Alzheimer’s: another reason to be sceptical about statins

The front page of the Daily Express on Friday led with a new warning about statins – combining them with certain blood pressure pills could raise your risk of muscle pains, lung disorders and kidney damage. Hmm yes well.

 Even as a cholesterol/statin sceptic I thought that was remarkably over-hyped – statin side effects are massively underplayed and finding they go up a bit when mixed with another drug is more of a clinical technicality than front page news.

However there is a statin risk which should be a serious cause for concern – lowering cholesterol may well raise your chances of developing Alzheimer’s. I’ll come to that in a moment.

First there is one aspect of the Express story that raises a wider issue – the way the buck is subtly passed when any new risk factor is identified.  The standard official response is is to say: “If you are worried discuss it with your doctor.” It seems sensible but the implications aren’t reassuring. It’s a line that’s been trotted out rather a lot recently.

Need for serious sanctions

Earlier this week it was used in response to the report that found that more women are harmed by unnecessary treatment following a mammograms than benefit from detecting a cancer. The week before, when a brilliant BMJ investigation exposed the appalling corruption involved in official EU licensing of hip implants, you were also invited to discuss how it might affect you.  In both cases serious sanctions would seem appropriate.

In the case of mammograms because convincing research showing that the dangers of over-diagnosis from breast screening dates back over a decade. A clear statement of risks and benefits has taken so long because of the readiness of the mammogram establishment to ignore or denigrate evidence of harm, as I described recently in the Mail. The fact that the European Medicines Agency allows licensing bodies to behave in a way that openly favours business interests rather than the patient, should also trigger an investigation.

 Shifting responsibility

There’s nothing wrong with discussing safety with your doctor, but when that’s all that happens it is a brilliant way of shifting the responsibility for producing safe products from the authorities onto you. If in the future you suffer as a result of mammograms or hip implants or indeed statins then the fact you were told about the risk, discussed it and went ahead becomes just one of those things.  For a book that discusses this see here.

To appreciate how odd the response to medical dangers is, look at what happens with when something dangerous about a car is picked up.  In 2010 it was found that the throttle on some Toyotas could stick in the open position. But rather than saying: “If you are worried about the “dangerous acceleration” issue, discuss it with your dealer and decide if Toyota is right for you”, the company recalled nine million cars.

The truth is that medicine is far more dangerous than the motoring. An estimated 15 people died from driving 10 million cars at risk from the acceleration issue in the USA. If all drugs and other conventional treatments had to be withdrawn at that level of mortality, medicine would become impossible.

Drugs carry serious risks because of the way they work. A single molecule, such as cholesterol that is part of a complex interlocking system, is blocked or boosted with a drug – statins. Inevitably they do things you don’t want as well as the ones you do. And the more important the system you are blocking the more likely the harm.That’s why statins could cause the sort of brain damage that shows up in Alzheimer’s.

Last week I wrote about the growing evidence for links between the raised insulin and insulin resistance that diabetics suffer from and an increased risk of Alzheimer’s. What I didn’t appreciate then was that lowering cholesterol might be equally damaging.

You may be familiar with the idea that cholesterol is involved in brain function but maybe not just how important its role is. A review article in the European Journal of Internal Medicine last year makes it clear.

 Cholesterol’s vital role

“The brain represents only 2% of the body’s total mass, but contains 25% of the total cholesterol,” reads an introductory paragraph. “Cholesterol is required everywhere in the brain as an antioxidant, an electrical insulator (in order to prevent ion leakage), as a structural scaffold for the neural network, and a functional component of all membranes. Cholesterol is also utilized in the wrapping and synaptic delivery of the neurotransmitters. It also plays an important role in the formation and functioning of synapses in the brain.”

Personally I’d want to know my odds of benefiting from blocking something that vital were better than the 100 -200:1 that is on offer from stains for primary prevention. The article goes on to describe a number of specific ways cholesterol is used in the brain.

It’s directly involved in the action of  a gene known as ApoE. A  harmful variation – ApoE4 – is well known to raised your risk of both heart disease and Alzheimer’s . So what does ApoE do? “It has an essential role in the delivery of fat, cholesterol, and antioxidants from the liver to all the cells of the body,” writes the author Stephanie Seneff, a Senior Research Scientist in the Computer Science and Artficial Intelligence Laboratory at MIT who has recently been turning her attention to biochemistry and medicine.

The ApoE4 variation causes brain problems because it doesn’t work so well and lowers the amount of cholesterol available to the hippocampus – the brain region crucial for memory.

More evidence for the harm from having too little cholesterol comes from research showing that Alzheimer’s patients have low levels of cholesterol in their spinal fluid, along with not enough lipoproteins,  triglycerides, and free fatty acids. Parkinson’s patients, who also suffer brain damage, have low levels of cholesterol in their blood.

