Cholesterol Symptoms: High and Low Cholesterol Explained

Cholesterol Symptoms: How High and Low Levels Affect Your Health

Cholesterol is a lipid, or fat-like substance, that helps structure cell membranes and produce hormones. However, elevated or reduced levels of cholesterol can be harmful. High cholesterol is usually asymptomatic. Complications such as coronary artery disease or stroke develop over time due to plaque build‑up.

Did you know cholesterol can be both a friend and a foe? It plays a vital role in hormone and vitamin production, but maintaining the right balance between good cholesterol (HDL) and bad cholesterol (LDL) is critical.

An ideal HDL level is 60 mg/dL or higher, while the total cholesterol should remain under 200 mg/dL. Fluctuations in these levels lead to symptoms of either high or low cholesterol.

According to a study published in the Indian Journal of Community Medicine, approximately 31% of Indian adults aged 35–54 show high cholesterol symptoms, while around 72% of younger individuals (mostly aged 19 or younger) exhibit low cholesterol levels.

What are the symptoms of high cholesterol?

High cholesterol occurs when excess fatty substances accumulate in the blood. A total cholesterol 200–239 mg/dL is borderline high; ≥240 mg/dL is high. LDL‑C and non‑HDL‑C are the main treatment targets.

High cholesterol symptoms are often silent, becoming evident only when serious complications arise.

High cholesterol itself causes no direct symptoms. Complications (e.g., angina, xanthomas in severe cases) may appear after years of vascular damage, which include:

• High blood pressure (130/80 mm Hg or above)
• Angina or chest pain
• Diabetes (blood sugar of 200 mg/dL or more)
• Skin lesions like papules and plaques
• Persistent fatigue and weakness

Whereas these are considered common high cholesterol symptoms, men and women sometimes experience some unique symptoms. Females have a higher amount of good (HDL) cholesterol compared to males. The oestrogen hormone in the female body plays a crucial role in boosting the proportion of HDL cholesterol.

What are the Effects of High Cholesterol Symptoms?

Untreated high cholesterol increases the risk of serious health complications, including:

• Heart Attack : Plaque build-up in the coronary arteries reduces blood flow, potentially leading to angina and heart attacks.
• Ischaemic Stroke : When plaques rupture and form clots in the arteries leading to the brain, the resulting blockage can cause an ischaemic stroke.
• Peripheral Artery Disease (PAD) : Fatty deposits in limb arteries can lead to numbness, cramps, and pain. In severe cases, PAD can cause tissue damage or amputation.
• Atherosclerosis : This is a condition where the arteries become narrowed and hardened due to plaque accumulation, directly linked to high cholesterol.

What are the symptoms of low cholesterol?

Low cholesterol is often overlooked but can be equally dangerous, as low HDL levels are particularly concerning. It is generally diagnosed when:

• LDL is at 50 mg/dl or lower.
• Total cholesterol is 120 mg/dL or lower.

Some major symptoms of low cholesterol include:

• Nervousness
• Agitation
• Confusion
• Mood disorders

What are the types of cholesterol and their determining factors?

Cholesterol is primarily classified into two types, which combine to form the total cholesterol count:

• HDL (High-Density Lipoprotein):Usually known as "good" cholesterol. The ideal level in this case is 60 mg/dL or higher.
• LDL (Low-Density Lipoprotein):Generally referred to as "bad" cholesterol. Its ideal level is below 100 mg/dL.

Maintaining a healthy HDL-to-LDL ratio is crucial to preventing cardiovascular and neurological issues.

What are the Effects of Low Cholesterol Symptoms?

Lower LDL reduces cardiovascular risk. Low HDL is a risk marker, not a direct cause of heart disease. However, an extremely low total cholesterol level has the following effects:

• Depression and Anxiety : Low levels of total cholesterol (120 mg/dl and lower) often cause mood disorders that could lead a person to become impulsive, aggressive and violent. 
  When cholesterol maintains membrane stability, it influences the serotonergic function. A lower level of cholesterol hampers serotonergic functions and causes impulsivity and violence.
• Haemorrhagic Stroke : Haemorrhagic stroke is mostly associated with a lower level of LDL, that is, 50 mg/dl and lower (low-density lipoprotein cholesterol). Low cholesterol levels increase the fragility of endothelial cells and slow the repair of small intracerebral haemorrhages. This leads to bleeding in the brain.
• Preterm Birth in Pregnant Women : A lower level of total cholesterol, particularly low maternal serum cholesterol at the time of early pregnancy, is linked with preterm birth.
• Causes Certain Types of Cancer : Lung cancer, breast cancer, haematological cancer and cancer in the nervous system are some of the types of cancer that might occur if a patient has low HDL cholesterol (40 mg/dl for men, 50 mg/dl for women).
• Peripheral Polyneuropathy : This condition is normal for patients with diabetes. Moreover, several studies have found that there is an association between peripheral polyneuropathy and low levels of HDL. 
  Now that we have an understanding of the symptoms and effects of high and low cholesterol levels, let us look at the causes, diagnosis and prevention.

What are the causes of low cholesterol levels?

The common causes of low cholesterol levels are:

• Insulin Resistance: Usually, insulin resistance occurs when the HOMA IR test result is higher than 1.0.
• Smoking: Regular smoking alters lipid metabolism, often lowering HDL.
• Abdominal Fat: People with a waist circumference of 35 inches or more have a higher level of abdominal fat that contributes to increasing cholesterol levels.

Moreover, low HDL levels could occur due to some rare conditions, such as APOA1 deficiency, familial combined hyperlipidaemia (FCH) and Tangier disease.

What is the cause of high cholesterol?

The most common contributors to high cholesterol are lifestyle choices. Following are a few details:

• Unhealthy diets rich in trans fats and processed foods.
• Physical Inactivity
• Tobacco Use and Alcohol Consumption
• Some medical conditions also lead to high cholesterol, such as chronic kidney disease, hypothyroidism, polycystic ovary syndrome, and diabetes.

How are Cholesterol Symptoms Diagnosed?

Some of the most common cholesterol symptom diagnoses involve:

• Medical and Family History: Includes assessment of physical activity and dietary habits.
• Lipid Profile Test: Measures total cholesterol, HDL, LDL, and triglycerides.
• Additional Tests: May include Apolipoprotein B (ApoB), Lipoprotein(a), and plasma ceramides.

These tests help determine risk levels and tailor treatment accordingly.

How to Maintain Cholesterol Level?

Maintaining optimal lipid levels is essential to continue living a healthy life. Here is how to do it:

• Take statins(if prescribed): proven to lower LDL significantly.
• Eat a Balanced Diet: Include whole grains, pulses, fruits, healthy fats like mustard and groundnut oil, and nuts such as almonds and walnuts.
• Quit Smoking and Limit Alcohol
• Exercise Regularly: Even brisk walking for 30 minutes daily helps.
• Reduce Saturated and Trans Fats: Avoid deep-fried snacks and processed foods common in urban Indian diets.

Final Words

Cholesterol abnormalities can affect anyone, young or old. While high cholesterol symptoms are prevalent among adults aged over 40, low cholesterol is becoming increasingly common among adolescents and young adults due to erratic food habits and metabolic issues.

Key contributing factors include genetics, sedentary lifestyle, obesity, and dietary imbalances. Regular monitoring, conscious lifestyle changes, and timely intervention can go a long way in ensuring good cardiovascular and overall health.