The statin madness infecting the greater part of the tribe of physicians has finally reached out and touched me personally.
We all hear horror stories about all kinds of occurrences, but, although we feel empathy for the victims, we don’t truly understand until it happens to us directly.
I’ve railed in numerous posts and to anyone who would stand and listen to me about the idiocy of prescribing statins to the vast majority of those they’re prescribed for. I read comments from female readers of this blog telling me how their doctors are insisting they go on statins despite there not being any evidence that statins provide any benefit to women. I hear about young men with no history of heart disease but minimally elevated cholesterol levels being put on a statin with the understanding that they need to be on this drug for life. This despite there not being any evidence that statins prolong the lives of those young men who take them.
Based on these examples and a thousand others, I’ve become convinced that prescribing statins is a reflex action for many doctors. And I have to shake my head because these are not benign drugs. In fact, they come with a contingent of fairly serious side effects, many of which can last long after the drugs have been discontinued.
But only now do I truly understand how dismally, unthinkably, reflexively stupid some doctors can be.
Here’s what happened.
My father, who is almost 86 years old, has been afflicted with a serious degenerative neuromuscular disease for many years. At this point, he is virtually totally paralyzed. He can move his left arm at the elbow maybe two inches, but that’s it. He can breathe, chew and talk, though his formerly deep voice is now barely a whisper due to the partial paralysis of his vocal cords. He requires round the clock care, which my sister and a cadre of paid caregivers provide. When we can, MD and I go to Michigan to do our turn of waking up every three hours during the night to turn him.
He recently had a very mild heart attack. It was the kind that doesn’t really change the EKG reading but does cause some heart muscle death as evidenced by elevated enzymes. He was in and out of the hospital in a few days and back home seemingly none the worse for wear.
MD and I arrived a couple of days before Thanksgiving, and he appeared to be his normal self.
Over the long Thanksgiving weekend, I noticed the urine in his catheter had turned a sort of darkish mahogany color. For several years, he has had an indwelling catheter placed directly into his bladder through his abdominal wall. One of the concerns of patients with permanent catheters is urinary tract infections, which he gets occasionally. So my first thought was that he had developed an infection. But he didn’t have any of the symptoms he normally has when he develops an infection. No fever, no bladder pain, no back pain. He felt OK—or at least what passes for OK in his state.
I was running through the list of everything that could cause such urine discoloration. One cause can be from drugs that are metabolized and released via the urine. I asked my sister if my dad was taking any new medications. She retrieved his discharge orders from the hospital. When I read them, I couldn’t believe my eyes.
He had been put on Lipitor upon discharge. And a large dose at that. 40 mg, which is half of the largest dose available. I immediately discontinued his dose and had the remainder of the pills destroyed so one couldn’t be given to him accidentally.
And it wasn’t even a thinking decision. The statin is hardwired into the discharge orders of everyone leaving the hospital after a heart attack. You can see below how it was done. This particular order spanned two pages, so I’ve sort of cobbled them together for better readability.
As you should know from reading this blog, the second sentence in these orders is a total and absolute lie unless you are a male under 65 years old, which my father at almost 86 is not.
Not only that, take a look at the recommendation for diet for those being discharged after having a heart attack.
Do these people not keep up with the literature?
Once I realized he had been taking a statin, a whole new possibility for his dark urine open up for me. He could have rhabdomyolysis. Rhabdomyolysis is a rare but frequently fatal reaction to a statin drug. It comes about if the drug causes muscle breakdown as it does in many people. Which is why a good percentage of people on statins have muscle pain and weakness. Most don’t break down a significant enough amount of muscle to cause problems. But some do. And those who do break down a lot of muscle release it into the blood stream where it wends its way to the kidney. The elevated protein from the muscle breakdown can the clog the kidneys and actually destroy them. Some people have to go on dialysis, others die before they get that chance.
