Cholesterol, the Brain, and Autism

Dr. Kurt Woeller, D.O. | Sunrise Functional Medicine

For decades, cholesterol has been framed as something to fear—something to lower, manage, or eliminate. But this simplified view leaves out a much bigger, more important story, especially when it comes to brain health and neurodevelopment. Emerging research suggests that cholesterol is not just a cardiovascular issue—it plays a critical role in brain development, hormone production, immune function, and even social behavior. In the world of functional medicine, this has opened up important conversations about cholesterol balance, particularly in individuals with autism spectrum disorder (ASD).

Dr. Kurt Woeller, DO, of Sunrise Functional Medicine, has been following this research for years. What’s becoming increasingly clear is that both low and imbalanced cholesterol levels may be far more relevant to neurological health than we once thought.

Cholesterol: Not the Villain We Thought

Cholesterol is a waxy, fat-like substance found in every cell of the body. It helps maintain the integrity of cell membranes and serves as a building block for many essential processes. In fact, cholesterol is required to produce:

• Sex hormones and steroid hormones
• Cortisol, which helps regulate stress
• Vitamin D, which supports immune and neurological health
• Bile acids needed for digestion and nutrient absorption

Perhaps most surprising to many people: the brain contains more cholesterol than any other organ in the body. Nearly 60 percent of the brain is made of fat, and cholesterol is a major component of myelin—the protective sheath surrounding nerve cells that allows for efficient communication between neurons.

The Brain Makes Its Own Cholesterol

Here’s where things get especially interesting. Cholesterol from food or the liver cannot cross the blood-brain barrier. Once that barrier fully closes in infancy, the brain becomes responsible for producing its own cholesterol supply. This means someone can have normal—or even high—cholesterol levels in the bloodstream while still having insufficient cholesterol in the brain.

This imbalance is referred to as cholesterol dyshomeostasis—when cholesterol levels are not properly regulated across different tissues in the body. From a functional medicine perspective, the goal isn’t simply “lower” or “higher,” but rather the right amount of cholesterol in the right places.

Cholesterol and Autism: What the Research Shows

Large-scale studies from institutions including Harvard Medical School, MIT, and Northwestern University have identified a meaningful connection between autism and abnormal lipid (fat) metabolism. In one analysis of over 80,000 individuals with autism, researchers found that:

• People with autism were nearly twice as likely to have abnormal cholesterol or triglyceride levels
• Lipid abnormalities were more common even in individuals not taking medications known to affect cholesterol
• Families showed patterns of shared lipid abnormalities, suggesting genetic and metabolic influences

Children with autism who also had abnormal lipid levels were more likely to experience conditions such as epilepsy, sleep disorders, ADHD, anemia, hypothyroidism, and vitamin D deficiency.

These findings reinforce what many functional medicine practitioners have observed clinically: metabolic health and neurological health are deeply intertwined.

Low Cholesterol: An Overlooked Risk

While high cholesterol often gets the spotlight, low cholesterol may be equally problematic—especially for the brain.

Research has linked total cholesterol levels below approximately 145 mg/dL with mood disturbances, anxiety, poor sleep, irritability, and behavioral challenges. In children with autism, low cholesterol appears to occur more frequently and has been associated with higher rates of anxiety, depression, and intellectual disability.

Rare genetic conditions such as Smith-Lemli-Opitz syndrome (SLOS), which impair cholesterol synthesis, further highlight cholesterol’s role in behavior and cognition. In these cases, cholesterol supplementation has been associated with improvements in alertness, sociability, irritability, and communication.

Oxytocin, Cholesterol, and Social Behavior

One of the more compelling pieces of this puzzle involves oxytocin, a hormone often referred to as the “social bonding” hormone. Research suggests that cholesterol plays a role in stabilizing and optimizing oxytocin receptors in the brain. When cholesterol levels are insufficient, oxytocin signaling may be less effective—even if oxytocin itself is present. This has led researchers to explore whether improvements seen with cholesterol support may, in part, be related to enhanced oxytocin receptor function.

While this area of research is still evolving, it offers a fascinating biochemical link between cholesterol metabolism and social engagement.

Lab Testing: Looking Beyond Total Cholesterol

Understanding cholesterol status starts with appropriate testing. A fasting lipid panel typically includes:

• HDL (high-density lipoprotein): Often called “good” cholesterol, but both very low and very high levels may carry risks
• LDL (low-density lipoprotein): Often labeled “bad,” though extremely low levels may also be problematic
• Triglycerides: A type of fat influenced by diet, metabolism, and inflammation
• Total cholesterol: A broad snapshot that must be interpreted in context

From a functional medicine standpoint, numbers are never evaluated in isolation—they are interpreted alongside symptoms, history, inflammation markers, nutrient status, and overall metabolic health.

Supporting Cholesterol Balance, Not Extremes

Approaches to cholesterol regulation depend on whether levels are low, high, or imbalanced—and always on the individual.

Support strategies may include targeted nutrition, addressing inflammation, optimizing digestion and absorption, correcting nutrient deficiencies, and identifying underlying infections or autoimmune activity. The goal is not aggressive suppression or blind supplementation, but restoring balance. Dr. Woeller emphasizes that cholesterol management should always be personalized, particularly in neurologically complex conditions like autism.

A Thoughtful Conversation, Not a One-Size-Fits-All Solution

Medications such as statins remain an area of active debate, especially because some can cross the blood-brain barrier and potentially affect brain cholesterol levels. This doesn’t mean they are never appropriate—but it does mean the conversation deserves nuance.

Functional medicine focuses on asking better questions:

What is driving the imbalance?
How is the brain being supported?
What does this individual actually need?

Cholesterol is not simply a cardiovascular risk marker—it is a foundational molecule for brain development, hormone production, immune regulation, and neurological function. In autism and other neurodevelopmental conditions, abnormal lipid metabolism may be a meaningful piece of a much larger puzzle.

By looking beyond fear-based cholesterol messaging and focusing instead on balance and function, practitioners like Dr. Kurt Woeller help families explore new pathways toward understanding, support, and individualized care. Learn more and request a consultation >>