Medical Forum / General / General / March 2007
Is it possible for cholesterol to be too low?
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Emily - 14 Mar 2007 02:54 GMT I am weird. I have VERY LOW CHOLESTEROL. My total cholesterol, as well as my LDL are too low to be measured. My HDL is admittedly too low at 34, but well, since all else is so low, no one is too concerned, and they say there isn't much to be done about it anyways..., my triglycerides are 45. I am 30 yrs old (will be 31 Sunday). I learned this about my cholesterol (it was low at my last physical, but still measurable, total at 100, LDL and HDL in the forties, and triglycerides at 75) when I went to get possibly diagnosed with diabetes. I have since become an official diabetic, but we are still trying to figure out if I'm T1 or T2. (weirdness going on there too--nothing makes sense.) Also, in the process of all of this, it was discovered that my WBC was 37,800 one day!! My PCP was sure this was a machine error, ran it again, still very high. She sent me to the hospital lab for a redraw and test on THEIR machines, still in the 30,000 range. So, I am being followed by a hematologist for this. Smear looked good--nothing out of the ordinary, no high concentration of one type of WBC, no abnormal looking cells etc. Of course, that day my WBC was down to 12,000--much better but not normal. I've had several CBC's since, and they have been 16,000 (with slightly low platelets), 22,000 (all else normal I think)--after an allergic reaction to glyburide, and 18,000 all else normal. I have one last chance to "pass" my CBC tomorrow, and then if my WBC is still high, I get a bone marrow biopsy on Thursday to rule out anything nefarious.
Well, I was of course concerned about the high BG readings, and the High WBC readings, and all the docs said my cholesterol was GREAT, and such. Well, I did some research into low cholesterol, and found that it may not be so good to be TOO low. I asked my endo about it, and she said she'd never heard anything like that, but she'd also NEVER seen any one with a total cholesterol under a hundred before, even on statins etc. So, I'm definitely an anomaly. I also found that low cholesterol can be linked with some cancers. I did have a totally normal abdominal cat scan (thanks to the high white cells, and some of the VERY weird ways my glyburide reaction manifested itself. Sever abdominal pain seemed to be a far worse symptom for me than the facial swelling that eventually closed one of my eyes. At least they gave me both benadryl and phenergan for the stomach pain, and I stopped taking the glyburide as I wasn't eating and everything got better. That's when I made the connection. Plus, once the tummy settled, the residual face swelling made several people comment that it looked like I was reacting to something. I then realized, of course, the Glyburide. We won't be doing that med again. No problems of that sort since stopping it.
So, does anyone know if it is indeed possible for cholesterol to be too low? I did find a few studies that showed septic people who got VERY low cholesterol were more likely to die. (the sepsis somehow triggered the low cholesterol?) I have survived septic shock twice in my life now. The first time, the surgery done to release the infection didn't find anything to drain--just a huge mass of cellulitis--and I was basically carted back to the ICU to wait until I died. (I was four, this was secondary to the chicken pox). I didn't die, amazingly. The second time, I turned septic on the 14th day of a two week I.V. antibiotic regimen for an infected hand. I had a resistant bacteria. My hand surgeon had NEVER had a patient in the ICU before--he said hand infections just don't usually get that bad. The ID though maybe I had necrotizing fasciitis. However, the surgery was minimal--just a tiny pocket of pus to drain, but I did nearly die that day (WBC up at 40,000, blood not clotting etc. BP only up to 70/30 despite many liters of saline, I was being forced to retain, and BP raising meds etc.). Surgeon can't believe that the small amount of puss drained really helped much, but I did get almost instantly better after surgery. And, resistance studies of the bacteria in my blood (which did eventually grow out of my hand, and never out of my PICC line), didn't come back until AFTER Surgery, so I wasn't started on Bactrim until after that--the only antibiotic that would kill the resistant bug! So, I don't know if both my sepsis incidents permanently lowered my cholesterol (I doubt it), or if I was lucky to survive, and possibly had low cholesterol then (I know I was lucky to survive both times. Actually, there is a debate amongst doctors whether I have a good or bad immune system. See, someone with a good immune system doesn't generally turn septic at the drop of a hat. However, someone with a bad immune system doesn't generally survive sepsis. Most people with good immune systems dont'...).
