If mental health is defined as a state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life, then we need to take care of the garage in which this vehicle is kept. Measures of depression and anxiety assess things such as self-disparagement, pessimism, lack of drive, apprehension, inability to relax, and irritability, to name a few. Interestingly, these evaluations have demonstrated a relationship to low lipid and lipoprotein concentrations.
In work done at the end of the last century, an inverse association between mental challenges and total cholesterol and lipids was found. That means when one goes up, the other goes down. Testing young adult females, Duke University Medical Center discovered that women “…with low total cholesterol concentrations (<4.14 mmol/liter) relative to those with moderate to high cholesterol levels, were more likely to have higher scores on the NEO depression subscale…and anxiety subscale…” after adjustments were made for age, body mass index, oral contraceptive use and physical activity. (Suarez. 1999)
Before we got too involved, it pays to know that 4.14 mmol/liter is equal to a cholesterol level of 160 mg/dL, or just plain 160. Cholesterol is a steroid substance necessary to human life. It forms the cell membranes in all organs and tissues of the body, is essential to the production of the hormones we need for growth, development, and reproduction, and it makes the bile acids necessary for absorption of nutrients. Very little, if any, dietary cholesterol becomes serum cholesterol.
Back in the 1990’s it was noted that cholesterol levels below 160 were tied to excess mortality from all causes, primarily from a variety of cancers, respiratory and digestive diseases, and violent deaths from suicide and trauma. Reasons behind low cholesterol have been ascribed to genetics, resistance to dietary sources, acute infections, and alcohol use/abuse. (Meilahn. 1995) If suicide is tied to depression, then it may be a legitimate effect. Depression is twice as common among women as men, with about one in four suffering at some point in her lifetime. The greatest vulnerability appears during the childbearing years, the time when its diagnosis is often overlooked. The turbulence of hormones flooding a woman’s system at different times and in differing amounts can surely be a potent stressor.
Scientists in Barcelona, Spain, realized the connection of cholesterol to neuropsychiatric disease in a review of related literature that preceded their interest. They found a link to early death, suicide and aggression, and personality disorders and dementia. (Martinez-Carpio. 2009). It appears that the good intentions of reducing what was thought to be the cause of cardiac mortality opened a different can of worms. The Japanese explored the intrigue that was sparked when total mortality was not reduced despite reduction of mortality due to coronary heart disease, and found an increase in death rates due to suicide and accidents, many of which were tied to risky behaviors in persons with low cholesterol levels. (Kunugi. 2001) Does low cholesterol compromise judgment? The U. of California conducted trials in the early 90’s to determine the cause behind the rise in suicides in men older than fifty years, and found that depression was three times more prevalent in those whose cholesterol was lower than 160. Health status, number of chronic diseases, number of medications, and exercise seemed not to have had an adverse effect on depressive signs and symptoms. This led to the suggestion that the intentional lowering of cholesterol be more deliberate. (Morgan. 1993)
Cedars-Sinai Medical Center, in Los Angeles, reported that serotonin, a neurotransmitter that controls impulsive behaviors, is tied to cholesterol levels at the synapses. Low membrane cholesterol decreases the number of serotonin receptors, thereby reducing suppression of aggressive and destructive behaviors. (Engelberg. 1992) That magic number, 160, once again made headlines in the Netherlands, where epidemiologists discovered a higher prevalence of depression in males whose cholesterol was below that level. (Steegmans. 2000) Low cholesterol was cited as causative to rises in criminal violence in Sweden, following the association of reduced cholesterol values to low serotonin activity. (Golomb. 2000) Reduced levels of total cholesterol, LDL, and HDL resulted in minimized serotonin values in personality disordered cocaine users, as reported by addiction researchers in their journal. (Buydens-Branchey. 2000) In school-aged children, those with cholesterol values lower than 145 were three times more likely to have been suspended or expelled from school. This is an absolute consideration, and has nothing to do with socio-economic status or ethnic background, nor with nutrition status or academic achievement. (Zhang. 2005)
Life is supposed to be a balancing act. Lots of us overdo something. The balance between total cholesterol and HDL can allay fears of cardiovascular disease, despite cholesterol in the 200 range. Cholesterol levels below 170 can make us irritable…and irritating.
Suarez EC. Relations of trait depression and anxiety to low lipid and lipoprotein concentrations in healthy young adult women. Psychosom Med. 1999 May-Jun;61(3):273-9.
Elaine N. Meilahn, MD Low Serum Cholesterol Hazardous to Health? Circulation. 1995;92:2365-2366
Martínez-Carpio PA, Barba J, Bedoya-Del Campillo A.
Morgan RE, Palinkas LA, Barrett-Connor EL, Wingard DL. Plasma cholesterol and depressive symptoms in older men. Lancet. 1993 Jan 9;341(8837):75-9.
Engelberg H. Low serum cholesterol and suicide. Lancet. 1992 Mar 21;339(8795):727-9.
Paul H. A. Steegmans, MD, Arno W. Hoes, MD, PhD, Annette A. A. Bak, MD, PhD, Emiel van der Does, MD, PhD and Diederick E. Grobbee, MD, PhD Higher Prevalence of Depressive Symptoms in Middle-Aged Men With Low Serum Cholesterol Levels Psychosomatic Medicine 62:205-211 (2000)
Beatrice A Golomb, Håkan Stattin, Sarnoff Mednick Low cholesterol and violent crime Journal of Psychiatric Research. Volume 34, Issue 4 , Pages 301-309, July 2000
Laure Buydens-Branchey, Marc Branchey, Jeffrey Hudson, Paul Fergeson Low HDL cholesterol, aggression and altered central serotonergic activity Psychiatry Research. Volume 93, Issue 2 , Pages 93-102, 6 March 2000
Zhang J, Muldoon MF, McKeown RE, Cuffe SP Association of serum cholesterol and history of school suspension among school-age children and adolescents in the United States. Am J Epidemiol 2005; 161:691-9.
Scanlon SM, Williams DC, Schloss P. Membrane cholesterol modulates serotonin transporter activity Biochemistry. 2001 Sep 4;40(35):10507-13.
Laure Buydens-Branchey,a Marc Branchey,a and Joseph R. Hibbelnb ASSOCIATIONS BETWEEN INCREASES IN PLASMA N-3 POLYUNSATURATED FATTY ACIDS FOLLOWING SUPPLEMENTATION AND DECREASES IN ANGER AND ANXIETY IN SUBSTANCE ABUSERS Prog Neuropsychopharmacol Biol Psychiatry. 2008 February 15; 32(2): 568–575.
BRIAN HALLAHAN, MRCPsych and MALCOLM R. GARLAND, MRCPsych Essential fatty acids and mental health The British Journal of Psychiatry (2005) 186: 275-277
Hillbrand M, Waite BM, Miller DS, Spitz RT, Lingswiler VM Serum cholesterol concentrations and mood states in violent psychiatric patients: an experience sampling study. J Behav Med 2000; 23:519-29.
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