Cholesterol and cognitive decline
As a group the elderly are keenly health conscious. Probably as a percentage of their population more elderly try to eat right and take care of themselves than any other group. And with good reason since the Grim Reaper is lurking right around the corner waiting to harvest them at the earliest opportunity. Senior citizens have seen their friends and relatives succumb to disease and realize more than most how precarious life really is.
But the elderly have a problem. Most of them get their health information from the mainstream press. And as regular readers of this blog know, the mainstream press is more often wrong than right. (See Gina Kolata’s review of Gary Taubes’ book in last Sunday’s New York Times and you’ll see what I mean.)
Based on what they read in the press, most people of retirement age or beyond are busy cutting the fat and cholesterol from their diets, obsessing on their cholesterol levels, avoiding saturated fat like death, and loading up on plenty of complex carbs. If these folks have a cholesterol reading that’s a little above ‘normal,’ their doctors usually start them on statin drugs. And these patients take them religiously.
Problem is as I reported earlier, the statin drugs have never been shown to be effective in preventing illness in people over 65. In fact, the opposite has been shown – elderly people taking statins are more likely to die from cancer. But their doctors don’t know that because they have been sold a bill of goods by the pharmaceutical industry working feverishly to tap the elderly as a source of revenue for statins.
The majority of the medical data out there shows that a higher cholesterol is correlated with better health and longevity among the retirement set, but few of them know it. And fewer yet know that a lower cholesterol level is associated with cognitive decline.
If there is one thing that elderly people fear more than heart disease and cancer it is probably Alzheimer’s disease or any kind of mental decline. Unfortunately, their fixation on their cholesterol levels are herding more and more of them in that very direction.
The brain represents about 2 percent of a person’s overall weight yet contains about 25 percent of the cholesterol in that person’s body. Just those figures alone ought to tell you that cholesterol is pretty important in cognitive function, but most people aren’t aware of those figures. And won’t learn them from the mainstream press (which get’s its info from the pharmaceutically-driven medical press), but will continue mistakenly to think of cholesterol only in terms of heart disease risk.
A group of researchers in the Netherlands did a study looking at cholesterol levels and cognitive decline and found that the elderly with the highest cholesterol levels were able to think better than their counterparts with low levels of cholesterol. Their paper has been accepted by the journal Neurobiology of Aging, and is awaiting publication.
The researchers divided a group of 1181 elderly people (ave age 75) into groups of high cholesterol, medium cholesterol and low cholesterol levels. They administered reliable tests designed to determine general cognitive function, memory and information processing speed. Across the board subjects with the highest cholesterol levels performed the best, followed by those with medium cholesterol levels. The group with the lowest cholesterol levels performed the worst.
The scientists followed these groups of people for about six years and found that all groups followed about the same trajectory of mental decline, but the group with the highest cholesterol levels ended up with better function than the other two groups simply because they started from a better position at the beginning.
The research team also studied members of the group of subjects who were carriers of a certain genetic marker that is associated with greater rates of Alzheimer’s disease. The folks in this group that had the lowest cholesterol levels had a more precipitous decline in mental function over the six years than did those who had the same genetic marker but were in the high cholesterol group.
This is not the only study that has shown the cholesterol is protective against cognitive decline – it’s only the most recent. And I doubt that you will read much about it in the mainstream press. I doubt that it will be picked up by every newspaper and TV news station as was the idiotic ‘study’ that was totally misreported on red meat and colon cancer that I posted about earlier.
It’s truly unfortunate that our parents and grandparents who are so desperately trying to maintain their health are so wrapped up in trying to rid themselves of the very molecule – cholesterol – that will do the most to keep them from falling prey to the cognitive decline they dread so much.
If you want to improve the health of your elderly relatives, the best thing you can do is hide their statins and buy them a steak dinner.
from tomorrows front page The Times (of London)
http://www.timesonline.co.uk/tol/news/uk/health/article2633701.ece
God help us all. I guess I need to read this study.
Cheers–
MRE
One place where Gina Kolada, and many, if not most, writers and critics miss the boat, is by saying that people who have lost weight on a low carb diet, gain it back when they go off the diet. Well, DUH! Wow, what a surprise!
