Are Cholesterol-Lowering Drug Regimens Causing Depression?
Low cholesterol is a risk factor for depression, according to integrative psychiatrist James Greenblatt, MD, of Waltham, MA. Speaking at the recent iMosaic conference, Dr. Greenblatt said there are 11 studies showing strong correlations between low total cholesterol and increased depression and suicidality.
The brain is the most cholesterol-rich organ, and cholesterol is a building block for many important hormones. This doesn’t mean that high cholesterol levels are healthy, but neither are levels that are too low. Dr. Greenblatt contends that America’s statin-mania is a key contributor to the epidemic of depression.
He’s seen patients in whom serious depression resolved simply by reducing statins and allowing cholesterol to rise up. "I sometimes go against cardiologists, but you’re not helping anyone if you increase risk of suicide while trying to prevent a heart attack"
About cholesterol (blood fats)
Blood fats include triglycerides, LDL cholesterol and HDL cholesterol. When levels of these fats are abnormal or disturbed patients are at risk of atherosclerosis, hypertension, coronary artery disease, stroke and a number of other disorders.
The most common types of blood fat disorders that patients can present with (either alone or in combination) are:
High LDL: low-density lipoproteins (LDL’s) transport cholesterol and triglycerides away from cells and tissues that produce cholesterol (e.g., liver), towards cells and tissues which are taking up cholesterol and triglycerides (e.g., peripheral tissues, muscles, nerves, etc). When too much LDL cholesterol circulates in the blood, it can slowly build up on the inner walls of the arteries that feed the heart and brain. Together with other substances LDL can form plaques, thick, hard deposits that can clog those arteries. This is why cholesterol inside LDL lipoproteins is called bad cholesterol. The risk of having a heart attack or stroke rises directly as a person's LDL cholesterol level increases.
Low HDL: high-density lipoproteins (HDL’s) carry cholesterol away from the arteries and back to the liver, where it's excreted via the hepatobiliary excretion route. HDL also removes excess cholesterol from plaques in arteries, thus slowing the progress of cardiovascular disease. This is why HDL cholesterol is known as the "good" cholesterol. Low HDL cholesterol levels increase the risk for cardiovascular disease.
High triglycerides: triglycerides are fats that contain a glycerol molecule attached to three fatty acids. These fats come from foods and are also made endogenously by the liver. The fat stored in the body is predominantly made from triglycerides. LDL carries triglycerides from the liver into the peripheral tissues and deposits it there; HDL carries it from the peripheries back to the liver for excretion. For this reason, hypertriglyceridaemia is commonly associated with high LDL and low HDL levels. High blood triglyceride levels are associated with increased risk for cardiovascular disease.
Symptoms & Signs
High cholesterol levels may cause few, if any, symptoms. Diagnosis is usually made through blood tests. Severe symptoms may include:
Fat deposits that form growths that look like yellow plaques in the tendons and skin.
Extremely high levels of triglycerides may cause enlargement of the liver and spleen, and pancreatitis, such as severe abdominal pain.
Can also cause symptoms of cardiovascular disease such as angina and hypertension.
Aetiology / Risk Factors
Major causative factors and risk factors that can contribute to dyslipidaemia (blood fat disorders) include:
Diet rich in cholesterol, saturated fat and trans-fatty acids
Excess calories in diet, particularly sugar and refined carbohydrates
Low fibre diet
Polycystic ovarian syndrome
Obstructive liver disease
Acute and chronic alcohol abuse
Poorly controlled diabetes and/or insulin resistance
Overactive pituitary gland
Nephrotic syndrome and/or kidney failure
Systemic lupus erythematosus
Medications (e.g., oestrogens, oral contraceptives, corticosteroids, beta blockers, anabolic steroids and isotretinoin)
Diet and Lifestyle
Dietary and lifestyle guidelines that may assist in the management of dyslipidaemia include the following:
Weight reduction where appropriate is essential. A Ketogenic Diet is a safe fat loss program that burns fat quickly, helps to lower blood triglycerides and increase beneficial HDL levels.
Maintaining dietary fibre is an important part of dietary management of dyslipidaemia. Water soluble fibres, taken with adequate water, swell in the stomach to create a sensation of fullness which helps reduce appetite. They also help prevent cholesterol absorption from the gut and promote ease of elimination.
Diets should also include soy protein because it reduces total cholesterol when combined with a low-fat diet.
Dietary intake of foods high in antioxidants is important as an inverse association has been found between dietary antioxidants and risk of CVD – vitamin E appears to be of particular value.
Omega-3 fatty acids (particularly DHA) from cold-water fish may be beneficial for lowering elevated triglyceride levels.
Permanent change in the amounts of saturated fat and cholesterol consumed is also required.
The Mediterranean Diet has been found to be beneficial in managing dyslipidaemia. This is comprised of whole grains, fresh fruits and vegetables, fish, olive oil and garlic. This diet is high in monounsaturated fatty acids and has been shown to increase HDL cholesterol plasma levels and reduce susceptibility to LDL oxidation.
Lifestyle modifications that are beneficial include increased physical activity, stress reduction and smoking cessation (tobacco use lowers HDL cholesterol).
A comprehensive integrated detoxification program involving both gut repair and liver regeneration may assist in the management and prevention of dyslipidaemia by improving overall hepatic function, and reducing the inflammatory stimuli of toxicity, dysbiosis and poor diet.
Professional Weight Management Program
A carbohydrate-controlled, Ketogenic fat loss program is an essential approach for those with severe insulin resistance, who will usually also be overweight or obese.
Reducing dietary glycaemic load will reduce insulin release and help patients lose fat, particularly visceral adipose tissue, thus helping to minimise the risk of many chronic illnesses.
Wellness Lifestyle Program
This program is for those of relatively normal weight (i.e. fat percentage) and activity. This approach is designed to maintain a healthy body composition and insulin sensitivity by utilising an anti-inflammatory diet, stress management and regular exercise, all associated with optimum health and longevity.