Statins and vitamin D
The last post I wrote was on statin drugs and the couple before that were on the many benefits of vitamin D, one of which is the prevention of heart disease. According to a number of papers, statin drugs seem to increase levels of vitamin D in those who take them, which makes me wonder if any benefits that statins provide don’t come from this increase in vitamin D levels. If so, it would be a whole lot cheaper and a whole lot safer to simply take vitamin D3 supplements.
This issue reminds me of a talk on the mechanism of action of statins that I sat through at a medical meeting in Napa, California about 10 years ago. At that time researchers knew that along with their cholesterol-lowering capabilities statins also acted as anti-inflammatory agents. Statins increase the production of nitric oxide, an extremely short acting substance that has relaxing and anti-inflammatory effects on the lining of the arteries. The researcher giving the talk was from Harvard, and he had done a study in which he compared the nitric oxide releasing ability of l-arginine (an amino acid) and a statin drug. He found that the way that statins increased the production of nitric oxide mimicked the way l-arginine did the same thing. He proudly announced that his research showed for the first time how statins really worked to exert their anti-inflammatory effects. I wondered at the time why he didn’t just recommend that patients be given l-arginine – a natural substance with virtually no side effects – instead of statins? I would have asked the question, but this was a mainstream medical meeting, and I figured if I asked that question I might be stoned.
Thanks to this and subsequent research, we know that the anti-inflammatory benefits provided by statins can be had cheaper and more safely by taking l-arginine, available at health stores everywhere. ( Incidentally, know what the best natural source of l-arginine is? Wild game. Just another piece of evidence in favor of a Paleolithic diet.) And now we know that statins increase production of vitamin D, another heart-healthy substance.
Dr. John Aloia and his group (who did the study I posted about previously) noted that their African American subjects who were on statins had significantly higher levels of vitamin D than did those who weren’t on statins.
A total of 208 women were randomized to receive vitamin D3 (n=104) or placebo (n=104). 51 women were on statins. At baseline, the subjects on statins had a significantly higher 25-OHD level [a measure of vitamin D in the blood] than the subjects who were not on statins (51.2 ± 20.1 nmol/L versus 43.2 ± 18.0 nmol/L respectively, p=0.008). This was also true when averaging 25-OHD levels across the 3-year study period and looking at active and placebo patients separately. 185 subjects had follow-up 25-OHD levels drawn every 6 months during the study. Higher levels were seen in the statin use subgroup whether they were on placebo or active vitamin D. There was no interaction seen between vitamin D use and statin use, i.e. the impacts are additive (p=0.5502).
(Click here to read Dr. Aloia’s report, published in the American Journal of Cardiology a couple of months ago. )
It has been shown that patients on statins have fewer hip fractures as compared to those patients not on statins. Is this due to the increased levels of vitamin D? Probably, but no one knows for sure yet. And no one knows how statins increase vitamin D levels.
But I do know that I would much prefer to take a few grams of l-arginine and 5,000 IU of vitamin D3 daily than I would to take a statin. All of the benefits and none of the risk at a fraction of the cost. Hmmm. This isn’t rocket science – just common sense.
Hi and Merry Christmas!
Fo a post meno woman on Armour thyroid, are there any contraindications for the above supplementation?
Thanks.
Not that I can think of.
Merry Christmas back.
Cheers–
MRE
Hi Dr. Mike,
Here is an interesting study abstract: L-Arginine Therapy in Acute Myocardial Infarction
The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial
http://jama.ama-assn.org/cgi/content/short/295/1/58
Wondering if there’s more to it or bad luck?
Regards,
Alex
Hi Alex–
I’m familiar with this paper. There are too many variables that could have caused these problems – along with simply chance – that it would take to long to discuss in the comments section. The thing that raises my eyebrow about it is that it seems to fly in the face of known biochemistry and physiology, which always makes me suspect. And other papers have shown a positive effect with l-arginine supplementation. Were I in a post-infarct status, I would opt for the l-arginine myself in a heartbeat.
Cheers–
MRE
Another labeling and usage question. Most of the Vitamin D supplements I’ve seen just say “Vitamin D” on the labels. Are “D” and D3″ used interchangeably? Is that proper usage?
Vitamin D can be either vitamin D2 or vitamin D3. Most supplements now that contain vitamin D3 list it as such. If it says ‘vitamin D’ I would bet that it is vitamin D2, which is much less biologically active than D3.
Cheers–
MRE
I live near Seattle and have already started the vitamin D, as we’ve been told we are at higher risk for MS and it might help.