Um yeah, so, should I worry about too low cholesterol, or just worry about all the other weirdness going on right now? Could it at all be related?
Emily
Carol - 14 Mar 2007 15:31 GMT I am not a doctor and this is from personal experience and some minor Internet research.
>VERY weird ways my >glyburide reaction manifested itself. Sever abdominal pain seemed to be >a far worse symptom for me than the facial swelling that eventually >closed one of my eyes. Your symptoms are listed as possible side effects of glyburide use. Not to say it wasn't an allergy, but it may not have been.
<...>
>(with slightly low platelets), 22,000 When my mother was ill, her platelet count was 40,000, which they called "quite low" but not low enough to warrant infusion. Doctors informed us normal is 240,000 [my research indicates 150-400,000]. At that level + ~1200mg/day of ibuprofen use for arthritis, she was getting hematomas under the skin anywhere she scratched an itch. Beware of any medications that "thin" the blood or claim to be "good for the heart" since they'll be operating almost 100% by reducing the availability of whatever platelets you've got.
===== As far as your general health...
Have you ever been tested for celiac disease? http://www.ask.com/web?q=celiac+disease&qsrc=0&o=0&l=dir These may be helpful for your doctor: http://www.aafp.org/afp/980301ap/pruessn.html http://cpmcnet.columbia.edu/dept/gi/celiac.html
It's also possible to be gluten intolerant without the genetic marker for what is usually called "sprue", and without confirmation of wheat allergy, despite what my mother's GP believes. Either may produce no outward symptoms, but decreased nutrient absorption as more and more damage is done to the small intestine will become evident. This disease could cause low cholesterol due to malabsorption of fats, and general malnutrition due to malabsorption of everything. Also your history of high antibiotic intake has probably resulted in disrupted intestinal flora, leaving you open to anything from parasites to increased intestinal permeability (aka "Leaky Gut Syndrome") - another possible cause (or result, ironically enough) of gluten intolerance, and a possible cause of your high WBC. Most GI specialists seem to know about this, while many GPs don't, in my experience.
Blood tests should be done before stopping wheat - once you have succeeded in stopping all gluten intake, the tests will be negative, and this isn't a dietary step you want to go through unwarranted, believe me. If you are found to be gluten intolerant, feel free to email me. I can save you a few hundred hours of research and trial-and-error.
Carol
Emily - 14 Mar 2007 16:23 GMT > I am not a doctor and this is from personal experience and some minor > Internet research. [quoted text clipped - 6 lines] > Your symptoms are listed as possible side effects of glyburide use. > Not to say it wasn't an allergy, but it may not have been. Interesting. None of the docs (My GP, the E.R. doc, the ENDO had EVER heard of glyburide causing stomach pain,and the pharmacist said there weren't any major side effects, I just might burn more in the summer sun. They decided the stomach pain must all be related as it stopped once I discontinued the glyburide....but were indeed puzzled by it. Of course, I'm always one to get the weird side effects that like only 1% or less of the population gets....
> <...> >> (with slightly low platelets), 22,000 [quoted text clipped - 7 lines] > for the heart" since they'll be operating almost 100% by reducing the > availability of whatever platelets you've got. I don't know the platelet value. The slightly low was only once, they normalized after. They were 300,000 today. the 22,000 was the WBC. Not on advil right now. Do take it for joint pain and such, but haven't had any since the tummy troubles. Though, likely the tummy is fine now....