Wouldn’t ya think that, since the premise is that high carb in = obesity out…. gee, I wonder why I got FAT again??? when I returned to my old way of eating.
Seems to me that folks have got to realize they’re not looking at a short term diet, but a life long way of healthy eating. Everyone wants a quick fix; instant gratification; a pill to cure all while we still scarf down our chocolate cake, french fries, and Coca-cola.
Why do I never hear of what happens when you go “off” Jennie Craig, or Weight Watchers?
Are most people who are “dieting” in one form or another only looking for a quick cosmetic fix, as espoused by the still overweight Kirstie Alley? Yeah, she’s a looker who no doubt can afford the best followups in cosmetic surgery, but how’s her heart? And don’t tell me she hasn’t had liposuction.
People are so gullable.
By the way, I LIKE Kirstie Alley- I’m only annoyed at the use they make of her. Why not show some geriatric subject in a nursing home claiming great health benefits for the Jennie Craig way of eating? It’s all so damned annoying!
Hi Dorothy–
Like you I get torgued at these bozos who say something along these lines: Yeah, the diet didn’t really work for me. I lost a lot of weight, but I just regained it as soon as I went off the diet.
People actually tell me that all the time. It’s mind boggling. I often wonder if these people had a terrible medical problem that required medication to control. Would they be surprised if their condition returned if they quit taking their medicine? The depth of the dumbth of a lot of people – including our friend Gine – is pretty astounding.
Cheers–
MRE
On another (more specific) note…
Dr Eades I was wondering what your opinion is in regards to conditions such as familial hyperlipidemia (where there is a genetic trait which prevents the body from regulating the level of LDL produced)? Isn’t it true that excess LDL floating around in the blood is prone to oxidation, where it can contribute to vessel damage (or is my understanding incorrect)?
I totally agree cholesterol concern is likely overblown but isn’t it true at least some people might benefit from saturated fat restriction for this reason (they lack the ability to effectively regulate LDL production because of the trait)?
I have a high total cholesterol, but the ratio is fantastic and my triglycerides are non-existant. The funny thing is before reducing weight (46 bmi – 20 bmi) through low carb, my triglycerides were high, hdl was low… but the LDL/total cholesterol was low. My LDL cholesterol has remained relatively constant, but the HDL has almost trippled whereas the triglcyerides are one fifth the old value. In my case a high total cholesterol means health, and lower cholesterol is a sign associated with the metabolic disease process (insufficient HDL secondary to the high insulin levels).
There is virtually no evidence that saturated fat causes cardiovascular disease. Gary Taubes’ book goes in excruciating detail into why that belief is so widespread today despite there being no real data to back it up.
Cheers–
MRE
It is a shame that people even need to take statins because lower cholesterol can be achieved with a healthy diet. Some of the comments here stated that cholesterol lowering does no good and that high cholesterol results in longevity… however this is not the case. There is absolutely NO EVIDENCE whatsoever that increasing someones cholesterol while it’s declining with age or not, will extend longevity. This is complete nonsense. For those that need statins please do what your doctor says and take them.
Are you quite certain there is “absolutely NO EVIDENCE whatsoever” that increasing cholesterol doesn’t bring about benefit? I wouldn’t be quite so dogmatic if I were you. And unless you are a physician taking care of specific patients I wouldn’t be advising people on statins one way or the other.
Cheers–
MRE
I was under the impression that Low Carb eating reduced some kinds of cholesterol.
Is it reducing the ones that could help cognitively?
Hi Dan–
Eating low-carb typically reduces elevated cholesterol, but doesn’t lower it too much. Nor does it lower an already low cholesterol level.
Cheers–
MRE
[...] excellent post from Michael Eades discusses a new study that found elderly people with lower cholesterol had [...]
Thank You Dr. Eades for putting me onto the Malcolm Kendrick book. Arrived yesterday from Amazon and I’m half done already. What a stitch!
“When the liver makes fats, it makes saturated fats, and saturated fats alone. My God, do our own livers not know how unhealthy this is?” “Anything above 4 mmol/l and you will be statinated. Resistance is useless.”
