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.
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.”