> ===== > As far as your general health... [quoted text clipped - 27 lines] > > Carol Thanks for the info on celiac disease. I've heard a lot about it, and I do know that many type 1 diabetics also have celiac disease. (I'm still waiting test results to find out if I'm type one or two...). I've not been tested, would never have thought I'd had it, don't SEEM to be bohtered by gluten, but then I suppose one never really knows, does one? Not without the tests. I suppose I don't entirely want to be tested, since I DON'T want to go gluten free, what a pain, but of course, if it will help me feel better, it's probably a good idea. I might mention it. I would think my endo would know about it, since it is often seen with diabetes. Plus, she could refer me to a gastro if needed. I dunno. I do know that ultra low cholesterol can be caused by fat malabsorbtion, and can also lead to deficiencies in fat soluble vitamins. So perhaps there is something going on there. I've not been on any antibiotics recently, so I'm not sure if they are still playing a role in me. I'm sure some of the gut flora killed off by them ages ago has had a chance to come back. Dunno though. I did have a ten day course of them in Jan for a UTI (that discovered the diabetes), but haven't been on any since, and I think my last course (a z-pack for some nasty asthmatic bronchitis that WOULDN'T go away--had a few courses of antibiotics over several months then) was about a year ago. Anyways, thanks for the reply, and the info. If I do get tested for celiac, and I'm positive, I'll definitely look you up again and take you up on your offer of wisdom. I'm sure I'll still have some trial and error, but any head start I can get will be helpful.
Emily
Carol - 14 Mar 2007 21:43 GMT >> I am not a doctor and this is from personal experience and some minor >> Internet research. [quoted text clipped - 14 lines] >course, I'm always one to get the weird side effects that like only 1% >or less of the population gets.... http://www.glyburide.com/glyburide_sideeffects/ (and others, but not NIH)
Bloating & heartburn on the "may happen" list, stomach pain on the "see your doctor if it continues" list. I see also "unusual bleeding or bruising" on the "see your doctor immediately" list - was this when you had the platelet dip? Scary product.
> the 22,000 was the WBC [not platelets]
I'm glad I misread then.
>I suppose I don't entirely want to be tested, >since I DON'T want to go gluten free, what a pain, but of course, if it >will help me feel better, it's probably a good idea. Some of the fringe doctors now are saying all grains are bad, or at least, that the food pyramid is upside down. Many agree that sugar and things that immediately break down into sugar (what my grandmother used to call 'starches') at the level most of us eat them is tantamount to poison. I'm not prepared to cut out all grains, but those that are so refined that they need nutrients put back in are definitely receiving my long hard stare at the moment, and these are mostly wheat flours in commercially prepared baked goods of all kinds. Actually, since I've been shunning transfats otherwise, these things are starting to taste pretty rotten anyway.
>I might mention it. >I would think my endo would know about it, since it is often seen with >diabetes. She might not think of it if you don't have diahrrea or other obvious intestinal upset, but up to 40% don't have any symptoms.
>Plus, she could refer me to a gastro if needed. I dunno. I do >know that ultra low cholesterol can be caused by fat malabsorbtion, I read that's the huge majority of the cause of it, and there's only one place that could happen, right? Where food is absorbed - the small intestine. Also if your body is parsing your food as an alien invader, that could maybe account for the WBC? You can't live without fat - get tested.
Carol
Emily - 14 Mar 2007 23:57 GMT > On Wed, 14 Mar 2007 15:23:35 GMT, n <XrUJh.16702$PF.2426@attbi_s21> <snip>
> http://www.glyburide.com/glyburide_sideeffects/ > (and others, but not NIH) [quoted text clipped - 3 lines] > or bruising" on the "see your doctor immediately" list - was this when > you had the platelet dip? Scary product. Interesting. I asked my reg pharm about glyb and heartburn, said possible, not likely. Of course, all side effects have to be listed, and all med profiles look scary. Heart burn is on a may happen list, not a likely to happen list, so that means many people don't get side effects from glyb. The call your doc right away side effects are likely those of allergic reactions--the swelling rash etc. The heartburn may not have been related to the allergic reaction, but I'm sure there was one since the face swelled so, and a funny (but not itchy) rash/redness that appeared is now gone. (I didn't notice it at the time, didn't really look at my chest, hematologist noticed it later, and said it looked like it was going away, it was and did).
>> the 22,000 was the WBC > [not platelets] > > I'm glad I misread then. Yah, not a good number for WBC's but an even worse one for platelets. No, the slight dip in platelets was not after the glyb, well maybe my very first dose, but less than an hour after that... it wasn't a huge dip I don't think, but since they were 300,000 today, they are good. WBC's were down to 15.3, but were more skewed I think than before. almost all neutrophils. I don't now yet if I escaped a bone marrow biopsy. I have an appointment with the doc tomorrow, and she'll do one if she wants, otherwise, she may let me get by with just having another CBC in a bit.. Dunno...
