Physician and neuro-imaging specialist Douglas Bremner explains on his blog why driving down your cholesterol score with statins might not be such a bright idea (Do Statins Make You Stupid?) or a sexy one (Statins Interfere with Orgasm, Live Update from the American Psychosomatic Society Annual Meeting, March 5, 2009). He writes regularly about medical issues at his blog, an offshoot of his book Before You Take that Pill: Why the Drug Industry May Be Bad for Your Health.
What does this have to do with ADHD? Maybe nothing. But I can’t help but suspect that adults with untreated ADHD have a higher risk of being prescribed statins. Here’s why.
First, though, I’ve often wondered why so many physicians fixate on lowering the cholesterol numbers even as they harbor no clue that our brains (and the rest of our bodies, too) need cholesterol. Moreover, they indicate little to no understanding of mineral and vitamin deficiencies’ effect on cholesterol and triglycerides. If they did, they might advise supplementing with magnesium and B vitamins before jumping on the statin bandwagon. If you have mineral and vitamin deficiencies, chances are that’s creating harmful effects throughout your body. But alas, our medical system does not excel at cross-disciplinary knowledge. (In other words, the cardio specialists know the heart but not always the brain’s effect on the heart — and vice versa; and few physicians are educated about nutrition and, thus, have much respect for it, either. )
Over the years, I’ve observed what appears to be an inordinate number of adults with ADHD who have been prescribed statins long before their ADHD was diagnosed (usually at their own or their partners instigation, not their physician’s). Of course, the same is also true of sleep apnea and other physical conditions that seem related to ADHD but haven’t been studied.
For example, some sleep specialists (including those at a nationally reknowned sleep center) would rather saw someone’s jaw in half (“Your airway’s too small!”) than cede ground to the brain and ADHD’s impact on dopamine. Yet, dopamine is increasingly thought to be a factor not only in sleep apnea but also Restless Legs Syndrome (more specifics on these in a future post), two conditions that also seem inordinately common in the adult ADHD population, if the support groups are any indication. In short, don’t go to a sleep clinic for an ADHD evaluation.
And I also wonder if people with undiagnosed, untreated ADHD might be prescribed statins in higher-than-average numbers. In other words, is ADHD a risk factor for high cholesterol, high triglycerides, and a host of other physically debilitating conditions?
While there will always be exceptions, the symptoms of untreated ADHD can conspire to create a dismal health picture. Low initiation and motivation often mean meager exercise or erratic routines (overdoing it for a while and then underdoing it). “Self-medicating” with sugar, sodas, and unhealthy snacks creates a host of health problems, including diabetes and yes, high levels of “bad cholesterol.” For these people, treating the symptoms of high cholesterol and triglycerides with medication is not solving the problem. In fact, as Dr. Bremner points out, statins can actually decrease cognitive function, not a good thing for adults who are already suffering cognitive impairments.
One reason many physicians say they resort to statins instead of guiding their patients in developing healthier lifestyles is: “People just won’t follow through!” But do these physician ever stop and ask themselves why some people can — and do — follow healthful routines — and some people cannot? In these cases, do they think to rule out ADHD? Not usually, in my experience.
(By the way, Dr. Bremner, a researcher and Professor of Psychiatry and Radiology at Emory University School of Medicine and the Atlanta VAMC, is also the author of The Brain Imaging Handbook, a glossy, illustrated primer on brain imaging. While suitable for clinicians and college-level study, I found it intriguing reading. Especially the captions.)
Tagsadhd and sleep apnea, cholesterol and brain function, douglas bremner, Health risks of ADHD, statins and ADHD, statins and brain function
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March 6, 2009 at 7:12 pm
Jeff
I think only Dr. Gregory House (http://www.fox.com/house/) takes into consideration the constellation of factors that may be causing a particular. Many real life doctors are way too busy probe into the depths of a patient’s life to find out what really makes them tick.