He is such a good read, but in the process I am learning boatloads about the whole subject. One question: As a practicing prep school chemistry teacher, I accept what he is writing, but there are precious few references (which compared to the Taubes’ book is a good thing). From what you’ve read, is his science essentially correct (allowing for the simplifications required to make it readable?) I fully expect that he will be savaged in the reviews by other “so-called” experts.
I ordered 3 more copies to pass out as birthday presents, and my wife and teenage children want to read it as well (as they should)!
Thanks again,
Dave Futoma
Hi David–
The lack of references is one of the negatives I pointed out about this book when I first reviewed it. But, like with the title, the publishers often make the call on whether references make it into the book or not. In both PP and the PPLP the publishers made us leave the bibliography and references out because the material ran too long.
Cheers–
MRE
What are your thoughts on the paper that was quoted in the nytimes review of taube’s book, about a calorie is a calorie is a calorie. I know it’s not, but they seem to mention a study that shows that it is. I haven’t read that study(would like to), but it’s gotta be wrong somehow right?
I plan to post on it in the very near future. Even if it were right, which it isn’t, it would only be one study among many showing the opposite.
Cheers–
MRE
Suggest you also make sure to read the comments generated by the UK Times article. Looks to me like the majority of commenters talk about adverse experiences with statins and actually debunk the article. Dominoes finally starting to fall….or at least go teeter / totter?
W
Hi Wil–
I love it when that happens.
Cheers–
MRE
the study (WOSCOPS) wasn’t exactly a raging success originally, according to the figures in Uffe Ravnskov’s book
That is correct.
None of my posts are getting through, but I thought you might be interested in this article. Fasting and calorie restriction up regulates SIRT1. SIRT1 is being found to be a factor in lifespan and disease such as insulin resistance, cancer, and heart disease. You think low cholesterol apparently means higher risk of death, whereas it’s actually falling cholesterol due to a disease.
This new study links the longevity gene SIRT1 to lower cholesterol. As I said, since going on CR my total cholesterol is now 109mg/dl and Tryglycerides between 35 – 53 mg/dl
Long-Life Gene Might Help Lower Cholesterol
http://www.forbes.com/forbeslife/health/feeds/hscout/2007/10/11/hscout609058.html
I enjoy your posts, but on this I think you’re dead wrong. However I agree statins are not the solution. A healthy diet is the solution.
Hi Matthew–
Your posts are getting through. I’ve just been traveling and answering a few comments here and there as I can get to them.
I said it before, but I’ll say it again. I posted about data from a study. Data is data. And in this case the data show that elderly people with higher cholesterol levels perform better on tests measuring cognitive function. In the discussion section of the paper the authors considered the possibility that the lowered cholesterol in some subjects could have been the result of poor nutrition and frailty, but they said that that was a possibility, not the actual cause.
You can argue with this data all you want, but it is still the data. You and anyone else who cares to can draw your own conclusions about what these data mean. Since the brain contains 25% of the cholesterol in the body (more than any other structure) that indicates to me that cholesterol is important for the brain to work properly. In view of that it makes sense to me that a lowered cholesterol would hamper cognitive function, which is exactly what this study showed.
Cheers–
MRE
Dr Mike:
While we are discussing statins, here is another link to another asinine article about the benefits of statins taken from the CBC.
http://www.cbc.ca/health/story/2007/10/12/statins-lung.html
Statins slow lung decline in smokers, elderly: study
Pushing statins. Sales must be down.
I don’t think sales are down; I just think they want the entire population on them.
Cheers–
MRE
Hi Dr Mike,
Thanks for the comments on hubby’s numbers and I really do appreciate that you took the time to do so. For the record, I don’t put any stock in cholesterol numbers myself, but sometimes I have to fight fire with fire. Hubby’s numbers actually used to be higher and several years ago his PCP did put him on a statin. His then GI was very upset about that when he found out and immediately took him off of them. If I remember correctly, the GI wasn’t all that sold on the cholesterol/heart disease link, himself. Unfortunately, hubby’s current GI and PCP are both sold on it and it’s a constant battle every time they run his numbers. They are both part of the CU School of Medicine and are, of course, passing it right along to all those med students.
Good luck in dealing with a tricky situation.
Cheers–
MRE