High Cholesterol Symptoms: Fatigue

What is cholesterol?

Cholesterol is a kind of fat (lipid) that is produced in the liver and circulates in the bloodstream as lipoproteins, comprised of lipids and proteins. It can be found in some foods and is essential in moderation for healthy living. A balance between build-up and breakdown of cholesterol is necessary for optimum utilisation. 

At desired levels, cholesterol plays a vital role in the body:3 

  • Key insulating material that sheaths the nerves and ensures the smooth transmission of impulses which ensures brain health and proper functioning of the nervous system.
  • A key component of the membrane lining all cells of the body.
  • Vital for making vitamin D and steroidal hormones.
  • Important in the production of bile, which is important for the digestion of fatty nutrients.
  • Ensures cellular integrity, maintenance of body shape, and supple skin including, providing healthy bones, teeth, and muscles.

Differences between LDL and HDL cholesterol

Cholesterol is generally subdivided into good cholesterol (crucial for good health) and bad cholesterol (implicated in diseases). Good cholesterol refers to high-density lipoprotein (HDL), which clears bad cholesterol from the bloodstream and returns it to the liver for breakdown and removal. Bad cholesterol — also known as low-density lipoprotein (LDL) — tends to clog the blood vessels with excess cholesterol from the liver, thereby triggering inflammation and restricting blood flow. This heightens the risk of cardiovascular diseases; that is not to say that cholesterol does not deposit onto other parts of the body to cause problems. Maintaining a healthy level of HDL can help regulate excess LDL levels.

Measurement of cholesterol

A simple blood test would suffice for monitoring cholesterol levels (HDL or LDL).4 This can be used along with results for other lipids (triglycerides)—and blood pressure, BMI, etc.—that can serve as important biomarkers for cardiovascular health. This ensures that optimal levels are maintained, and diseases (e.g., cardiovascular, cardio-metabolic) for which high cholesterol levels are a risk factor are prevented. The rule of thumb is to maintain higher HDL (good cholesterol levels) and lower LDL (bad cholesterol levels).

Elevated total cholesterol is an indirect metric for excess LDL (bad cholesterol) in the blood. It can be calculated from the formula (HDL + LDL (triglycerides/5). The measurement unit for cholesterol is millimoles per litre (mmol/L), and the normal range of total cholesterol (on average) is less than 5.17 mmol/L—this varies with age, sex, and other factors.5 The British Heart Foundation and NHS recommend routine checking of cholesterol levels, especially for those above 40 years of age and those that have a risk of heart disease. 

Risks associated with high cholesterol

Underconsumption or overconsumption of cholestrol can result in diseases such as atherosclerosis (blocking of arteries with fatty material, inflammatory material, blood clot, and scar tissue). 

 This may be due to genetic disorders that affect the metabolism of cholesterol, lifestyle factors, or even pre-existing disease conditions. Look at the list of culprits:6

  • Foods rich in saturated fat like red meat, whole milk, cheese 
  • Inactive or sedentary lifestyle
  • Abdominal obesity
  • Smoking 
  • Diabetes 
  • Old age 
  • Ethnic background (e.g. South Asians are more susceptible to having high cholesterol levels)
  • Kidney or liver problem
  • Hypothyroidism (under-functioning thyroid glands)
  • Genetic disease (familial hypercholesterolemia)

Symptoms of high cholesterol

It is interesting to note that high cholesterol may not be associated with obvious or typical signs and symptoms (regarded as asymptomatic). The patient may notice a range of symptoms:7,8,9 

  • Severe unprovoked fatigue coupled with shortness of breath. 
  • Abnormal heart rate
  • A rapid increase in body weight
  • Excessive sweating 
  • Persistent leg pain 
  • Yellowish deposit in the eyelid
  • Feeling of numbness/tingling or coldness at the extremities 
  • Angina-like symptoms (e.g., chest pain)
  • Neck and shoulder pain/swelling
  • Thickening and bluing of toenails 
  • Thinning of the skin on the legs 
  • Poor healing of ulcers/wounds
  • Nausea

Is fatigue a symptom of high cholesterol?

Fatigue is described as a subjective feeling of lack of physical and/or mental energy.1 Several factors predispose an individual to fatigue; notably, abnormal cholesterol levels are one of them. High (total) cholesterol can cause fatigue in many ways. For this article, two will be highlighted. 