One of the signs of rhabdomyolysis is a dark, mahogany-colored urine. As you might imagine, I became concerned. I know rhabdomyolysis is rare, but since the consequences are so disastrous, I wanted to eliminate it as a concern. Which can be easily done with a urinalysis. The best way is a blood test combined with a urine myoglobin, but I figured just a standard urinalysis that checked for protein would be okay. Unless he had a huge amount of protein in his urine, I didn’t really need to worry.
In my years in practice, I have had many, many doctors from out of town call me and ask if I could run a lab for them or do a quick X-ray or whatever, and I’ve always been more than happy to do so.
The doctors that I contacted in the area of Michigan where my folks live do not operate by that same code of professional courtesy. I called several urgent care centers, told them I was a physician from out of town and that I would like to bring a urine specimen from my paralyzed father in for a simple urinalysis. In each case, I was told that I would have to pay for the urinalysis and pay for the office visit and bring my father in.
I didn’t care about paying for the urinalysis or the office visit and told them that. As I explained, my problem was getting him there. He is totally paralyzed, which means we can’t just throw him in the car and drive over. We have to call and ambulance, get him loaded, drag him to the office, get him unloaded, get him in, get the urine, then do the whole thing in reverse. A major production just to get a simple UA.
No dice. Totally indifferent and absolutely not helpful.
I then called the doctor on call for his medical group. She called back, but didn’t have his chart available because she was working out of a town a hundred miles away. After I badgered her, she finally sent me to a lab halfway across town where I could get a carry-in UA done. I got the specimen and headed off. When I got there, I was met again with total indifference. There were no records for my dad. And the on-call doc hadn’t called the order in for the UA. When I finally got back through to her, I passed the phone to the gum-smacking, totally disinterested receptionists who took the order.
Of course, no one called me back with the results. I would really have been going ballistic had my father had any symptoms at all, but he was fine. Early Monday morning the home-health nurse came by to replace his catheter, which was a week overdue because she had been on vacation. When she pulled the catheter, it was obvious that it had been partially dislodged, probably during one of the bed changes or nightly turnings. Hell, for all I know, I did it.
Once he got his new catheter in place, his urine cleared and has been fine since. And just last night – Thursday evening, five days after I dropped off the urine specimen – I got the results. Only +1 protein, so certainly not rhabdomyolysis. Had I been able to get just a simple UA on Sunday, I could have saved myself a lot of angst.
The whole experience enlightened me as to what medical care is like now (at least in that part of Michigan). Sadly, it’s probably going to get worse.
But back to the statin prescription.
How could any doctor in his/her right mind write such a prescription for an 86 year old, totally paralyzed man who has normal cholesterol? Even one who has elevated cholesterol? After about age 50, the higher the cholesterol, the greater the longevity. So, again, why would anyone write a prescription for a non-benign drug to an elderly patient? Plus, the chance for rhabdomyolysis is greater in the elderly who take statins as well as those who are taking a ton of other drugs, as is my dad. It’s a set up for disaster with no potential upside to balance the risk.
It is blind stupidity to prescribe a statin under these circumstances.
And not just any old statin. The script was for a large dose of Lipitor, a fat-soluble statin. Fat soluble statins are much more likely to be involved in drug interactions, and they can induce insulin resistance and possibly cause diabetes. If you’re going to give an unnecessary drug, why wouldn’t you at least give one with the fewest side effects?
There are seven statins available right now. Five of them are fat soluble and two are water soluble.
Fat soluble statins
Atorvastatin (Lipitor)
Cerivastatin (Baycol)**
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Simvastatin (Zocor)
Water soluble statins
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
I doubt that one doctor in 500 who prescribe statins know there are lipid soluble and water soluble and which are which. Now you’re ahead of the game.
If I had to take a statin or prescribe one, I would certainly take or prescribe a water soluble one. These drugs pretty much pass through the kidneys unchanged, and since they don’t have to be metabolized in the liver, there is less likelihood of serious liver problems, which are a problem with the lipid soluble statins. And, as I mentioned above, the lipid-soluble statins are more inclined to cause drug interactions, insulin resistance and probably diabetes. Why use them at all?
