In this talk, Dr. David Perlmutter challenges the long‑standing narrative that cholesterol is inherently harmful and should be minimized. He presents epidemiological evidence showing that higher total cholesterol levels in older adults are associated with substantially lower risks of dementia and mortality. A Neurology study of nearly 400 individuals aged 70+ followed for 18 years demonstrated a 69‑80% reduction in dementia risk for those with the highest cholesterol levels. He explains cholesterol’s essential biological roles—serving as a precursor to steroid hormones and vitamin D, maintaining neuronal membrane integrity, supporting neurotransmission, and acting as a neuronal antioxidant. Perlmutter also notes that low LDL (“bad”) cholesterol correlates with increased Parkinson’s disease risk. Finally, a Lancet study of people aged 85+ followed for five years showed a 48% lower mortality risk among those with the highest cholesterol. He concludes that cholesterol should be viewed as a vital component of health and longevity rather than a target for elimination.
Chapters
The war on cholesterol has been waged for the past couple of decades because cholesterol is obviously something very terrible. We've got to eliminate cholesterol in our foods and lower our blood levels of cholesterol to the lowest possible levels because if we don't, something terrible is going to happen. Well, that's not exactly true. It turns out that lower cholesterol levels are strongly associated with increased risk for becoming demented. Again, the lower the cholesterol, the higher the risk for becoming a demented person. Let's have a look at some science. This is a study from the journal Neurology that correlates the levels of cholesterol with risk of becoming demented, entitled High Total Cholesterol Levels in Late Life associated with reduced risk of dementia, meaning that cholesterol is very protective over the brain. It's a study of close to 400 individuals aged 70 years or older who were not on cholesterol treatment, and they were examined over an 18-year period of time, and they had 6 different evaluations, and they looked at these individuals after they measured their cholesterol levels at the very first visit. So in other words, six times during the 18-year period, they had measurements of their brain function, and they correlated this to their levels of cholesterol at the beginning. And what you'll notice here in this first graph is that those individuals with the highest cholesterol at age 70 years had a 69% reduction for being demented. At age 76 years. Those individuals with the highest cholesterol were at an 80% reduced risk for becoming demented. Those individuals by age 79 years who had the highest levels of cholesterol had a 55% reduced risk for becoming demented. This is very powerful information. We've got to understand that cholesterol is our friend. If you look at this slide, you'll realize that cholesterol is the precursor to our steroid hormones—things like cortisol, estrogen, testosterone, and even vitamin D—that cholesterol provides structural integrity and fluidity to the cell membranes, including the brain cells, the neurons; that cholesterol is important for neurotransmission—basically how the brain works—and it's actually a neuronal. Antioxidant, meaning it protects the brain. Now we often hear about so-called bad cholesterol or LDL, and it's interesting to note that studies have demonstrated that in Parkinson's disease, risk of Parkinson's disease is actually much increased in those individuals who have the lowest levels of so-called bad LDL or bad cholesterol. And finally, I'd like just to look at the risk of death, the risk of becoming a dead person. And in this study from The Lancet entitled Total Cholesterol and Risk of Mortality in the Oldest Old, meaning annualized risk of death in these individuals 85 years or older who were followed for 5 years, that looking at the lowest, meaning less than 193 in cholesterol, compared to the highest, Meaning 248. And just look at this graph in terms of who gets— who dies, basically. Those individuals with the highest cholesterol have a 48% reduced risk of dying during the course of this study. So I think it's very important that we reframe our understanding about cholesterol and understand that it plays a vital role in health and longevity, especially as it relates to brain and brain function. It's really important that we take a step back and stop castigating cholesterol. It's actually very, very important for health. I'm Dr. David Perlmutter.
