Although
statins get a lot of flak in the Primal health community, you have to
hand it to them. They may not cure cancer, or single-handedly save the
economy and bring back all the jobs, or render entire populations
totally immune to cardiovascular disease, but they do exactly what
they’re meant to do: lower
cholesterol.
And they’re very good at what they do. You want lower LDL without
changing what you eat or how much you exercise, or trying that crazy
meditation stuff? Take a statin. Do you want to hit the target lipid numbers to lower your insurance premium? Take a statin.
Except that statins lower cholesterol by inhibiting HMG-CoA
reductase, a crucial enzyme located upstream on the cholesterol
synthesis pathway. If that were all HMG-CoA reductase did for
us, that’s one thing. At least we’d know what we were getting ourselves
into when we filled the prescription. But the “cholesterol pathway”
isn’t isolated. Many other things happen along and branch off from the
same pathway.
Some would deem those other products of the pathway inconsequential
when you have the opportunity to lower cholesterol. Okay; that’s a
normal reaction given the widespread hysteria surrounding
blood lipids.
Still, I maintain that we should give the benefit of the doubt to our
physiology and assume the unfoldment of the body’s processes happens for
a reason, even when we’re unaware of the “benefits” or existence of a
particular process. There are a lot of moving parts in the meat sack
your consciousness calls home. Probably a good idea to let them happen,
or at least know what’s going on down there.
What else is downstream of HMG-CoA reductase?
CoQ10: Statins block CoQ10 synthesis. Because CoQ10
production is downstream from HMG-CoA reductase, statins interfere. This
is a problem, for CoQ10 is an endogenous
antioxidant and vital participant in the generation of cellular energy. It helps us generate
ATP to power our cells, tissues, and structures. Muscle contractions require it. Deficiencies in
CoQ10 have been
linked to heart failure and high blood pressure. Luckily,
supplemental CoQ10 is both widely available and,
according to many studies,
effective at countering some of the muscle-wasting effects of statins.
Squalene: Since squalene is the precursor to
cholesterol, blocking squalene production is an expressed purpose of
statin therapy. Good if you want to lower cholesterol at all costs, bad
if you enjoy the antioxidant effects of squalene.
Vitamin K2: Statins interfere with vitamin K biosynthesis. The pathway inhibited by
statin use is the
same pathway used to convert vitamin K into vitamin K2,
which is protective against cardiovascular disease. Interestingly, the
sites in the body where statin-related adverse effects predominate – the
brain, kidney, pancreatic beta cells, and muscles – also happen to be
typical storage sites for
vitamin K2.
Vitamin D: Since
vitamin D synthesis in the skin upon
UV exposure requires cholesterol, statins
may impair it. This hasn’t been studied yet, save for one
short term study
where statin users’ vitamin D levels were monitored for a month.
Although no changes were noted, changes in CoQ10 production take months
to appear after statin therapy and vitamin D production may require a
similar time frame to show changes.
Testosterone: Steroid hormone production is also dependent on cholesterol, and statin therapy is associated with a small but
significant reduction in circulating testosterone levels in men.
What are some possible side effects of statin therapy?
Statins may cause myalgia, or muscle pain. If you
listen to anecdotes from people who’ve taken statins, this is probably
the most common side effect. On the other hand, most clinical trials
suggest that muscle pain is rare. What can explain this discrepancy?
“Mild
symptoms… such as fatigue, myalgias, or mildly elevated CK (creatine
kinase, a marker of muscle damage), are usually not reported to the US Food and Drug Administration in a drug’s postmarketing period,” suggesting that “clinical trial estimates of these adverse events are an underestimation of the real world event rate.” In
some cases, statins even lead to rhabdomyolysis, a severe, often fatal
type of muscle damage which overloads the kidneys with broken down
muscle protein.
Statins impair adaptations to exercise. When you add
statins to an aerobic exercise routine, the normal improvements in
cardiovascular fitness and mitochondrial function are attenuated (
PDF).
Furthermore, due to the possibility of musculoskeletal pain and/or
injury, exercise also becomes less attractive and enjoyable. It’s no fun
working out – or even going for a walk – when you ache all over.
Statins increase the risk of musculoskeletal injuries. In a recent
study,
statin users (characterized by use of a statin for at least 90 days)
were more likely than non-users to develop musculoskeletal pain,
injuries (dislocations, strains, tears, sprains), and diseases. Another
study found similar results for statin use and
osteoarthritis, rheumatoid arthritis, and chondropathies.