But what is D3?
Jeanne
Hi Jeanne–
Vitamin D3 is a more active version of vitamin D than the vitamin D2 that is often found in supplements.
Cheers–
MRE
I was put on Lipitor after a major stroke at 53. The pain almost killed me. When I dropped Lipitor, I also dropped the pain pills, the antidepressants, the tranquilizers and the sleeping pills. A later double blind trial proved what I already knew – Lipitor was the cause. Since then I’ve found that post meno women do not get much benefit, if at all, from statins. I tell my doc that I’m being intransigent about statins because of experience, not just Big Pharma phobia.
Most of my mother’s family had hypercholesterolemia (whew!) and most lived into their 80’s, one into 90’s and still going. We’re talking one of those HUGE early 1900’s families – 14 lived to adulthood. Most died eventually of strokes. I’m taking my chances, since 1/2 my Dad’s siblings died before 65, but Dad is almost 91.:-) Strokes vs cancer – hmmm.
Hi Sandra–
See an earlier lengthy post of mine. As far as I know there is no evidence that statins are helpful in women either pre or post menopausal. There is some evidence that they are associated with increased rates of cancer in people over 65. Also, in people over 65 it seems that the higher the cholesterol levels, the greater the longevity.
Cheers–
MRE
PubMed seems to indicate that L-Arginine has some wonderful benefits.
Is L-Arginine HCL the preferred form, or does it not matter?
Most of the supplements sold are l-arginine HCL variety, but there is some controversy as to what is the best form. A number of companies have their own proprietary forms of arginine – and all these companies claim that the HCL is an inferior formulation. I’m in the process of trying to get to the bottom of all this – I’ll keep everyone posted when I do.
Cheers–
MRE
Does Fosamax interfere with cal/mag/d3 supplementation in regards to osteopenia?
I think Fosamax is a lousy drug and would never use or prescribe it myself, so I haven’t bothered to research how it interacts with nutritional supplements.
Merry Christmas to all,
I wanted to mention that wild game may be a great source of l-arginine but if it is game that was shot with lead shot – there are real dangers of lead poisoning to those who consume it. New research on deer meat shows that lead remnants are found throughout the meat and are consumed by the predator, in this case California Condors and Eagles. I believe other research showed that children who regularly consumed “wild” game (shot with lead shot) had something like 5-10 points lower IQ than other children! I can supply references for this information if desired.
Hmm. I had never thought of this. I eat wild game from time to time that has been killed with lead shot. I almost broke a tooth once in Spain eating rabbit that was filled with lead shot. I would definitely be interested in seeing any data you have on this.
Thanks–
MRE
Interesting reading, Dr. Mike, especially since I also received the following article today reminding me of niacinimide’s potential use as an antioxident/anti-inflammatory, and its benefits for diabetics.
http://www.vrp.com/articles.aspx?page=LIST&ProdID=397&qid=&zTYPE=2
Just another reminder that it’s hard to beat natural substances. Thanks for keeping us informed, once again.
Interesting. Thanks for the link.
Cheers–
MRE
So this explains it!! I have been wondering for years how statins could help by lower inflammation, but other drugs that also lower inflammation (NSAIDs, steroids) also seem to increase heart attacks. I figured it had to be that statins lowered inflammation by a different means…..oh this makes sense!!
So many of the supposed benefits of statins, for those that can tolerate them, could be explained simply by the increase in Vit D!
I already take Vit D, but will check into the l-arginine!
Re: Lead shot in foods:
Now there is a delicious alternative to lead shot and wild game:
http://www.seasonshot.com/How.cfm
Not entirely sure how tongue-in-cheek it is, but it sounds like a healthier alternative to lead.
Now if we can only figure out how to shoot the birds on the wing with it…
Cheers–
MRE
Would arginine take me out of ketosis?
It shouldn’t; it’s an amino acid.
MRE
As to “no side effects”, what about herpes re-activation? From time-to-time I’ll read an encouraging article on arginine supplementation, forgetfully try it one more time, and soon get a sore on my lips. (The last product I used for a few days had about 3 mg of arginine in an effervescent form, and I was already noticing some improvement just prior to the inevitable lip breakout.) Is there some way around this side effect (?) that would allow me to use this enticing supplement?
Hey will–
Thanks for bringing this up. That is the one side effect of arginine, and I forgot to mention it. When I get back home I’ll see if I can do a little literature search and find out if there is a way around the problem. Or maybe a reader will give us some info.
Cheers–
MRE
Isn’t grass-fed beef also a good source of arginine? That would avoid the lead-shot problem.