There’s still a lot more to be done to prove definitively that too too little cholesterol damages the brain along with too much insulin and glucose.But avoiding these two highly plausible risk factors is remarkably simple and doesn’t involve adding new risks the way drugs do. It’s what we advocate in our book. Make sure you have enough good fats and eat foods that don’t push up blood sugar.

It’s what Dr Seneff’s recommends too. “Simple dietary modification, towards fewer highly-processed carbohydrates and relatively more fats and cholesterol, is likely a protective measure against Alzheimer’s disease.”

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Comments

  1. Alzheimer’s disease is correlated with increased concentration of cholesterol in the brain, and a study last year found that cholesterol could increase the cleavage of APP to Amyloid beta (debatably a major cause of Alzheimer’s). You are oversimplifying this I think. Sorry if I’m off topic… I found this when searching google for whether statins could be used to treat Alzheimer’s. This is another side apparently… I’ll look for journal articles that support this.

    • Hi – this is a complicated area but there seems to me to be some sensible reasons why lowering cholesterol in the brain would not be a good idea. First the full version of article by Stephanie Seneff that I summarise is impressive;what’s more the naturally high levels of cholesterol in the brain seems a good reason not to be very enthusiastic about lowering it.

      Then there is the fact that for a long time people have complained about a kind of brain fog that can come on after starting on statins – there has been been a book about it, called. I think,” Lipitor; thief of memory”. So possible that it is having a negative effect.

      Then there is a side-effect warning put out by the MHRA in November 2009 called “MHRA PUBLIC ASSESSMENT REPORT: Statins: updates to product safety information” which added some new adverse drug reactions. What’s striking is that at least half and possibly more originate in the brain: sleep disturbances, memory loss, micturition disorders, sexual disturbances, depression and interstitial pneumopathy.

      Complicating matters even further is a paper in the October 2009 edition of the Journal of Lipid Research where John Albers report finding that that similar statin drugs can have profoundly different effects on brain cells. I quote from a press release from Eurekalert:

      ” Albers and colleagues looked at the expression of genes related to neurodegeneration, and found that indeed, despite using biologically equivalent drug concentrations, differences were seen both between cells, and between drugs; for example, simvastatin reduced the expression of the cholesterol transporter ABCA1 by approximately 80% in astrocytes, while pravastatin lowered expression by only around 50%.

      “Another interesting difference was that while both statins decreased expression of the Tau protein –associated with Alzheimer’s disease—in astrocytes, they increased Tau expression in neurons; pravastatin also increased the expression of another Alzheimer’s hallmark, amyloid precursor protein (APP)”

      So complications. Finally there is the point that cholesterol levels tend to be lower in the brains of elderly people so attempting to lower them further would not seem a promising strategy.

  2. Refused Insurance Coverage:

    I was refused coverage by 3 insurance companies because my cholesterol is high. When I spoke to the insurance company representatives, they indicated that they would consider coverage as soon as I had my cholesterol “Problem” under control.

    Dr. would not agree that benefits of Statins outweighed the risk:

    I spoke to my Dr. about the insurance coverage issues, at which point he pulled out the menu of Statin drugs and suggested I start taking one immediately. I asked him if he would put a note in my chart that the Statin drug prescribed would not cause more harm than the potential benefits. He would not. He said he knew that statins would impact the cholesterol levels in my blood tests so that the insurance companies would insure me, but that there is a growing body of evidence indicating that I could end up with dementia, diabetes, or have a heart attack due to the weakening of my heart.
    So I asked him why in the world he would prescribe something that could cause such harm, at which point he said he was thinking about that a lot lately, and changed his position on prescribing me a Statin drug (probably because he was worried that since I asked him so many questions I was a future legal risk).

    Insurance Companies force people to take harmful drugs:

    My Doctor empathized with my challenges with insurance companies, and then suggested that until someone sues insurance companies for indirectly forcing people to take potentially harmful drugs, people like me would be just another insurance statistic. I suspect there are millions of people taking statins because it is the only way they and their family can have insurance. There are millions of people potentially killing themselves with harmful drugs because insurance companies are forcing them to ingest poison.

    • Jay – thanks very much for that. A particular twist on the statins saga I hadn’t heard of. Do let me know if there are any further developments. Presumably you don’t have either the funds or the time to take your insurance company to court?

  3. What I personally know is that whilst taking Simvastin I was suffering leg pains so intense it was making my day to day life so uncomfortable and within a week all these pains vanished when I stopped the pills. I had been going to the GP for almost a year over this leg problem and he said I had to live with it one of the side effects of my diabetes I even queried if it could be the statins and he said impossible! Well I prefer to go with the fact I am now without pain, restless legs and can sit and relax without feeling I wanted to cut my legs off!

  4. Statins are oversold, I agree. But they probably have a role in preventing or slowing down vascular dementia in those with high LDL cholesterol? Tough balancing act.

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