Here is another list you might find helpful if you or someone you know is on a lipid-soluble statin and would like to switch to a water soluble one. These are the five most commonly prescribed statins. All these doses are equivalent. So if you’re on 40 mg of Zocor, then ask your doc to change you to 10 mg of Crestor or 80 mg of Pravachol. Remember, only Crestor and Pravachol are water soluble.
Dosage equivalents
Crestor 10 mg
Lipitor 20 mg
Zocor 40 mg
Pravachol 80 mg
Mevacor 80 mg
Here is a link to a comment in a previous post followed by my response. You can see the difference in outcome with a lipid- vs a water-soluble statin.
Lipid (fat) soluble statins make their way into the cell membranes, which are basically fats. But fats that are highly functional in terms of their relationship to the cells they enclose. Anything absorbed into fatty tissues is more difficult to get rid of than that absorbed into a water-based part of the cell. Whenever I think of these drugs socked away in the fat cells and cell membranes of the people who take them (unnecessarily), I always remember the words of Dr. Ernest Curtis, cardiologist and author of The Cholesterol Delusion, a book I highly recommend:
As severe as some of these short-term side effects can be, they pale into relative insignificance when compared to the potential long-term problems. The chief difficulty here is that no one knows what the long-term effects may be from altering the basic biochemistry of the human body over a period of time. Because cholesterol is the key element in the formation of cell membranes, which are the protective coat for the cells, it may be that blocking cholesterol’s production will weaken the protective barrier and allow the entry of toxins or carcinogens that were previously excluded. There are disturbing reports of increased cancer in some cholesterol-lowering studies, but, in fact, this process may take many years to play out. It’s enough at this point to acknowledge that the long-term effects are completely unknown. This is a risk that should receive serious attention before half the population is placed on these drugs, that, in effect, accomplish nothing more than low-dose aspirin or an extra glass or two of water each day.
** Cerivastatin was voluntarily withdrawn from the market in 2001 due to excessive deaths from rhabdomyolysis.
Dr. Eades – your father is very lucky to have a son who is a doctor who can fight for him.
My father is very lucky to have a daughter like my sister who is there for him always.
Yes he is. I have a close friend who nursed her similarly disabled mother until her recent death at 101. It is a great sacrifice but also a rare gift.
You are right for giving praise where it is due. I hope she sees this. Being a caregiver like her, can feel like a very thankless job. Kudos to her and kudos to you for recognizing her devotion.
I hope you send this blogpost to the prescribing physician!
I would have to send it to everyone on the list who uses that preprinted discharge order form. Yeesh. Talk about cookie cutter medicine.
Send it to the one who signed the order. Even if you tick him or her off, He/she will show the letter around to colleagues, and perhaps SOMEONE will get a clue!
I wonder sometimes if all MDs should be required to be a “mystery shopper” for health care annually. The problem is that coming through the Staff entrance for over time can make you indifferent to the problems of the people coming in the front door. I’m actually having that problem now with my primary and we’ll be switching soon.
Also, just as a random (and gentle) observation, why didn’t you change the catheter if it was a week overdue and showing abnormal discharge rather than running around getting a UA no one cared to let you do? Hindsight is 20/20 here, but this is somewhat the story of an MD rather than a nurse. 😉
And one last thought, as layperson who gets quite frustrated herself by bureaucracy of modern medicine. It’s quite possible that the walls you encountered in getting the UA done were far more correct than the loose “professional courtesy” than you are use used to and have granted. Legally, you don’t have the right to practice in MI nor are you your Dad’s formal physician (I assume).
Maybe the real issue here is that it’s dumb to require a physician’s order to have harmless testing like a UA done. Until then it’s not required, though, it’s probably good that someone can’t walk off the street and announce “I’m a physician from another state” and get any old testing done.
I thought the same thing about the mystery shopper deal. It would be a real eye opener for all of them.
I couldn’t change the catheter because it is an indwelling supra pubic catheter and I didn’t have a replacement. Nor have I ever changed a supra pubic catheter, so I didn’t actually know the process.
