Health Wanted: Bottled Water

The Episode

It’s sexy, it’s hip, it’s healthy, it's wreaking havoc on the environment, and it costs way more than just getting it from the sink. 

This week on Health Wanted, we’re talking about the strange obsession with bottled water.

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The Listener Questions

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Can statins make dementia worse, and should people with dementia stop taking them?

Dementia is a difficult disease not only for the person diagnosed but also for the family members and caregivers who surround them. And it’s hard to do your own research these days, because you can truly find anything to support what you already suspect, so the trick is to find the highest quality data across all research and see if there’s a consensus there.

So let’s first talk about how cholesterol, dementia, and statins are linked.

Your body needs cholesterol to stay healthy. The waxy, fat-like substance is essential to build cells and make hormones. But there’s good cholesterol and bad cholesterol, and you need the right balance. Your body makes its own cholesterol in the liver, which we call blood cholesterol, because it then circulates in the bloodstream with the help of proteins.

These cholesterol-protein packages are called lipoproteins; some are low-density lipoprotein (LDL), and some are high-density lipoprotein (HDL). LDL is known as “bad” cholesterol because it has more of the pure, fatty cholesterol that can build up as plaque in your arteries. And, like a clogged pipe, when this plaque builds up, it restricts blood flow to your heart and your brain. 

HDL is known as “good” cholesterol because it has more of the proteins that can actually absorb that built-up plaque and remove it from artery walls. But cholesterol from the blood cannot pass the blood-brain barrier and enter the brain, so the brain has to make its own. And, in fact, the majority of all your cholesterol is found in the brain. It’s essential to build and maintain connections between neurons. Statins are a type of medication designed to lower the amount of the “bad” LDL in your body by slowing down the amount of cholesterol your liver makes.

Dementia is a bit of an umbrella term used to describe a range of conditions, caused by damaged and destroyed neurons, that affect memory and thinking. And what links all of these things together is that both reduced blood flow to the brain and reduced cholesterol levels in the brain are associated with an increased risk of dementia. 

The idea here is that statins can lower the amount of LDL a person has, which then slows the buildup of plaque in your arteries, which can improve blood flow, and, in turn, could benefit brain health. But, while cholesterol can’t cross the blood-brain barrier, statins can, which could cause the brain to produce less cholesterol as well, which would harm brain health.

So which is it? It’s an emerging area of research, which is why we don’t have a definitive answer. Currently, the body of evidence suggests that statin use does not raise your risk of dementia. Several studies even show a possible link between statin use and a lower risk of dementia when you don’t have an impeded blood flow to the brain.

There is one study that suggested lipophilic statin use (meaning statins that are blood soluble) in people with low to moderate blood cholesterol had a higher likelihood of converting to a dementia diagnosis in 8 years of follow-up than those who use no statins, hydrophilic statins, or lipophilic statins who have high blood cholesterol. So even in the case of evidence for statin use contributing to cognitive decline in people who were already at risk, it’s still a very specific subset and over a period of almost a decade. 

So you really have to think too: if there is some general risk we’re not yet seeing, what is the greater risk to your loved one? A potential increased cognitive decline from being on statins, or an increased risk of heart attack or stroke from being off them? So in this case,  follow the doctor's advice regarding statins; the body of evidence supports their use, even in people experiencing dementia.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
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