>> I suppose I don't entirely want to be tested, >> since I DON'T want to go gluten free, what a pain, but of course, if it [quoted text clipped - 17 lines] > She might not think of it if you don't have diahrrea or other obvious > intestinal upset, but up to 40% don't have any symptoms. Oh, I'm not expecting her to think of it. I'm expecting to mention it, and then she will know about what I am talking. Like, Hey, low cholesterol could indicate I'm not absorbing fat, what do you think of celliac disease as a possibility? Could we just have the blood test for it and see if that shows anything?
>> Plus, she could refer me to a gastro if needed. I dunno. I do >> know that ultra low cholesterol can be caused by fat malabsorbtion, [quoted text clipped - 6 lines] > > Carol I'm eating tons of fat, so I'm not living without it, LOL. O.k., my body doesn' have much.... Yeah, getting tested is smart. A simple blood test can show if we need to look further, right? Oh, and the whole carb thing is kinda par for the course for diabetics. Well, sorta. Of course, we don't have to be worry about the gluten in the carbs per se, but well, we are always thinking carbs and such. Of course, I'm still just figuring the diabetes out, and am not doing so well with it. My test results to see if I'm T1 or T2 aren't all in yet, so I'm on NO MEDS and my Blood sugars are now rising. I broke 500 once, and am now never below 200. I am often in the 300 or 400 range. Not so great... Hopefully, I'll get test results tomorrow, and then I can get on something. Definitely not something like glyburide though. It did a number on me, and I don't want to mess with anything in that class again--especially since it's a sulfa drug... and well, the face swelling and rash were kinda indicative of an allergic reaction to SOMETHING. The only new thing being the glyb. The heartburn may have just been all glyb and not allergies, but the swelling and rash, more so. Ah well.
Again, thanks for the reply. I'll ask the endo about celliac, and get a blood test next time I see her. I do have gastro issues. But, they come and go, and can often be attributed to my thyroid levels, so of course it gets complicated. I have so much going on, that it's hard to know what is it's own symptom, or what is exacerbated or caused by something else. And, all these illnesses (graves, other autoimmune stuff if I'm T1 and not T2, celliac etc.) all can go together.... sigh.
Emily
Robert1 - 16 Mar 2007 07:26 GMT > I am weird. I have VERY LOW CHOLESTEROL. My total cholesterol, as well > as my LDL are too low to be measured. My HDL is admittedly too low at [quoted text clipped - 74 lines] > > Emily Graves disease or hyperthyroidism is associated with low cholesterol levels. Actually you don't have low cholesterol levels as low is in the 50 mg/dl range. Diabetes usually is associated with abnormal high lipids but it seems your levels are being neutralized by your hyperthyroidism if present. Liver disease can also decrease the cholesterol level as well as yield to high glucose levels. I am hope they did liver enzyme testing, hepatitis testing if applicable.
When you say almost all neutrophils on the smear, I would guess you are saying mature segmented neutrophils and not bands or immature forms? I would imagine no toxic changes in the neutrophils also indicating a probable compartmental shift of neutrophils. Catecholamines or stress can do this. They can also elevate your glucose levels. Primary hematopoietic disease would generally result in a constant white cell level and go up with time and not down with time.
You need to get your endocrine system in line first before looking seriously at the lipid panel. It is not valid to do until then from a diagnostic point of view. Once the diabetes and graves is controlled then serious control of lipids can be achieved.
