Does low cholesterol cause cognitive impairment? Part II | Hacker News Reader

Does low cholesterol cause cognitive impairment? Part II

peterattiamd.com

89 pointsnradov40 comments

I'm a great believer in homeostasis. If you tweak cholesterol expression in one way, the body is going to react in another. Generally, the brain takes priority. I don't know how, but presumably the autonomic/hormone regulatory functions in the brain work better if they aren't marginalized, re-balancing what the body overall has to work with.

Whatever else I know in this space (not much: not a scientist, not in the field) I have become very skeptical of dietary influence on things like blood cholesterol levels. Sodium levels, I can believe something as simple as eating too much salt can alter: thats a really simple molecule. Fats and associated products are bigger, more complex, and carry things alongside which I don't think sodium usually does: the salts are simpler forms, the fats have complex side-bound payloads in the form of vitamins and fat soluable goodies. Your cells aren't just getting this stuff by osmotic pressure, they have active organelles which "seek out" the good stuff. Its the difference between random stochiometric and catalysed outcomes. There's energy, there's cellular structures, there's consumption and expression going on.

I'd take a statin if advised. I wish I wasn't on hypertension meds, I had a 10+ year hit, then a 10+ year window without, now I'm back on 'em again. I do far more exercise than I used to, and I eat as much yummy dairy and animal fat as humanly possible.

I too, second the notion that dietary changes are often not enough. I’ve gone through periods of moderately heavy alcohol use and eating terribly as well as phases where I am not drinking and exercising 3-4x a week, eating healthily. My cholesterol remained moderately bad in both situations and did not improve until a 6 month round of statin therapy.

I will add to the anecdata.

My cholesterol has been creeping up since I hit 30. At the time it started increasing, I was doing something like 15 hours vigorous exercise a week and eating pretty healthy. Not perfect, but pretty good. Doing that much exercise meant I ate a lot.

Arriving in my 40s (a lot less exercise now.. maybe 6 hours a week), my cholesterol got to the point where the doc was talking statins. I didn't like the sound of this and cut out all dairy and avoided fatty meats. The year I ate like that my cholesterol went up by 15%.

As a last resort before starting on statins, I went completely vegetarian (but not vegan) and my previous year's gain in cholesterol reversed in 6 months.

Reading up on it, that may be the one loss I get from cutting out meats and I'm destined for statins anyway.

But, fwiw, that's my experience with cholesterol and dietary changes.

More anecdata: I'm vegan, 31 and exercise plenty. My LDL cholesterol is still high - though not at statin level yet.

My dad is also vegan and is an amateur athlete. His cholesterol is high enough that they are talking statins.

His dad is on statins.

Yet despite this, nobody in my family has ever had a heart attack, stroke or heart disease.

Have you tried eliminating/restricting oils yet? Or, processed foods generally.

Sounds more like a genetic component here. I dont think most people can overcome strong genetic factors without drugs. Some populations even live long and healthy lives even with high cholesterol (I believe Iceland is one area).

When I moved to a plant based and whole grain diet my cholesterol massively dropped. It’s now healthy.

Is your vegan diet mostly based on unprocessed plants? Do you limit oils when cooking?

Vegan diets can be unhealthy, too.

Did you also try a diet high in walnuts and and oyster mushrooms?

There can also be a huge genetic component. I believe that family history should play a bigger role in determining one's risk. Some population live a long and healthy life even with high cholesterol (I believe Iceland is one area). But I'm not a pharma salesman (nor doctor), so what do I know.

how did you get off the BP meds?

My BP stabilised enough my GP suggested I try weaning off. I went half a tab, then half a tab every other day then stopped.

I do have hypertension in my heritage, but I was written up as idiopathic. Since it's returned I might find that changes. Still, a ten-year break was good. Who knows? Maybe I'll win another.

You probally did this, but take your BP at home.

Just walking into a Dr's office raises mine, and that's before the bill.

Most doctors will have you check your bp daily for a month to see if you are actually hypertensive.

"I have become very skeptical of dietary influence on things like blood cholesterol levels."

I think that's a decent heuristic on the input side.

Human beings seem wired to look for magic spells or rain dances. Eating particular special foods, or combinations of foods, or exotic ingredients seems to appeal to us.

I agree with you that this additive approach is probably mistaken.

"I have become very skeptical of dietary influence on things like blood cholesterol levels."

But on the output side ... if you stop energy inputs and just let your body run through the backlog, your cholesterol will drop. Probably plummet - and in a surprisingly short amount of time.

Rather than some exotic ingredient or weird food combination, simply staying in a fasted state longer, more regularly, would be the very first (and simplest, and least intrusive, and cheapest) step I would take.

Which is to say, "dietary influence" can be huge - just not on the input side ...

The issue is that it is very complex. You fat stores what you eat, so a diet will often not result in the significant lowering of things like cholesterol, until you've burned the fat around your belly. ...and as you said, your body can be adaptive in certain ways.

For these reasons, health is really about establishing routine lifestyle changes so that you can find that new healthy equilibrium.

From OP:

> [A]fter decades of research and billions of patient-years of use data, it doesn’t appear that people taking statins are at greater risk of these conditions [cognitive impairment, dementia, hemorrhagic stroke]. In fact, population studies actually suggest that statin use is associated with a reduced incidence of dementia, but observational studies like these are incapable of determining a cause-and-effect relationship.