As a gentle observation, why didn’t you change the catheter if it was a week overdue and showing abnormal discharge rather than running around getting a UA no one cared to let you do? Hindsight is 20/20 here, but this is somewhat the story of an MD rather than a nurse. 😉
Anyway, I’m about to have another gentle observation as a layperson who gets quite frustrated herself by bureaucracy of modern medicine:
It’s quite possible that the walls you encountered in getting the UA done were far more correct than the loose “professional courtesy” than you are use used to and have granted. Legally, you don’t have the right to practice in MI nor are you your Dad’s formal physician (I assume).
Maybe the real issue here is that it’s dumb to require a physician’s order to have harmless testing like a UA done. Until then it’s not required, though, it’s probably good that someone can’t walk off the street and announce “I’m a physician from another state” and get any old testing done. What’s to stop me from doing that? The only barrier then is knowing enough of the formal language to pass as an MD.
Is the pwd not also the consumer of heath care products and pays for either directly or via insurance?
Fortunately I ordered my own addition to the annual “standard” blood work up labs as my primary care physician did not.
Turned out after I requested copies of all past lab results and evaluated them I had been an undiagnosed diabetic for nearly 12 years ’cause not one had ordered an HBA1c!
Needless to say the primary care physician and I had words when he discovered I had added additional testing to the lab slip and he was summarily fired.
Yes it is easy for medical care professionals to continue ordered routine labs and miss the boat entirely.
Now with beta cells depleted I am an insulin dependent diabetic… likely >12 years back I might have been diet and exercise controlled.
This is unbelieveable Dr Mike. Is your father continuing to take this statin ?
I’m due to have open heart surgery early January to replace my bicuspid aortic valve – I’m not looking forward to this surgery at all – but also not looking forward to the fact that they might give me a statin post-operatively, regardless, just because it’s often done post heart operatively. How can I resist ?
No, I discontinued the statin.
One can always resist a medication by simply not getting the script filled and refusing to take it.
Oh I will when I’m back home out of hospital, I mean what about when I’m in hospital ? How can I resist statins then ? I’ll be in hospital for seven days post operatively.
They don’t give statins IV. You have to take them by mouth. When the nurse brings them round, do whatever you think is right.
Just say NO! I refused multiple medications when I was hospitalized, It’s your body and your life, not just receptacle for pharma profit making.
Tell the doctor you do not wish to be given a statin while you are recovering from surgery so you will know if whatever you are experiencing is the result of the surgery or the result of a new drug. This is reasonable. (And later, you can choose not to fill the prescription.) Don’t swallow anything in the hospital unless you know what it is. They likely will try to bully you so you may need an advocate to be with you to ask questions when you are not feeling up to it. Good luck with the surgery.
You should not have to worry for Aortic Valve Replacement, you have made it far enough through the process to schedule surgery, if they were going to treat with Statins I imagine they would have already tried to start them. If it is “just an Aortic Valve Replacement” (I know, not to you) it is important that you take the blood thinners and get the blood tests as ordered to prevent problems with the replacement valve.
Blood thinners are not required if a pig valve is used but when I had my aortic valve replaced I was given a blood thinner in the hospital anyway. When I asked about it I was told that it was “only for a few months”. and then put on a schedule to have the level of blood thinner checked.
When i got out of the hospital I searched pubmed and found four studies that said that blood thinners are of no benefit for those with a pig valve and found none that claimed any benefit.. Blood thinners like warfarin interfere with vitamin K recycling and cause bone loss and calcification of arteries. I quit taking the blood thinners and took copies of the four studies to my surgeon who simply said “don’t take in then”.
The pig valve was put in seven years ago and works great.
I can only imagine your frustration. I hear many stories of family being out of the loop on decisions like that. All the worse when you know better than they do.
Yes, a real nightmare.
I’m sorry you went through such hell with your father’s treatment.
Thanks.
Not sure if you realize, you can get 100 reagent strips to do your own home urine analysis from Amazon.com for about $13. Save yourself from some grief.