Emily - 17 Mar 2007 02:38 GMT > Graves disease or hyperthyroidism is associated with low cholesterol > levels. Actually you don't have low cholesterol levels as low is in [quoted text clipped - 4 lines] > to high glucose levels. I am hope they did liver enzyme testing, > hepatitis testing if applicable. Thanks for the reply. Actually, my thyroid has been ablated, and the graves is now under control (mostly). At the time of the lipid test, my thyroid tested low, so they upped my levoxyl dose. Since doing that, my BG's are now THROUGH The roof, more or less. They've been consistantly rising (they do come down, but now not below 200 much if ever). I was just put on insulin as a temp fix today, and I see my GOOD endo on Tuesday to try and figure out what is going on. My theory is my BG's were low (not normal, and still too high, but in a safer range--150-250ish most of the time rather than not under 200, often over 300 and spikes into the 400s and above 500 once) when the thyroid was low, and now that it is higher, they are getting higher. Dunno. Everyone is puzzled by me as I obviously don't have metabolic syndrome, and I have no family history of diabets (T1 or T2) etc. They were sure I would be a Type one (possibly LADA) but my c-peptide was in the normal range (i.e. I'm producing insulin, about what a normal person would,not tons like someone very IR, and not little to none like someone who is rapidly losing beta cells), and I didn't have any GAD antibodies. So, I was going to be called T2 and started on oral meds, but then my thyroid doc decided that my BG's were just getting too high, and the trend was going increasingly up, so he wanted me on some insulin to get them down right away, and then we'll go from there.
(they are also puzzled by the fact that my A1C was only 5.3, kept asking about anemia, but I said no that isn't a possibility--RBC count is always normal, it's just the white cells that are funky... had 10+cbc's in the past month or so....Of course, when I first started testing BG in early Feb. I would sometimes be hypo (not seriously) and sometimes be above around 170-220 much of the day, it's definitely been going WAY up since then... and I know my A1C will be MUCH higher next time....sigh.)
> When you say almost all neutrophils on the smear, I would guess you > are saying mature segmented neutrophils and not bands or immature [quoted text clipped - 4 lines] > Primary hematopoietic disease would generally result in a constant > white cell level and go up with time and not down with time. Yup, all the neutrophils looked normal on the smear not tons of immature ones or anything, and everything has always checked out well in my CBC's etc. other than the persistantly high white cells. I finally had a bone marrow biopsy yesterday--started developing night sweats on Monday, and they've happened every night since--throwing off blankets P.J's and everything, and being drenched in sweat... maybe we over shot the thyroid, even though it was just an increase from 125ug to 150ug a day of levoxyl... (yeah, my T3 and T4 went from off the charts high to off the charts low after ablation, opposite of course for TSH--last test done was both a TSH and T4 test that showed low...). The hematologist is expecting the biopsy to be normal, and then she can close that chapter in my medical file and I can work on the diabetes. And fine tuning the thyroid as needed. The hematologist ran a liver panel, the values were slightly elevated, but not hugely, and she presumed it was to do with the new/uncontrolled diabetes. Kidney stuff was also slightly elevated, but not too badly.
> You need to get your endocrine system in line first before looking > seriously at the lipid panel. It is not valid to do until then from a > diagnostic point of view. Once the diabetes and graves is controlled > then serious control of lipids can be achieved. Well, the plan is that we can stop worrying about the white cells once the biopsy results are in, and then I can deal with the diabetes, or whatever is going on with my endocrine system. While the doc who could see me earliest at the endo clinic is ready to just call me a type 2 and put me on oral meds, my thyroid doc (who also does diabetes, and is one of the really good docs there) is not so convinced. I'm back to being just labeled as hyperglycemic (as opposed to diabetic, despite a 190 FBG prior to the OGTT and a 375 two hour BG...), until he can make more sense out of what is going on to me. I do think the low/now high or normal (hopefully) thyroid function is playing some role, but I certainly can't imagine such a small change in thyroid function would cause such a huge change in BG's, though I could see it keeping me slightly below 200's and then bumping me up to not ever below 200, but not much over 300 either. The fact that now I regularly get into 400 territory is not good, and doesn't make sense. There are no signs of infection anywhere, other than of course the WBC, but no other symptoms or anything... SIGH.
At anyrate, thanks for the info, and yeah, once all else is figured out, then I can see if my cholesterol is still too low, and if I need to find out why. I just remember reading that anyone with a total cholesterol under 160 had a higher rate of mortality, from all sorts of causes. I also read a link with low cholesterol and depression. Well, i have battled depression for a LONG time, and while relatively stable now, it does kind of fit with the low cholesterol thing. (I think the low cholesterol contributed to the depression by not allowing proper use of seretonin and such, not that the depression caused low cholesterol, but that would make sense as to why the SSRI's (now I use an SNRI) work for me and I don't do well at any attempts to D/C them, despite being quite stable long term on them...)
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