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Medical Forum / General / General / March 2007

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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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