Statin Side Effects, Risks, and Alternatives

Statins ^[1] are a now famous (or infamous, depending upon your viewpoint) class of medicine used widely in American medicine. While studies do show they help reduce total and LDL (Low Density Lipoprotein) cholesterol and triglyceride levels, there are serious side effects to these medicines. They can lead to lethargy, headaches, muscle weakness, confusion, memory loss, and other side effects. More ominously, a recent study ^[2] of Crestor (a statin drug) showed an increase in type 2 diabetes rates for those using the drug versus the control group using a placebo.

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High Cholesterol Just Small Part of Cardiovascular Health Risks

Many people have the mistaken impression that high cholesterol is the biggest risk to your cardiovascular health. This isn’t likely true. There are a large variety of risks that are likely to be even more significant than high cholesterol levels. Many of them are not commonly tested for by doctors. Too many in the medical establishment have bought into “big pharma” pushing of statin drugs as the ultimate solution as they inaccurately believe high total and LDL cholesterol are the exclusive risk factors for cardiovascular diseases. As cardiovascular surgeon Dr. Michael Ozner points out in his book The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will) ^[5], many of the therapies and surgeries for cardiovascular disease that are common in the United States are probably unnecessary, raise health care expenses, and don’t really improve overall outcomes. Much better than surgeries would be to prevent cardiovascular disease in the first place. But there are many risks that must be managed.

As Dr. Ozner states, lifestyle and diet changes can do more to reduce cardiovascular disease risk than statins can do:

If we want to stop heart disease, we have to address the underlying causes: cholesterol levels, free radical production, inflammation. The good news is that, because heart disease is a metabolic disorder, all of these things are, to a certain degree, within our control. No one has to die prematurely from heart disease.

Preventing heart disease is in large part a matter of simply encouraging a healthy metabolism: eating the right foods, getting plenty of exercise, and avoiding chronic stress. And you can reverse heart disease the same way. Studies have shown this again and again, including one study published by Harvard-based researchers in the New England Journal of Medicine that concluded that lifestyle changes (diet, exercise, etc.) are capable of reducing cardiovascular disease risk by more than 80 percent—a figure which trumps even statin drugs, known to reduce the relative risk of cardiovascular disease risk by 30 to 35 percent.

Here’s a fairly complete list of common cardiovascular health risks. Note that high LDL and total cholesterol are just a small part of this list.

1. Elevated LDL Cholesterol
2. Elevated Total Cholesterol
3. Low HDL Cholesterol
4. Elevated C-Reactive Protein
5. Elevated Homocysteine
6. Elevated Blood Glucose (tends to indicate diabetes)
7. Elevated Hemoglobin A1C Levels (tends to indicate diabetes)
8. Insufficient Vitamin D
9. Insufficient Vitamin K
10. Elevated Triglycerides
11. Low Blood EPA/DHA (Omega-3) Levels
12. Low Testosterone and Excess Estrogen (for males)
13. Excess Insulin (tends to indicate diabetes)
14. Insufficient Blood Serum Nitric Oxide
15. Excess Fibrinogen
16. High Blood Pressure (hypertension)
17. Oxidized LDL Cholesterol

Before you fall into the trap of thinking that cholesterol is the only thing that matters and statins are the solution to your health problems, we strongly advise you read the following articles on cardiovascular health along with the rest of this article:

No More Heart Attacks! ^[6]

The Great American Heart Hoax (excerpt from Dr. Ozner’s book) ^[7]

How to Circumvent 17 Independent Heart Attack Risk Factors ^[8]

Cholesterol is Necessary for Human Health

Although many diet-conscious people realize that eating foods with high cholesterol can raise blood cholesterol levels, what many don’t realize is that the body itself creates cholesterol. The estimate is that the typical human of about 70kg weight (about 150 pounds) creates 1 gram (1000mg) of new cholesterol per day while consuming about 200mg to 300mg cholesterol via a typical American diet. So the self-created amount of cholesterol accounts for about 3 to 5 times as much as the typical dietary consumed cholesterol. Most of the approximately 35 grams of cholesterol in the human body is made by the body itself!