In other words: no, it doesn’t. The article is however a good overview of cholesterol metabolism in the brain and effects of statins.

Betteridge's law[1] of headlines is an adage that states: "Any headline that ends in a question mark can be answered by the word no." It is named after Ian Betteridge, a British technology journalist who wrote about it in 2009, although the principle is much older.[1][2] The adage fails to make sense with questions that are more open-ended than strict yes–no questions.

[1] https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...

Is Betteridge’s law ever useful?

Isn’t this already one recursion level too deep? ;)

Nice try, but we need to see your article to know it's a legit headline :)

Are you starting a proof of Gödel's incompleteness theorem?

The article's actual conclusion says "we don’t know for sure whether low desmosterol from statin use increases the risk of dementia".

But we have lots of evidence that statin use is associated with reduced risks of dementia.

Do we? I haven’t seen a single interventional study about that.

We have plenty of evidence staying us is associated with reduced risks of dementia.

We have far less evidence that stations reduce the risk of dementia.

No, this is not the conclusion of the article. Just because there is no correlation to EXTREME brain dysfunction, that does not imply there is not measurable cognitive impairment.

In fact, the article highlights the need for further research on a subset of drugs which permeate the blood-brain barrier because low levels of cholesterol synthesis are observed in the brain, and cholesterol is critical in brain function. ...and that such research may ultimately lead to recommendations to lower statin doses for some patients.

Is a randomized interventional study cited in the article? If not, then nothing has been proven. And that’s not accounting for the fact that statins do a hell of a lot more than just lower cholesterol.

Reminder that the eggs-cholesterol danger was fabricated by LBJ to hide inflating egg prices in 1966:

"When egg prices rose in the spring of 1966 and Agriculture Secretary Orville Freeman told him that not much could be done, Johnson had the Surgeon General issue alerts as to the hazards of cholesterol in eggs."

[0] "The Great Inflation and its Aftermath" (2008), by Robert J. Samuelson, pg. 95-96.

[1] https://www.npr.org/sections/money/2011/06/24/137400235/lbj-...

let's say that what you are claiming is true (although your reference leaves much to be desired) - that doesn't mean that there is no "eggs-cholesterol danger", just that it was used as a narrative to combat inflation.

It depends on what you consider "danger". If you drink too much water that can be dangerous. I believe the general consensus is that 1-2 eggs a day is not harmful. I believe they've also shown that saturated vs unsaturated fat intake is the main driver of cholesterol (plus carbs), not cholesterol consumption itself.

https://www.hsph.harvard.edu/nutritionsource/what-should-you...

In general it seems like -- and this is my outside perspective, not informed by any expertise, just casual reading -- the trajectory of nutritional science has more or less been "if something is bad in your body, then consuming it as part of your diet is bad; if something is good in your body, then consuming it as part of your diet is good" followed by later research saying "no, it turns out bioavailability doesn't work that way, and anyway the thing might have been a side effect rather than a cause of harm". See: dietary cholesterol, dietary fat, omega-3, probiotics, iron supplements, anti-oxidants

> although your reference leaves much to be desired

Is NPR not considered a trustworthy source? I thought they were generally fairly well regarded in that sense.

NPR is just referencing a quote from someone in a book. Not saying NPR is untrustworthy, just that extraordinary claims require extraordinary evidence.

> NPR is just referencing a quote from someone in a book.

"Just"?

Have you considered the verification processes NPR employs before it includes references in broadcasts and published articles?

What is extraordinary about a claim that eggs do or do not raise cholesterol negatively?

the extraordinary claim is that the narrative was made up to serve an alternate motive.

>> let's say that what you are claiming is true (although your reference leaves much to be desired) - that doesn't mean that there is no "eggs-cholesterol danger", just that it was used as a narrative to combat inflation.

But the message itself was deceptive. Regardless of the truth value of "eggs-cholesterol danger" the reason for telling people was something else - to combat inflation. There are a number of problems with that kind of manipulation, one of which is that the truth value of the statement will never be ascertainable due to biases all around.

BTW eggs contain everything you need (except air and water) to make a chicken. How bad can they be?

I'd like to see a study on those with naturally low cholesterol. My dad and I (and some of his ancestors) have very low cholesterol and great LDL and HDL numbers without any medication or special diet. Dad's been told he has really good genes. Except he has AD. His sister has just started showing signs of dementia. Their mother died with AD. I'm not liking my odds here.

Could be that the usual AD genes are strong. Could be that those genes co-occur commonly with the same genes that allow me to be a butter and bacon eating machine. Could be that low cholesterol is a really bad thing for brain health. I figure I've got about 10 or 20 years to find out.

Nigerians have lots of APOE4 (a gene that leads to much higher rates of alzheimers), and really low cholesterol. And they also have lower rates of AD.

I think base on current evidence your family might just have great cholesterol genes and bad AD genes.

Btw how old was your father, aunt and grandmother when they got AD?

Dad's 85. He was 82 when it became clear he was having significant problems, but mom had been saying he was having lesser problems before that. My aunt has just turned 80. Grandma died at 87. I'm not sure exactly when she became symptomatic, but it was also around 80. I'm 53. I figure I have 20-25 good years left.

The cholesterol connection is of interest because of my family history, but my current thinking is that the so-called Type 3 Diabetes pathway seems very plausible. Whether it affects brain health or not, I'm on the "carbs are bad" bandwagon.

Google Mary Newport

I would like to see a part three about cholesterol's link with depression.

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