Cholesterol is a molecule central to all human physiological processes at systemic as well as cellular levels. Cholesterol, combined with Apolipoprotein B as low-density lipoprotein (LDL) has been the focus of scientific research because the molecule has been proven to play a role in the development of cardiovascular disease, a disease of pandemic proportions. Considerable scientific and medical attention has been devoted to identifying the role and management of high levels of total serum cholesterol in order to address this global health burden, creating large scale awareness regarding lowering cholesterol concentration in circulation. However, the same molecule, combined into various lipoprotein moieties, is also involved in ‘normal’ physiological processes. In this review, an attempt has been made to elucidate some of the physiological events at the other end of the spectrum, when serum cholesterol levels are lower than normal. These health risks may need to be managed by going against the grain and actually raising serum cholesterol levels. Hypocholesterolemia is perhaps as much of a health risk as is hypercholesterolemia. These phenomena emphasize the fact that where cholesterol is concerned, maintenance of optimal systemic levels of cholesterol is more crucial than going towards either end of the cholesterol scale