It should be, but I’ve never really checked out grass-fed beef, so I can’t tell you for sure.
Cheers–
MRE
This is something – as a layman – I’ve been looking at since August. People diagnosed with high cholesterol should also have their vitamin D measured. Correcting a deficiency of anti-inflammatory is a no brainer before any patented pill.
You would think all doctors would feel this way, but, unfortunately, they don’t.
Cheers–
MRE
Humm. This seems wrong. The D3 warning part.
http://en.wikipedia.org/wiki/Cholecalciferol
Hey John–
That’s why I only link to Wikipedia explanations when I know they’re correct. Many aren’t.
Cheers–
MRE
I am rethinking my nutritional supplementation in light of your recent posts on D3 and my recent reading of The Protein Power Lifeplan (TPPL). In the book you viewed 400 IU of D3 as “optional” (p.410), but now you recommend 5,000 IU of D3 daily (in light of newer research, no doubt). Have your views changed since publication of TPPL on other key nutrients — types and quantities — particularly on magnesium, vitamin E, coQ10, alpha-lipoic acid, and vitamin C? Thank you. (And let me ask a silly question: What is the difference between an IU and an mg?)
Hi Ed–
No, other than vitamin D the recommendations remain pretty much the same.
An IU is just a different unit system than mgs, like the difference between inches and centimeters.
Cheers–
MRE
Hi there. Another question on D 3 supplements. I am hypothyroid and want to avoid soy and I eat lower carb. My Vit E capsule has a small amt of soyoil that does not bother me but a few of the versions of D 3 I saw had either soyoil or rice flour. Any particular brands you could recommend or can you comment on whether I can safely take the above?
Thanks and Happy New Year!
You should be able to take the one’s you’ve seen. There isn’t enough soy oil in them to spit at, so I don’t think they will cause any problems.
Cheers–
MRE
Okay, I bought some vitamin D. But then I read the relevant pages in “The Doctor’s Complete Guide to Vitamins and Minerals” by Mary Dan Eades, M.D. On pages 66 and 67 it says:
*…vigorous supplementation of vitamin D can lead to iron deficiency.
*Hypercalcemia, or high serum calcium, can occur from overuse (more than 1000 IU daily) of vitamin D in the diet. Symptoms can range from irritability to muscle spasm to actual seizure activity. Longer-term effects include calcification (or deposits of calcium) in the tissues (kidneys, lungs, arteries).
*Although some sources put 158,000 IU as the “toxic” dose, studies report that daily doses of as little as 10 times the RDA (or about 4000 IU) of vitamin D may cause loss of appetite, nausea, thirst, diarrhea, muscular weakness and joint pains.
I already get about 1000 IU of vitamin D daily from my multivitamin and my calcium supplements. If I add any more vitamin D to that regimen, am I asking for trouble???
Hi Merrylinks–
That’s the kind of disinformation you get when you read books by some offbeat quack. Your best off ignoring it.
Seriously, when MD wrote that book she used the latest info available than, which was almost 20 years ago. Since then the fears about toxicity from the newer dosage recommendations of vitamin D (especially D3) have vanished in the face of newer research. Also, the book has been updated since then, but MD didn’t do the updating.
Cheers–
MRE
Have been taking 1000 of d3 for almost a year, but was told at my last pe that my d level was only 22 and that was low. Doc advised increasing d supplements to close to 2000. Could my daily use of sod. bicarb.(1/2 tsp. in 8 0z h20) be interfering w/ d absorption? Or could it be the simethicone that I take for a lot of flatulence? Age 68, excercise 30+min. a day and eat a hi fiber diet; no meds other than vitamins and diovan 80. Jwo
It could a problem with bad absorption, but more likely simply not enough vitamin D3. Take your supplement with a meal containing fat for better absorption.
Best–
MRE
Taking L-Lysine together with l-Arginine could help avoid the herpes. Could you also please answer my question if we need calcium along with the D-3?
Vitamin D helps with the absorption of calcium. If vitamin D levels are where they’re supposed to be, usually calcium supplementation is not required. A high-protein diet also helps with calcium absorption, so a high-protein diet along with plenty of vitamin D decreases the need for supplementation.
Sorry it took so long to get to your comment. For some reason you got hung up in my spam filter.
Cheers–
MRE
Dr. Eades–you wrote, “when MD wrote that book she used the latest info available than, which was almost 20 years ago. Since then the fears about toxicity from the newer dosage recommendations of vitamin D (especially D3) have vanished in the face of newer research. ”
Did MD’s toxicity information come from studies? Was there something wrong with those studies? In other words, could you please explain why the old information is inaccurate and the newer information is accurate?