Doesn’t solve the statin madness, however.
I know, but I couldn’t get them on the day I needed them. I tried calling a couple of drug stores, but they didn’t sell them. After this experience, I may start carrying them with me.
My parents and my husband’s parents are a few years younger than your dad, but something I’ve noticed about that generation is that they feel it’s inappropriate to ask their doctors “impertinent” questions. Their doctors know best, always. But I believe you’ll agree, Dr. Eades, that that’s a dangerous opinion to hold.
One of the things I’ve learned from reading your very fine blog over the past few years is that the only way to ensure quality medical care for myself and my loved ones is to fight for it. That means educating myself and then going toe-to-toe, if necessary, with doctors, insurance companies, and even my loved ones (who firmly believe doctors’ high level of training prevents them from ever being wrong). So I just want to thank you for the invaluable education and encouragement you have given me and so many others through this blog.
You have learned well. That’s the only way to do it.
Bless you Dr Mike for being smart/experienced enough to raise high-holy-hell when the stupid, stupid, pro forma medical establishment tried to kill your father!!
It just points up how IMPOSSIBLE it is for anyone, even someone with credentials in the system, to do actual patient management… {dismayed} {depressed} {disgusted}
God Bless you, Dr. Mike, for your courage. We can imagine the pressures you must face to stop your mission of revealing truths to a vulnerable public. We know you will continue to be strong!
Thanks. Hope you guys are doing well.
Some statins are also derived from mold so patients should be tested to see if they have a mold allergy
http://www.statinanswers.com/types.htm
http://en.wikipedia.org/wiki/Statin#History
Very true.
As a pharmacy student in a state that has a more progressive role for pharmacists in patient care, this is exactly where we pharmacists are trained to intervene. Making therapeutic interventions when physicians do not make the best drug choice for the patient are occurring hundreds of times a day with the pharmacists I work with. We are lucky that the hospital I am at also has pharmacists and interns specifically trained in discharge as opposed to a nurse who is not trained for such tasks. I write this because this post hit close to home and the more physician buy-in we receive, the closer our profession can come to achieving provider status and improving our coordination with our physician colleagues for the good of the patient. I am happy to hear it wasn’t Rhabdo and I empathize with your situation. Keep up the great blog and take care.
Thanks. I’m glad that at least in some states there is an extra layer of vigilance.
Hopefully you were able to get your father off this totally inappropriate prescription (given age, etc).
Yes. Thanks for reminding me. I was so caught up in the outrage of it all when I was writing the post that I forgot to mention that I discontinued his statins the moment I found out about them. I’ve added that to the post.
I’m a professional Patient Advocate/Health Care Consultant/Health Coach with a medical background. A lot of what I do is protect my patients from the medical system, both doctors and hospitals.
Though it’s still early on, right now the need for intervention is running 100%. That is to say, in every single patient I have been able to intervene and stop a medication, procedure .. something .. that would do them harm, sometimes serious harm.
I’m sorry to hear what the system is like in Michigan. It seems much the same here in Georgia.
Enjoy your blog, BTW.
~~~
Amazing. Thinks for commenting. At least I’m not alone.
Nice try Mike but after you exposed yourself as a misinformed novice on healthcare policy in your last post, this does little to correct the damage.
I have been a supporter of your positions and a reader of your blog for years.
I also have recently encountered the statin mantra of the Minneapolis/St. Paul medical community. That mantra is the 1994 4S Study! (Scandinavian Simvastatin Survival Study) the 4S Study! the 4S Study!
Two cardiologists and two primary physicians recently beat me over the head with this reference as they prescribed 80mg of atorvastatin and all patted each other on the back for this “evidence-based” decision. (I was recently diagnosed with CVD based on a 65% blockage in one artery and an LDL level in the “borderline high” area. I am a 67 year old female with a family history of heart disease.)
I searched your blog this morning for some reference to the 4S Study and found nothing. Having read it myself, I guess it supports their decision, but I am not an expert parser of research. Have you ever commented on it?