The first one is fatigue associated with multiple sclerosis—a degenerative neuron disease of immunological/inflammatory origin. In this case, high cholesterol drives an unhealthy deposition of fat across the neural network (including neuromuscular junctions)—which disrupts nerve conduction, impairs metabolic and muscular functions, induces inflammation and ultimately endangers life. The main point is that fatigue (in this context) is promoted by the poor transmission of impulses to the brain and muscular system.1 

The other mechanism for high cholesterol-induced fatigue has cardiovascular underpinnings. An example of this is cholesterol embolization syndrome (CES).2 Here, cholesterol deposits within the walls of blood vessels then dislodge to another smaller blood vessel (arteries), leading to obstruction of blood flow and end-organ damage. When the brain is affected, fatigue is usually a severe warning sign. Of course, other symptoms like fever, weight loss, muscle tissue pain, and system-wide inflammation (e.g., renal failure, blue toe syndrome) may frequently erupt. 

By and large, fatigue induced by cholesterol can be managed by supportive care, and cardiovascular pharmacotherapy applies to cholesterol-related problems. 

What can you do about high cholesterol?

Cholesterol levels can be controlled by making the necessary lifestyle adjustments. For example:

  • Exercise
  • A balanced diet rich in fruits and vegetables 
  • Avoiding smoking and excess alcohol 
  • Taking cholesterol-lowering medicines like statins. 

It is important to emphasize that cholesterol-lowering medications must be taken under the supervision of a qualified medical professional (e.g., a lipid specialist).

Summary 

Cholesterol is a unique variety of lipids essential for good health when present at an optimal level; it can be produced in the body and obtained from food. However, a delicate balance must be maintained between its build-up and removal from the body.  High cholesterol level—specifically LDL—is a risk factor for heart attacks, strokes, and peripheral artery disease (PAD), among other diseases. Therefore, routine testing is important to monitor blood levels.

Although high cholesterol is asymptomatic, some symptoms warn of the danger it poses. Among these symptoms, fatigue is notable. It can be due to cardiovascular or neurological mechanisms. Ultimately, high cholesterol can be managed by lifestyle adjustments and the right medications.   

References

  1. Browne RW, Jakimovski D, Ziliotto N, Kuhle J, Bernardi F, Weinstock-Guttman B, Zivadinov R, Ramanathan M. High-density lipoprotein cholesterol is associated with multiple sclerosis fatigue: A fatigue-metabolism nexus? J Clin Lipidol. 2019 Jul-Aug;13(4):654-663.e1. DOI: 10.1016/j.jacl.2019.06.003. Epub 2019 Jun 18. PMID: 31307953.
  2. Saric M, Kronzon I. Cholesterol embolization syndrome. Curr Opin Cardiol. 2011 Nov;26(6):472-9. doi: 10.1097/HCO.0b013e32834b7fdd. PMID: 21993354.
  3. What is cholesterol? [Internet]. Org.uk. Available from: https://www.heartuk.org.uk/cholesterol/what-is-cholesterol
  4. Getting a cholesterol test [Internet]. Org.uk. Available from: https://www.heartuk.org.uk/cholesterol/getting-a-cholesterol-test
  5. UpToDate [Internet]. Uptodate.com. Available from: https://www.uptodate.com/contents/high-cholesterol-and-lipids-beyond-the-basics/print
  6. High cholesterol - causes, symptoms & treatments [Internet]. Org.uk. Available from: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol
  7. High cholesterol symptoms and prevention [Internet]. Medicines Online. 2021. Available from: https://medicinesonline.org.uk/high-cholesterol-symptoms-and-prevention/
  8. Knibbs J. High cholesterol: Extreme fatigue could indicate your levels are dangerously high. Daily Express [Internet]. 2020 Dec 21; Available from: https://www.express.co.uk/life-style/health/1375303/high-cholesterol-signs-extreme-fatigue-diet-lower-levels
  9. Times Now Digital. High cholesterol: Don’t ignore the toes, you could be missing 3 symptoms of high LDL [Internet]. Times Now. 2022.

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Ezekwesiri Nwanosike

Master's degree - Drug Discovery and Business Strategy, The University of Huddersfield
I am a business-minded Pharmacist who specializes in leveraging clinical data to improve patient wellbeing. My passion is ensuring that quality, safe and effective health information/products are within the reach of everyone.

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