Thanks in advance for any enlightenment you can provide.
Hi Merrylinks–
The old studies were accurate, but they were using an older form of vitamin D, not the D3 available now.
Cheers–
MRE
I don’t know if you caught it or not but Rabbi is correct in pointing out that Lysine is recommended to counter-act any herpes outbreak problem when taking arginine.
I did indeed catch it. But I didn’t comment. Thanks for bringing it back to light.
Cheers–
MRE
Just saw this:
http://www.sciencedaily.com/releases/2008/01/080125223302.htm
which says that vit D supplementation may be kind of like ingesting steroids- it shuts down the body’s own machinery for making it and all the good that comes of the natural production cycle.
I’ve just found this article or I would have written sooner. I notice in your reply to “None Given” that you sneer at Fosamax. Sadly, that’s what I’m on. And here’s my analysis of why…
Almost 8 years ago, I was diagnosed with breast cancer. Tamoxifen killed my liver, so I was put on Arimidex and, aside from joint issues, was happy with it until my bone density test took a nose-dive. They put me on Fosamax. After 6 months I bottomed out. No energy. Felt like I’d been run over by a truck. Read about D. Had the doctor check me at the end of December and I was at 29. Got a rescue dog. Started walking 1+ hours a day. Started taking 3000 mg of D. Heard about magnesium. Started taking 750 mg. a day. (Also taking 1400 mg. calcium.) Just read that zinc can lower copper and cause osteopenia. Have been taking 65 mg. of zinc for YEARS. Will ace that off my supplement list.
Also during this time period, my BP went up to 140/100 and wouldn’t come down and my triglycerides hit 400. I’m now on Tricor (which I despise) and Amiodipine/Benazepril which has given me a lot more energy than before. But I hate it just because I hate being on ANOTHER drug.
I can’t help but feel like all of this is connected and inter-connected. I would love to know what I can safely do, since I’m afraid to risk going off the Arimidex, but would love to get off the Fosamax, BP, and Tricor. So, here’s my actual question:
What natural remedies (i.e. ginger tea nightly and CoQ10 in the AM) can I take to lower my BP to the point that I can (slowly and with doctor’s ok) move off the BP meds?
What should I be taking for my bone density, if not Fosamax?
How do I get those tri’s under control?
Thanks!!
For medico-legal reasons I can’t give specific medical advice over the internet. It looks as though you are making the circuit of various supplements in an effort to solve your health problems. In my opinion the most efficacious steps one can take are to gain control with the underlying nutrition, i.e., food, then start fine tuning with supplements. in reading your comment, it looks like just about everything that’s troubling you could be significantly improved with a good quality, whole-food low-carbohydrate diet. I would urge you to discuss this possibility with your physician.
I was idly curious about whether Vitamin D might be protective against hospital-acquired MRSA infection and came across an article about how statins might be protective against MRSA.
http://goliath.ecnext.com/coms2/summary_0199-7216110_ITM
I would be very surprised if this turned out to be the case after stringent evaluation. Statins have been touted for just about everything, it seems, until they are rigorously tested. Then you hear no more.
John Cannell and Vitamin D
I have noticed that, thanks to the efforts of Dr John Cannell, many mainstream docs in my area have begun to order Vitamin D tests and supplement when found to be low.
Satellite Maps of the Earth
Satellite maps of the earth showing UV Sunlight exposure correlate with serum Vitamin D levels, and the farther north, the lower the Vitamin D, and the higher the incidence of Cancer and Multiple Sclerosis in our population.
These NASA space satellite photos of North America color coded for UV sun exposure can be seen on Dr. Grant’s Vitamin D Web Site. Here, you will see a pattern remarkably similar to the incidence of cancer and multiple sclerosis. This is thought to be due to differences in Vitamin D levels. The farther north with less sun exposure and lower Vitamin D levels, there is an increased incidence of cancer and multiple sclerosis.
Diseases Caused by, or Associated With Vitamin D Deficiency:
Again here is the list: Osteoporosis, Hypertension, Cardiovascular disease, Cancer, Depression, Epilepsy, Type One Diabetes, Insulin resistance, Autoimmune Diseases, Migraine Headache, PolyCystic Ovary Disease (PCOS), Musculoskeletal and bone pain, Psoriasis.