It’s no wonder they cling to the 4S study – it’s the first one to show an improvement, albeit very modest at best, in all-cause mortality, heart disease deaths and non-fatal heart attacks. Because virtually all of the other studies don’t show these benefits, Statinators cling to this one as if it were the Holy Grail while ignoring the rest. But, most people with good sense are a little wary. Why? Because only patients with relatively elevated cholesterol and low triglycerides were recruited, so the results don’t apply to those who don’t have elevated cholesterol AND low triglycerides. Plus the results of this study haven’t been replicated in other studies. And, relevant in your case, the most important benefit did not apply to women. Women made up 19 percent of the 4,444 patients recruited into this study. And none of them benefited in terms of all-cause mortality.
I want to scream when I hear the term “evidence-based medicine.” Talk about the last refuge of the ill informed. I can’t tell you how many self righteous twits have sniffed at me that they at least practice evidence-based medicine. All it really means is that somewhere there is a paper that backs them up. Or, much more likely, that they assume there is a paper out there that backs them up. Most of them are absolutely clueless as to how to even interpret a scientific paper, yet they are practicing evidence-based medicine. Give me a frigging break.
In terms of the S4 study, I wouldn’t say it is evidence-based medicine to rely on a single study that has never been reproduced in other centers. A study that used a fairly low dose of a particular statin, 20 mg Zocor (simvistatin) is being used in your case to justify using a large dose of a different statin, 80 mg Lipitor (atorvastatin). Based on the conversion tables, the dose the learned docs are prescribing for you is EIGHT times larger than the dose used in this study. Is that evidence-based medicine? Is there a study showing a huge dose of Lipitor works the same as a tiny dose of Zocor? See what I mean. I doubt that a single one of these ‘learned’ docs has even read the S4 study, much less any of the other studies on statins.
“Because only patients with relatively elevated cholesterol and low triglycerides were recruited, so the results don’t apply to those who don’t have elevated cholesterol AND low triglycerides.”
Is this what you meant? 4S subjects didn’t have high triglycerides?
The 4,444 patients recruited into the S4 study had elevated cholesterol (over about 265 mg/dl) and triglycerides under 220 mg/dl.
A Physician friend ( hospitalist), very close friend and myself do the gym 3x a week, plus many other hours together. I was discussing this issue and particularly the problems with sugar as relates to cholesterol, heart disease and mainly bringing up the questions about statins.
Recently, at the gym, My friend had a conversation with cardiologist, bringing up this whole matter.
Basically, the cardiologist agreed with all you say; the problem, he told my friend was the treatment required by studies.. He knew what you say is correct but was unable to go against the gold standard treatment, which is statins..The cardiologist said until a study unequivocally proved current use of statins wrong, he had to continue prescribing as dictated by the studies.
The bottom line: he feared lawsuits.
Gordon
P.S Now 74 years of age, my cholesterol is 145 and triglycerides are 115.. When I started exercise program 8 years ago, cholesterol 330 and triglycerides a stunning 770. Dedicated exercise and a study of food , the good, bad and ugly can be the best medicine available. Tks
So, let me get this straight. The cardiologist is waiting for a study showing statins kill people en masse before he quits prescribing them? The fact that the preponderance of studies out there show they provide no benefit isn’t enough, right?
That was the exact conversation which took place one week ago. !
Thank you for such an important post about an all to common and tragic pattern of prescribing and harm. You saved your father’s life, and I wish I’d been able to do the same for my mother, but she thought doctors were gods, especially those who were complimentary to her and who she wanted to please by being a “good patient.” That’s what cost her her life.
My robustly healthy 80 y.o. science fiction reading, web surfing, mother could not be convinced to refuse statin rx’s written repeatedly over several years by her primary doc despite my objections and even her endocrinologist’s. She had very low TGLs and very high HDL and “elevated” LDL at 78 and no heart or any other kind of disease. She was slim, very fit and made her way briskly up and down stairs, did exercise daily.