The human body itself creates cholesterol for a variety of needs. If it didn’t, the result would likely be fatal. Cholesterol is a critical component of cell membranes, myelin nerve sheaths, and even bile used to digest foods to extract fat-soluble nutrients such as vitamins A, D, E, and K. It is a precursor chemical to vitamin D and a variety of human hormones including sex hormones progesterone ^[9], estrogen ^[10], and testosterone ^[11].

Consequently, a low-cholesterol diet may not be enough to keep cholesterol levels low. Even a strict vegan diet which incorporates no animal products and therefore little to no cholesterol (plants make little to no cholesterol, unlike animals) is not enough to ensure that a human patient’s cholesterol levels will be healthy.

Overall fat intake must be severely limited to reduce cholesterol levels significantly. In particular, saturated fats and trans fats have a greater role in increasing blood cholesterol levels than unsaturated fats.

Further, not all types of cholesterol are viewed as harmful. HDL (High Density Lipoprotein) cholesterol is viewed as “good” cholesterol because it helps move fatty substances out of the blood and back to the liver. LDL (Low Density Lipoprotein) cholesterol is viewed as “bad” because it tends to get stuck on the lining of arteries and veins, causing the blood-flow-impeding blockage known as arterial plaque responsible for the disease atherosclerosis.

Lowering cholesterol too much can result in a wide range of medical problems including depression, anxiety, suicidal behaviors, violence, and hemorrhagic (bleeding) stroke. Generally these are not problems induced by low cholesterol unless total blood serum cholesterol falls below 165 mg/dL (milligrams per deciliter). However, if you start taking statins or other cholesterol-lowering therapies and notice any of these symptoms, you should consult with a doctor and request a lipid profile test (which in part measures cholesterol levels) immediately.

Statins Lower Both Cholesterol and CoQ10 Production

Statins work to reduce cholesterol by interfering with the chemical synthesis pathways that are used both to produce cholesterol in the body. However, those same synthesis reactions are also used to produce an important enzyme and antioxidant known as CoQ10.

CoQ10 is a critical enzyme for mitochondria to produce cellular energy. It’s also an antioxidant in aerobic environments, although it breaks down and starts being pro-oxidant and pumping out dangerous free radicals if there’s not enough oxygen.

CoQ10 supplements are really expensive, but should be considered for people taking statins. It is believed that a likely reason for many of the side-effects of statins is the lack of CoQ10 to allow adequate energy production in the mitochondria.

There’s a synthetic version of CoQ10 available for more than a decade that is better absorbed as an oral supplement than CoQ10, less expensive than CoQ10, and doesn’t break down into being a pro-oxidant like CoQ10 does when inadequate oxygen is available. It’s called idebenone and you can read more about it here ^[13].

Safer Alternatives to Statins

People who are having problems with statin side effects should consider trying both CoQ10 and idebenone supplements to see which works best for them. Also, they should look into alternatives that have fewer side effects such as red yeast rice ^[14] and omega-3 fish oils in order to reduce or eliminate their need for statins.

Exercise

Get some exercise each day. Take a 20 to 30 minute daily walk with a loved one. Pick up a sport that you can enjoy with a friend or loved one. Exercise tends to burn calories, thereby lowering triglyceride and glucose levels and indirectly lowering cholesterol.

Red Yeast Rice

Red yeast rice ^[14] has chemical compounds similar to statins, but at much lower dosages. It has been part of the Chinese diet for thousands of years, and as such has a much longer track record than high-dosage statins. It is usually packaged in 600mg capsules, and suggested dosages generally vary from two 600mg to four 600mg capsules per day.

