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Should we be Excited? or Skeptical?
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We all want the magic pill.
A recent video by board-certified vascular surgeon and cardiometabolic specialist Dr. Lily Johnston examined claims made by physician and science communicator Dr. Nick Norwitz about a 2024 dementia study.
Researchers reported a surprisingly strong signal for Alzheimer's protection with the cholesterol drug called ezetimibe, or more commonly, Zetia.
Dr. Lily Johnston recently looked at the same study and tapped the breaks.
Let's talk about it.
🧪 A New Look at a Promising Study.
This 2024 study wasn't originally about cholesterol.
Researchers screened FDA-approved drugs looking for compounds that might interrupt a protein interaction involved in neurodegeneration. Unexpectedly, ezetimibe emerged as a candidate.
In laboratory experiments, the drug:
reduced amyloid accumulation
reduced tau accumulation
increased autophagy (the brain's cellular cleanup process)
The researchers then examined a large healthcare database and reported that people taking ezetimibe appeared to have dramatically lower rates of Alzheimer's disease and related dementias.
If you'd like to read the study yourself, you can find it here:
https://agingcelljournal.org/Archive/Volume2/20240028/agingbio.20240028.pdf
That's pretty exciting.
🧪 The Skeptical Part
Dr. Lily Johnston reviewed the study herself and recommends caution.
Her first concern was that most of the evidence came from cell cultures and worm models rather than human brains.
Interesting biology?
Absolutely.
Proof that people avoid dementia?
Not yet.
She was even more skeptical of the human data.
The headline-grabbing result came from a retrospective billing database, not a randomized clinical trial.
That raises a number of important questions:
Were important differences between patients adequately controlled?
Were other medications considered?
Were all dementias grouped together?
Did people take the medication long enough before dementia developed to make a meaningful difference?
Johnston's conclusion was not that the study was wrong.
Her conclusion was that the study was generating a hypothesis rather than proving one.
If you'd like to watch her full discussion: https://youtu.be/Rzz2g9gRL_8?si=7SmMY3au_ve0QpsP
🧪 What About Other Evidence?
Johnston also points to broader human evidence.
A meta-analysis of 20 randomized trials involving nearly 140,000 participants found no significant reduction in dementia or cognitive impairment from LDL-lowering therapies overall.
Read more here:
https://www.acc.org/latest-in-cardiology/articles/2024/05/22/16/20/ldl-cholesterol-lowering
That doesn't directly disprove the ezetimibe findings.
The new study proposes a mechanism unrelated to cholesterol lowering.
But it does help explain why Alzheimer's researchers haven't suddenly embraced Zetia as a breakthrough prevention drug.
“It's not supplements... It is controlling blood pressure. It is managing and eliminating insulin resistance. It is exercise.”
— Dr Lily, May 6, 2026, YouTube: Is Ezetimibe the Secret to Preventing Dementia? Surgeon Reacts to @nicknorwitzMDPhD
🧪 Where They Actually Agree
What struck me most is that despite disagreeing about this study, both doctors ultimately landed in almost the same place.
Nick Norwitz sees an intriguing signal that deserves further investigation.
Lily Johnston sees an interesting hypothesis that requires much stronger evidence.
Neither believes a pill is likely to outperform the basics.
When it comes to reducing dementia risk, the strongest evidence still points toward:
managing insulin resistance
maintaining healthy blood sugar levels
regular exercise
quality sleep
overall metabolic health
That's not nearly as exciting as discovering a hidden Alzheimer's drug.
🧪 My Bottom Line
Maybe ezetimibe turns out to be important.
Maybe future studies confirm a completely unexpected role in brain health.
Or maybe this joins a long list of promising findings that never translate into meaningful benefits for people.
No matter what happens with ezetimibe, my takeaway remains unchanged: metabolic health comes first.
For me, that begins with food. Good nutrition, restorative sleep, regular exercise, and avoiding harmful exposures aren't nearly as exciting as a new breakthrough drug. But they remain the strategies with the strongest evidence behind them... and they're choices we can make for ourselves right now, today, without a doctor's note.
It would be nice to eat brownies all day and take a pill to make the fog blow away. But at this point, I believe this would never be good for my body and brain, even if it were possible
So I'll just keep eating like my brain matters.
And I hope you do, too.
I'm Glad You're Here
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Until next time, stay strong, wise, kind, and good.
Choose real food for real health.
Disclaimer: I am not a doctor, scientist, or nutritionist. I do not provide medical advice. I share personal experience and ongoing learning about health through real food.
Good morning!
I am a late boomer spreading the gospel of good health through good food.
My bona fides?
Beating back Alzheimer's by eating clean low-carb.
And dropping a little weight effortlessly as a bonus.
Real food for real health.
Join me?
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