Statins increase fatigue. In one recent
study,
a group of over 1000 healthy men and women aged 20 and older took
either statins or placebo. Those taking statins reported reductions in
overall everyday
energy and the amount of energy they were able to muster during exercise. These effects were more pronounced in women taking the drug.
Statins increase the risk of diabetes, with stronger statins having a greater effect.
Three mechanisms have been proposed. First,
statins reduce glucose tolerance and
induce both hyperglycemia and hyperinsulinemia. Second, certain statins
change how insulin is secreted by pancreatic beta cells. Third, the
reduction in CoQ10 impairs cellular function all over the body, leading
to dysfunction. These are features of statins. They may not all lead to
full blown diabetes, but these mechanisms occur uniformly across statin
users to varying degrees, and the
longer you adhere to your statin therapy the greater the risk.
Statins may increase the risk of certain cancers. Amidst
flashy, misleading headlines
claiming that statins could lower the risk of breast cancer based
entirely on an association between high cholesterol levels and breast
cancer from a study that didn’t even examine statins, we have
long term usage of statins actually increasing breast cancer rates in women and
overall cancer mortality in the elderly enough to offset the reduction in cardiovascular mortality.
Everything we know we only know because the pharmaceutical companies deign to provide it.
They control the flow of information. They have the raw data and
release only the published research that’s been picked clean and gone
over with a fine tooth comb. Actually, we don’t know what’s happening,
what’s been removed, and what’s been omitted because we don’t have
access to it. Seeing as how pharmaceutical companies have both the
opportunity and motive to omit or downplay unfavorable results, I’m not
confident we’re getting the whole story on statin side effects. For one
thing, large statin trials will often have a “run-in period” where
people who show poor tolerance of the drug are eliminated from inclusion
in the full trial. That’s just crazy. We
need trials
specifically looking at, or at least including, the statin-intolerant.
Side effects certainly are rare when you exclude the people who are most
likely to have them.
Okay, okay. Even with the potential for side effects, surely the benefit to heart health makes it all worthwhile. Right?
It depends.
Even though statins can reduce mortality from heart disease in
certain populations, they consistently fail to reduce all-cause
mortality in everyone but people with an established clinical history of
heart disease. For primary prevention in people without prior history
of heart disease, even those considered to be at the “highest risk”
(high LDL and such), statins
do not reduce all-cause mortality. Same goes for
the elderly (who seem to
suffer more depression and cognitive decline when taking statins). Nor do statins lower the total number of serious adverse events (
PDF), which
include death (from any cause), hospital admissions, hospital stays,
permanent disability, and cancer. That’s the story, time and time
again.
You might be less likely to die from a heart attack, but
you’re more likely to die from something else. It’s a wash in the end –
unless you have prior history of heart disease/attacks.
What does this mean for you?
If you’re currently on statins and notice any of the possible side effects listed above,
talk to your doctor
about cycling off. Your doctor works for you, not the other way around.
Express your concerns, come armed with a few studies printed out, and
suggest a trial period without statins to see how you respond under his
or her guidance. Keep them apprised of your status with frequent
updates. Turn it into an
N=1 self experiment.
Maybe it becomes a case study, even. Maybe you change your doc’s mind
about the realities of statin side effects; good documentation tends to
do that. Or maybe you realize that statins weren’t the problem after
all.
Statins may not hurt you. They may even help, if you’ve already had a
heart attack and you’re not elderly. I’m not saying you shouldn’t take
them. I’m only suggesting that if you’re experiencing any of the issues
mentioned above, you should probably consider
not taking them
with the help of your doctor to see if they resolve. And if your doctor
is pushing you to take statins because of some mildly
elevated cholesterol
numbers, think about all the important physiological processes that
occur along the same pathway whose inhibition you’re considering.
The narrative seems to be changing, though. Yeah, they
want to give statins to pregnant women and
there’s been chatter for years about putting them in drinking
water, but things are getting better. The pill-pushers have overreached.
Their latest curated guidelines for the primary prevention of
cardiovascular disease,
which looks suspiciously similar to the guidelines you’d come up with
if your primary goal was getting as many people taking your drug as
possible, are
receiving considerable push back from physicians in the UK. Mainstream doctors who write for TheHeart.org are
publicly questioning the utility of statins.
Statins have their place. I won’t deny that.
But they’re not for everyone and there are consequences, and I think people deserve to know that
Read more:
http://www.marksdailyapple.com/the-evidence-continues-to-mount-against-statins/#ixzz390sxL8pn