Omega-3 Fish Oils

Omega-3 fish oils, including EPA and DHA, help reduce triglycerides and LDL cholesterol levels. DHA is particularly important for the neurological development of fetuses and human babies, so this nutrient is especially valuable for both pregnant and nursing mothers. Many fish oil products contain small amounts of cholesterol.

Recommended dosages of EPA/DHA generally range from about 900mg to 2700mg per day. For typical fish oil capsules that contain 180mg of EPA and 120mg of DHA per 1000mg fish oil, this corresponds to three to nine fish oil capsules per day. Some “high concentration” fish oil capsules can reduce the number of needed capsules by half or more, and many of these also have no cholesterol. However, they are significantly more expensive. Fish oil supplements may “thin” the blood, so if you are taking anticoagulant or antiplatelet medications such as Coumadin, warfarin, or Plavix, be sure to tell your doctor about taking fish oil supplements as they may affect the medicine dosage you should take.

If you like to eat fish, try to stay away from long-lived predatory fish such as shark, swordfish, king mackeral, and tilefish. They tend to contain high levels of mercury and pregnant women are advised not to eat them at all. Fortunately, few if any fish oil capsules have mercury contamination, unlike fish itself. Consumer Labs tested 52 brands of fish oil and found that none contained mercury, dioxin, or PCB contamination. See their article Product Review: Fish Oil/Omega-3 Supplements and EPA/DHA Fortified Foods & Beverages ^[16] for a list of the brands tested.

Green Tea Extract

Another supplement you may want to take to help lower your cholesterol levels and neutralize any trace levels of mercury in fish is green tea extract. The catechins in green tea have been found by researchers at Purdue University to help bind to and eliminate mercury from the body. They also found that black tea, soy products, and fibers such as wheat bran, oat bran, and psyllium have similar effects:

(from Impact of phytochemical-rich foods on bioaccessibility of mercury from fish ^[17])

The effects of phytochemical-rich foods on bioaccessibility of mercury in fish tissue (the amount of mercury that is released from fish into gastrointestinal tract fluid following a simulated digestion) were investigated using an in vitro digestion. Total mercury in the aqueous phase following a simulated digestion of fish with added food treatments was used to measure mercury bioaccessibility. Green tea extract (31–2000 mg), black tea extract (31–2000 mg), and soy protein (50–100 mg) significantly reduced mercury bioaccessibility by 82–92%, 88–91%, and 44–87%, respectively. Grapefruit juice (0.5–10 ml) did not reduce mercury in the aqueous phase. Wheat bran (50–1000 mg) decreased mercury bioaccessibility (84%); oat bran and psyllium reduced bioaccessibility (by 59–75%, 15–31%, respectively) at amounts greater than 500 mg. We therefore suggest that co-consumption of foods containing phytochemicals at the same time as fish that contains mercury may potentially reduce mercury absorption compared to eating fish alone.

Given this, it may not be surprising that cultures that consume a lot of fish, such as Japan and coastal China, also tend to consume a lot of green and black teas and soy products.

Catechins also help lower LDL cholesterol and raise HDL cholesterol. Perhaps more importantly, they also reduce the rate of LDL oxidization that tends to damage the LDL and cause it to attach to vascular walls forming atherosclerotic plaque.

Other Dietary Supplements that May Help Lower Cholesterol

Lowering carbohydrates in your diet can help lower the stores of cholesterol and triglycerides in your blood and liver. This also helps reduce your risk of type 2 diabetes.

Plant sterols can help impede gastrointestinal absorption of cholesterol. They don’t appear to affect HDL cholesterol and triglycerides, however.

Extra-virgin olive oil can help lower LDL cholesterol levels but leave HDL levels unchanged. Be sure to select extra-virgin as more heavily processed olive oils are often missing the substances that produce this effect.