When she had severe muscle aches and her knee muscle gave up the ghost, requiring surgery, she refused to take more Zocor, though her doc assured her it was not the cause of her problems. Later, he convinced her to go on Crestor. She had hemorrhaging from her kidneys in short order, a painful histoscopy and was assured statins were not to blame.
She developed extreme fatigue, aches, pains and and markers of severe inflammation and her bicep muscle just detached or collpsed next. Finally, she stayed off statins for a brief time, but it was too late, and she was put on a high dose of Prednisone for about a year before tapering off of it for the resultant of her statin use.
Within a year of a completely normal, clear, perfect colonoscopy, she developed anemia and she had a colon cancer so large that it was painful while eating and blockage was so complete that only a (long delayed) virtual colonoscopy was possible. Her oncologist was in total disbelief that she could have had this cancer picture one year after a completely clear colonscopy.
It’s very likely that this endocrine cancer (adenoma) was caused by the statin or the Prednisone, both of which cause HPA axis and thereby immune dysfunction.
I won’t get off topic on the subject of what she suffered due to medical ignorance and outright incompetence before she died at 86. It was a gruesome insight to what passes for health “care” in the U.S. where drug companies own medicine and people pay with their lives if they are not vigilant or don’t even believe in the need for vigilance and refusal of what the doctor orders.
I’m really sorry for your loss and for what your mother had to endure.
Thank you for the topic and your vigilance about it.
And the forum to share instructive anecdotes.
[” It was a gruesome insight to what passes for health “care” in the U.S. where drug companies own medicine and people pay with their lives if they are not vigilant or don’t even believe in the need for vigilance and refusal of what the doctor orders.”]
It sounds simpleton, and even unreasonable to the brainwashed or uninformed. But I’m afraid the underlying theme here is just that .. medicine today is owned. Its owners are ruthless and powerful, and its American people who needlessly suffer and too often die from it.
Not that it’s all bad. But make no mistake, it’s dangerous out there.
Even doctors themselves are victims, to a significant extent. In many ways they are brainwashed, then browbeaten and backed into a corner by the system they have to operate in.
Thankfully, more and more medical doctors and others are beginning to speak out. We may not see any substantial change in the system anytime soon, maybe in our lifetime. But the more who become informed and defend and equip themselves, the better.
~~~
It can take on the appearance of a conspiracy, that’s for sure. What usually happens is this:
A drug company creates a product. Let’s use statins as an example. The undergo testing to get approved. During this process, a number of investigators become enamored of the drug. The drug companies seek these investigators out and pay them to express their opinions at various meetings and symposia. No one pays the naysayers, so, over time, the advice of these investigators (who are in reality paid marketers) influences many other physicians who have no real concept of what the scientific literature really says. As the mass of physicians prescribing the drug grows, more paid investigators are added to the ranks, and, sooner or later, a consensus opinion gets published. The consensus group is typically composed of all the paid investigator who are now the respected experts on the drug. The consensus then lays out how the drugs should be prescribed and for what. At that point, the rank and file physicians are worried about getting sued if they don’t follow the consensus view. That’s where we are now with statins.
I don’t understand why a doctor would prescribe a statin for a patient with a LDL of 78. Something’s fishy here. CAn you provide more details.
I found the line in your post intriguing: the higher the cholesterol at age 50, greater the longevity. My readings this year seem to be on the high side, and my doctor pounces on me at the first sign of high LDL. I am confounded by my readings as I am on a very clean diet, eating mostly at home and vegetarian. Looking back, maybe the 2 weeks before the bloodwork, i had feasted on ice cream a few times. Have stopped dairy, and added salmon to my diet since, but every time i tell the doc that no way am I taking drugs to reduce a small spike in cholesterol.
My readings were Cholesterol:270, Hdl: 58, Ldl: 188, cholesterol/hdl ratio: 4.7.
How do these numbers look to you, and anything I should we doing?
I’m sorry, but I can’t really give specific medical advice over the internet.
You didn’t include your triglycerides after fasting 12-14 hours, or your glucose.