March 7, 2009 at 2:25 am
Dr Charles Parker
Gina,
Thanks for bringing Bremner’s interesting material to the table, with such an excellent review of this material on statins, stupidity and ADHD.
I can confirm, from my own watch on the passing ADHD scene, that sleep apnea is clearly related to ADHD, and just heard this week an interesting piece on NPR about sleep apnea and ADHD in children, with an evocative story about a child with enlarged tonsils changing dramatically in ability to concentrate with a tonsillectomy.
As you well know, ‘ADHD’ is just the tip of the iceberg, and reductionistic, simplistic thinking simply doesn’t cover the majority of presentations.
You are so correct about the observation that medicine is indeed caught up with the one trick pony in the complexity of brain function and ADHD. Everyone seem bent on simply staying with description, and even after good evidence for >20 years, avoiding the interesting findings with brain function. So many are treating appearances and missing brain function, basic medical process, and neurophysiology.
- Also wanted to further compliment you on your thoughtful. encouraging review of the Bremner’s Brain Imaging Handbook over at Amazon – it’s one that I haven’t seen and will look forward to hooking up with Dr Bremner – it appears we are much on the same path – I look forward to that meeting.
BTW, and FYI – will be interviewing Dr Russell Jaffe next week on CorePsych Radio. Russ is an MD, PhD and a molecular cellular physiologist… who fully understands ADHD brain function, neuroimmunity, and how to specifically measure for contributory antigens.
Thanks,
Chuck
March 7, 2009 at 7:19 pm
Doug Bremner
Hi Gina,
Our primary brain cells that are responsible for everything our brain does, including paying attention and everything else that goes into things like ADD, need cholesterol for their basic building blocks. There has long been a debate about whether very low levels of LDL cholesterol increase the risk of suicide, and whether cholesterol lowering with statins could cause that. More recently there has been an appreciation that statins can affect your think, which led to one physician stating that “Statins make people stupid” and led to another physician writing a whole book called “Lipitor thief of memory”. Since sexual function is controlled by the brain we shouldnt be surprised that this recent study showed that statins can affect this, and since ADD is a brain based disorder we should not be surprised that it affects this too. Granted I am not saying never take statins. In men with heart disease they reduce risk of death, in men with risk factors or women with heart disease they reduce risk of heart attack, but in women without risk factors they do little. However many men with “risk factors” would probably be better off without them. Use diet and exercise to reduce risk factors rather than taking statins.
March 9, 2009 at 10:28 pm
Gina Pera
Thanks for your comments, Dr. Parker.
I haven’t seen a recent study on tonsillectomy vis a vis ADHD/ sleep apnea, but one that was widely cited from a year or two ago did not convince me that the surgeons have this one right, as least as far as their claim: That tonsillectomy can essentially “cure” ADHD.
I think the study I recall had an n of 10, and the follow up consisted of about 6 months. Given no independent verification, I’m prone to suspect that the parents (who perhaps wanted to avoid ADHD medication) and the surgeons (who perhaps wanted to claim new territory in the growth industry that is ADHD) did a little wishful thinking.
Moreover, in my experience, kids with ADHD are more prone to having allergies. Once the allergies and ADHD are addressed, the tonsils often recede. The same is true for many people with ADHD I know who have had the various “soft palate” and other 16th-Century-sounding surgeries recommended by the sleep experts. They might get better sleep, but their ADHD remains.
But what do I know? I’m just a layperson observer. Maybe you even wrote a post about that at http://www.corepsychblog.com
March 9, 2009 at 10:33 pm
Gina Pera
And thanks for setting us straight on the statins, Dr. Bremner. A scientist friend of mine was trying to convince me they’re the bees knees, but I wasn’t so sure…
Jeff, do you think real-life doctors are too busy or most really don’t know the questions to ask? My personal physician has stopped taking insurance so the bean counters don’t dictate the way she practices medicine, and I pay out of pocket to see her. Health reform…where do we begin…