Fiber products such as psyllium ^[18], glucomannan ^[19], beta-glucan, oat bran, pectin, and other soluble fibers tend to capture cholesterol in the digestive tract and expel it from the body before it can be absorbed or reabsorbed. Foods with high fiber levels along with high protein and low carbohydrate levels include most types of beans. Ground flax seed is also a good source of fiber and protein with low carbohydrates, and can be easily added to many foods without adversely affecting flavor.

There is some evidence that chitosan ^[20], made from shrimp, crab, and lobster shells, can also help reduce cholesterol and body fat levels by mechanisms similar to fiber products. However, the studies on chitosan seem to be less consistent than for other soluble fibers.

The downside to fibers and similar supplements is that they adversely impact absorption of fat-soluble nutrients. If possible, it is best to take fiber supplements an hour or more before and two hours or more after any meals containing fat-soluble nutrients and supplements to help reduce this effect.

Adding a small quantity of walnuts and almonds to your diet may also help lower LDL cholesterol, especially if you replace the calories from foods with saturated fats (cheeses, meat, etc.) with nuts that are high in polyunsaturated fats. For instance, rather than topping your salad with shredded cheese, toss in a handful of walnuts or almonds.

Niacin ^[21] can help boost HDL levels, generally at 500mg or more per day. While 500mg per day is probably not likely to cause problems for people with no liver problems, it is advisable to get metabolic test done periodically to look for niacin-induced liver damage especially for patients who already have liver troubles or are taking more than 500mg per day of niacin. Doctor-supervised dosages can range well beyond 500mg per day.

Guggulsterones (also called gugulipids or similar spellings) and artichoke extract are both reputed to increase the generation of bile. Bile production consumes some of the body’s stores of cholesterol. Combined with plant sterols and fibers, this may help the body dump more cholesterol into bile and then rid the body of the cholesterol-laden bile rather than reabsorbing the cholesterol. The result seems to be a lowering of LDL cholesterol without a lowering of HDL cholesterol.

Some additional information on gugulipid:

(from Natural Supplements Proven to Lower Cholesterol and Triglycerides ^[22])

Gugulipid was granted approval in India for marketing as a lipid-lowering drug in June 1986. Studies show it lowers total cholesterol and LDL cholesterol while elevating HDL cholesterol (the good cholesterol). It appears guggulsterones increase the uptake of LDL cholesterol from the blood by the liver. Studies in humans demonstrate that guggulsterone can produce a cholesterol reduction of 14-27 percent within four to 12 weeks, and a 22-30 percent drop in blood triglyceride levels in patients with high cholesterol and/or high triglycerides. A striking feature is its lack of toxicity. Unlike other cholesterol-lowering drugs, the administration of gugulipid has not revealed any significant side effects, liver damage or toxicity in human or animal studies to date.

As an example of one of the studies of artichoke extract:

(from Lower High Cholesterol With Herbs and Supplements ^[23])

A double-blind, placebo-controlled German study found that 1,800 mg of artichoke extract per day for six weeks significantly lowered total cholesterol by 18.5% compared to 8.6% in the placebo group and lowered LDL cholesterol by 22.9% compared with 6% in the placebo group. The ratio of LDL to HDL decreased by 20% in the artichoke group compared with 7% in the placebo group. There were no adverse effects associated with artichoke use.

We believe that even though many “safer alternatives” exist to statins for lowering LDL and total cholesterol and boosting HDL cholesterol, it’s important to get periodic blood tests to verify what is happening inside your body. You need the tests to verify the effect, adjust dosages, and detect any unusual and potentially harmful side effects before they cause significant damage. Fortunately, lipid profiles and common metabolic tests to look for kidney and liver problems are relatively inexpensive.

