Last week the media reported that researchers based at Kaiser Permanente found an association between cholesterol levels in middle-aged people and the risk for those people of developing Alzheimer’s disease and other forms of dementia in old age. I thought, “Jeeze! These people just can’t leave it alone.” So I’d like to propose a cholesterol theory of my own: cholesterol causes obsessive and myopic behavior among researchers.
Here’s what the Kaiser researchers report.
First, borderline levels as well as high levels of cholesterol increased the risk of Alzheimer’s and other dementias. The researchers were impressed with the statistics, saying that they showed cholesterol to be a “significant risk factor.” Nonsense. The worst statistic was this: people with cholesterol above 240mg/dl at mid-life had a relative risk for Alzheimer’s in old age of 57%. What that means is that out of a thousand people with “desirable” cholesterol below 200mg/dl, about 40 developed Alzheimer’s while out of a thousand with “high” cholesterol above 240mg/dl, about 63 people developed Alzheimer’s. Not very impressive. And no one, especially the media, seems to notice that having so-called desirable cholesterol is not a free pass.
Second, the researchers have no idea how cholesterol might cause dementia. They just found an association between cholesterol levels at mid-life and the incidence of dementia in later life. This is like asking, “Why is it raining?” and being told, “Because water is falling from the sky.” Nevertheless, a new story in the cholesterol myth has been added: cholesterol causes dementia.
This report prompted me to pick up a medical classic: Jens Moller’s Cholesterol: Interactions with Testosterone and Cortisol in Cardiovascular Diseases published in 1987 and based on Moller’s decades of research and clinical practice.
Let’s start at the beginning. Cholesterol is good for you. It plays a number of critical roles in your body’s biochemistry. Of particular importance, cholesterol is the molecule your body uses to make cortisol and testosterone. In turn, your body makes estradiol from testosterone. Both men and women have all three of these hormones.
The significance of cholesterol, cortisol, and testosterone for Moller was that they regulate one another. Cortisol increases in response to stress, whether internal or external. Among other actions, it causes conversion of protein to glucose in what is called a catabolic process. Catabolic processes shift cell metabolism from aerobic (that is, oxygen using) to anaerobic energy production (that is, in the absence of oxygen). It was Moller’s contention that this shift is at the core the metabolic mischief that presents as cardiovascular disease.
On the other hand, testosterone is anabolic: it builds tissue and promotes aerobic energy production. When things are working well, cortisol and testosterone are in balance as is their precursor cholesterol. When cortisol increases due to stress, the body increases the supply of cholesterol in order to increase testosterone and bring the body back into balance. If the processes that caused the imbalance persist, this system degenerates and remains out of balance.
So high cholesterol means that your body is under stress and is trying to restore balance. Based on that science and his own extensive clinical practice, Moller successfully treated heart patients with testosterone. His arguments and evidence are compelling. His work has been completely ignored. If someone’s ideas don’t fit with what the scientific establishment deems acceptable and these respected experts have no arguments against those ideas, they simply don’t talk about them.
Although that’s a moral to the story, it’s hardly one worth following. However, there’s another moral from Moller’s book that is worth following.
Conventional research and practice don’t distinguish between pathology and physiological degeneration. Pathology is caused by disease. Physiological degeneration is an accelerated version of the decline experienced by all organisms, often captured by the word aging. Pathology is how an organism responds to a disease agent, such as a virus. Physiological degeneration is a process that the organism experiences internally and is often made worse by environmental factors, such as social inequity.
Cholesterol is not a disease agent. Alzheimer’s disease is not a disease.
With a disease, we need to help the body defend itself. With aging, we need to help the body restore balance. That the very smart people who do these studies that perpetuate the cholesterol myth are unable to figure this out doesn’t mean that you and I can’t.