Vitamin D deficiency has been reported in 57% of 290 medical inpatients in Massachusetts, 93% of 150 patients with overt musculoskeletal pain in Minnesota, 48% of patients with Multiple Sclerosis, 50% of patients with lupus and fibromyalgia, 42% of healthy adolescents, 40% of African American Women, and 62 % of the morbidly obese, 83% of 360 patients with low back pain in Saudi Arabia, 73% of Austrian patients with Ankylosisng Spondylitis, 58% of Japanese girls with Graves’s Disease, 40% of Chinese adolescent girls, 40-70% of all Finnish medical patients. (the above is from Dr Cannell newsletter)
Low Vitamin D in Florida?
Surprisingly, we have been seeing low vitamin D levels even here in sunny Florida demonstrated by serum 25-OH Vit D blood testing. These people avoid the sun for fear of skin cancer.
To read a synopsis of Dr John Cannell’s excellent work…
http://jeffreydach.com/2007/06/10/vitamin-d-deficiency–by-jeffrey-dach-md.aspx
Vitamin D Deficiency by Jeffrey Dach MD
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954-983-1443
http://www.naturalmedicine101.com
To read a synopsis of Dr John Cannell’s excellent work…Vitamin D Deficiency by Jeffrey Dach MD
Jeffrey Dach MD
Hi, Nite Jones: the best chance you have to lower BP naturally is by losing weight. Exercise would help, too, of course. But I doubt that any supplement would help, except perhaps celery seed and other natural diuretics. Good luck to you.
I have heard of a supplement Arginine Alpha Keto Glutorate (AAKG) which is supposed to be better than pure L-Arginine. Can you tell me more about this and if it does what is claimed i.e. burn fat and help build muscles? Thank you
Sorry, but I’ve never heard of it and have no experience with it.
You wrote that statins will increase plasma vitamin D levels. Vitamin D and cholesterol are both made from 7-dehydrocholesterol and if statins block formation of this precursor it might give a signal to rest of the body that there is a need for more circulating vitamin D and quick. So statins might accelerate the rate a person uses vitamin D from the storage.
What do You think?
Could be. I need to go back and recheck all the steps in these synthesis pathways. I was under the impression that 7-dehydrocholesterol was a derivative of cholesterol and not the other way around.
Did You find how and where 7-dehydrocholesterol is made in our body?
You were right that 7-dehydrocholesterol is made from cholesterol. Interestingly this paper:
“Provitamin D3 in Tissues and the Conversion of Cholesterol to 7-Dehydrocholesterol in vivo” from 1951 tells that 7-DHC is made mainly in the gut wall. What does this mean? Has dietary or cholesterol in bile acids a role in a production of this vitamin D precursor?
I haven’t looked into it yet. I’m not surprised to find that much of it is made in the gut wall because the gut is where a lot of cholesterol is made.
here are 2 studies to consider, in these particular settings
in AMI:
“L-Arginine Therapy in Acute Myocardial Infarction
The Vascular Interaction With Age in Myocardial Infarction”
JAMA. 2006
http://jama.ama-assn.org/cgi/content/full/295/1/58
There was no significant change from baseline to 6 months in the vascular stiffness measurements or left ventricular ejection fraction in either of the 2 groups, including those 60 years or older and the entire study group. However, 6 participants (8.6%) in the L-arginine group died during the 6-month study period vs none in the placebo group (P = .01). Because of the safety concerns, the data and safety monitoring committee closed enrollment.
with **long term** use in PAD:
“L-Arginine Supplementation in Peripheral Arterial Disease
No Benefit and Possible Harm”
Circulation. 2007
http://circ.ahajournals.org/cgi/content/full/116/2/188
Conclusions— In patients with PAD, long-term administration of L-arginine does not increase nitric oxide synthesis or improve vascular reactivity. Furthermore, the expected placebo effect observed in studies of functional capacity was attenuated in the L-arginine-treated group. As opposed to its short-term administration, long-term administration of L-arginine is not useful in patients with intermittent claudication and PAD.
and a letter to the editor:
http://circ.ahajournals.org/cgi/content/full/117/6/e157
http://www.hindawi.com/journals/ije/2010/957174.html
Dr. Eades, just read this very recent study, which contradicts your statements and shows no association between statins with improvements in vitamin D status. Please comment on this with an updated ammendum to your blog article.
Thanks,
Dr. S.
what do you think about the speculation that statin drugs can cause vitamin D deficiency?
New question: Is there a contraindication to taking more than 800mg of d3 if one is on a calcium channel blocker for hypertension? (asking for a 45 yr. old male relative)
Not that I know of, but I’m not the world’s expert on vitamin D.