Future Treatments

In the future, some patients with unhealthy cholesterol profiles may use synthetic HDL and gene therapy based upon the population of a town in Northern Italy that has very low HDL blood levels yet little to no cardiovascular disease due to an unusual form of HDL containing a protein known as Apoliprotein-I Milano. See the article Synthetic HDL Cholesterol Reduces Artery Clogging In 6 Weeks ^[24] for more information. FDA Phase III clinical trials are expected to begin soon, so a medication based upon this form of HDL may be available in a few years. Gene therapy to modify human genes to produce this form of HDL are even further away, but look even more promising. Mouse experiments have found that the ApoA-I Milano gene causes a 65% reduction in vascular plaque buildup.

Summary

Before resorting to statins to lower cholesterol, try some of the available dietary supplements, diet, and exercise changes. There are a lot of options to try, so you may wonder what is most likely to work and what is most affordable.

In particular, we think that omega-3 fish oils, green tea extract, niacin, and additional soluble dietary fiber are all inexpensive dietary supplements that are likely to have a significant positive effect. Other alternatives exist, however some of them (such as guggulsterones and artichoke extract) are more expensive and don’t have as much research backing them up.

Cooking with extra-virgin olive oil can help at an affordable cost. Substituting more nuts such as almonds and walnuts for cheeses and other high-saturated-fat ingredients is also helpful. Using beans as a protein source rather than meat is also likely to be helpful due to their high-protein, low-carbohydrate, high-fiber combination and may even help reduce your food expenses.

If you must use statins, try to use the lowest possible dosage by combining them with alternative therapies per your doctor’s advice. Also be sure to supplement your diet with CoQ10 and/or idebenone to keep your mitochondria working properly and reduce the risks of many of statin side effects and to get retested for blood lipids periodically to ensure that your total cholesterol levels do not drop too low.

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Further Reading

VAP Test Improves Cardiovascular Risk Determination ^[25]

Life Extension Overstock Products: Mega EPA/DHA and Niacin ^[26]

Wikipedia: Cholesterol ^[27]

Wikipedia: Statins ^[1]

Should You be Taking a Statin? What the Crestor Study Really Found. ^[2]

LDL and HDL Cholesterol: What’s Bad and What’s Good? ^[28]

The Great Cholesterol Myth ^[29]

Low cholesterol levels have been associated with depression, anxiety, violent behavior, suicide and hemorrhagic stroke. ^[30]

Low Cholesterol, Depression Linked To Early Death ^[31]

Statin alternatives or just placebo: an objective review of omega-3, red yeast rice and garlic in cardiovascular therapeutics. ^[32]

Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. ^[33]

The Heart Scan Blog: Mercury and Fish Oil ^[34]

You asked: Does fish oil contain mercury? ^[35]

Omega-3 fatty acids found in fish are good for you; fish contaminated with chemicals is not. Dr. Judith Reichman has advice ^[36]

Impact of phytochemical-rich foods on bioaccessibility of mercury from fish ^[17]

Green Tea Lovers ^[37]

Tea catechins inhibit cholesterol oxidation accompanying oxidation of low density lipoprotein in vitro ^[38]

Cholesterol: The top 5 foods to lower your numbers ^[39]

Foods That Lower Cholesterol ^[40]

Can Artichoke Leaf Extract Lower Cholesterol?
Artichoke Leaf Extract Appears Promising, But More Studies Are Needed

Natural Supplements Proven to Lower Cholesterol and Triglycerides ^[22]

Lower High Cholesterol With Herbs and Supplements ^[23]

Wikipedia: Glucomannan ^[19]

Wikipedia: Chitosan ^[20]

Chitosan for Weight Loss and Cholesterol Management: Clinical Studies ^[41]

A new study linking pollutants found in fish to insulin resistance and type-2 diabetes may further turn people off fish and boost the omega-3 supplements market. ^[42]

Apo A-I Milano Better HDL Cholesterol ^[43]

Synthetic HDL Cholesterol Reduces Artery Clogging In 6 Weeks ^[24]

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These statements have not been evaluated by the Food and Drug Administration. The products mentioned in this post are not intended to diagnose, treat, cure or prevent any disease.

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