production of critically important hormones.8,9 We believe that elevated cholesterol is a consequence of insufficient hormone production and serves as compensatory mechanism. Conversely, low cholesterol is responsible for poor production of steroid hormones. We believe that in studies in which cholesterol levels below 160 mg/dL were correlated with potentially dangerous outcomes and diseases—such as suicide, alcoholism, disorders of the lung and digestive system, cerebral hemorrhaging, stroke, and some cancers—patients had limited amounts of raw material (cholesterol) for hormonal production and reconstruction of cellular membranes.

After reviewing the medical literature on the link between hypocholesterolemia and various pathologies, we suspected that this patient’s problem was insufficient hormone production. Lack of cholesterol for steroidogenesis can be a causal factor for the multiple disorders mentioned previously. One study showed impaired reproductive efficiency in hypo-cholesterolemia induced animals.10 In this case report, we can hypothesize that hypocholesterolemia played a crucial role in the patient’s deficient production of steroid hormones, and that her multiple symptoms were related to those deficiencies. From our point of view, any program that does not restore “foundational chemicals” (such as steroid hormones) is doomed to failure. This is because metabolism will continue to be slow, intestinal absorption will be poor, the immune system will be defective, and the neurohormonal system will be imbalanced. This is why we always stress the importance and necessity of the first step of any program: restoration of optimal levels of steroid hormones.

Cholesterol is especially abundant in the nervous system and plays an important role in cellular structure and function. Changes in serum levels may affect neurotransmission in the central nervous system. Substantial evidence suggests that serum cholesterol levels may be associated with variations in mental state or personality.11 Imbalanced blood chemistry and lipid metabolism can usually influence depressive states. It is known that neurosteroids such as DHEA may antagonize cortisol activity and have mood-elevating effects of their own.12 A low DHEA level can be an indicator of diminished capacity to protect against stress.

Intensive pharmacological studies suggest that neurosteroids may be involved in learning and memory processes.13 Patients with fatigue may experience significant impairments in learning and memory,14 and can suffer from major depression, anxiety, and panic disorder.15 Treatment for chronic fatigue is usually symptom based and includes pharmacological and behavioral strategies.16 Our findings suggest that physiological and psychological factors work together. Restoring normal physiology is central to correcting disorders such as those described in this case report.

Obesity’s causes are poorly understood, and both the prevention and treatment of obesity are difficult.17 In this case, a weight-loss program was initiated only after a significant improvement in quality of life. It is known that:

• HCA may be helpful in weight loss because of its effects on metabolism.18

• CLA can reduce fat deposi- tion and increase lipolysis in adipocytes, possibly with enhanced fatty-acid oxidation in both muscle cells and adipocytes.19

Hypocholesterolemia is usually associated with reduced antioxidant reserves and absolute vitamin E levels.20 This is why our program incorporated antioxidants.

Exercise was also an important part of our program, as physical activity can enhance the synthesis and release of cholesterol in the liver.21 This is very important because an enhanced cholesterol level can be expected to increase hormonal production, thus reducing the amount of hormones to be replaced.

This case study describes a patient who had low level of steroid hormones related to low cholesterol, with multiple symptoms typical of hormonal deficiencies. Multimodal approaches using hormones, nutritional supplements, exercise, and lifestyle modifications can help control most problems related to low cholesterol. Hypocholesterolemia can be a potential warning sign of concurrent diseases or a signal of rapidly declining health.

Sergey A. Dzugan, MD, PhD, was formerly chief of cardiovascular surgery at the Donetsk Regional Medical Center in Donetsk, Ukraine. Dr. Dzugan’s current primary interests are anti-aging, biological therapy for cancer, cholesterol, and hormonal disorders.