Low triglycerides with high HDL are a pattern that is a marker for LDL that is large, bouyant and fluffy. It’s non atherogenic.
A Harvard-lead study author reported:
“High triglycerides alone increased the risk of heart attack nearly three-fold.
And people with the highest ratio of triglycerides to HDL — the “good” cholesterol — had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.
“The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio (Circulation 1997;96:2520-2525).”
My dr. wants me on statins, but I don’t argue. I say ok, fill the prescription, paid by my insurance, and then sell them back to the pharmacist at a generous discount. The Drug company, the doctor, the pharmacist and myself make money.
So much of what you have written is also in the experience of myself and my immediate family members so I can deeply empathize. I am so sorry for the difficulties your father, your sister and yourself are experiencing. For better or worse, at least you are an MD and therefore command somewhat more respect from fellow MDs–imagine what non-MDs or worse homeopaths, herbalists and acupuncturists (me) experience when advocating for one’s elderly relatives within the conventional medicine arena. It might even be funny if the consequences were not so dire (my mother nearly died in agonizing pain because they would not listen, and that was just the last of many malpractice events she has suffered.)
I have no answers beyond constant and extreme hyper-vigilance… that and being constantly girded for war, but on the other hand, we all know how damaging such hyper vigilance and preparedness for battle can be. So how to balance? I don’t know. And given my personal and professional lives, it’s a constant koan.
That’s why I and my fellow tribe members are so grateful when we find one such as you. Please keep advocating reason, logic, human intelligence and compassion just as you have been doing. It may sometimes seem like an impossible and insurmountable challenge, but the change must start from somewhere. Thank you for your work.
My family lives in Michigan. I would appreciate a private email letting me know the general area where this happened, if you feel you can.
I can tell you that even with the MD I got no respect and no help.
It happened in the Farmington, West Bloomfield, Birmingham area.
I figured as much. It’s a bit better in the North, I think, but still not as we would wish.
About fifteen years ago, in the walk-in I worked at that time, I noticed that the other physicians put every single patient on a statin – thereby making sure that they became permanent patients. i would go around, give my little talk about diet and exercise and bad side effects, and would take every patient off the drug. And I always had good reasons: They basically all had unexplained elevated liver function and muscle enzyme tests.
Sad to hear that since then things have not improved, but have become worse! Thank you for you work!
Alexa Fleckenstein.
Thanks for all your ground zero educational efforts.
A different statin question – a close friend had a couple of instances of a-fib and has been placed on a statin (20mg Zocor) because statins supposedly reduce stroke incidence, and stroke is a possible sequela of the poor atrial clearance when fibrillating. In your opinion, doctor, is this a reasonable use of statins? I talk with him frequently, and watch for any cognitive impacts (none so far) but his muscle endurance is dropping, which does concern me. If there really is a potential benefit to statins in such a case, I’ll sit down and shut up. But I have serious doubts about the risk:reward ratio. Thank you.
In my view, it isn’t a reasonable use of statins. Why not treat it with an antiarrhythmic drug to stop the a-fib? Does this doc really think that if the patient throws a clot as a consequence of the a-fib, a statin might prevent it?
I had a similar experience with my Dad who passed away in July of 2012. In April of 2012 he had a fairly major heart attack at age 88. He ended up having a triple bypass from which he recovered fairly well. After he was home he couldn’t remember things like how to use his computer and he just seemed to be out of it in other respects. He was living in Iowa near my sister and I was 130 mi away in Illinois and didn’t realize that they had put him on a statin after the surgery.
As a point of background, his total cholesterol had been above 300 for over 50 years. And being quite well read on alternative medicine, he had never consented to taking a statin, and I seriously doubt he knew he was after his surgery.
He did pass away 3 months after the surgery, but it was from complications of his chronic lymphocytic leukemia which he had also lived with for over 30 years.
After reading Dr. Malcolm Kendrick’s book “the Great Cholesterol Con” a second time, I’m convinced my Dad’s memory problems were due to the statin. As you said, why would you prescribe this to an 88 year old??
Pitiful.
I hear so many stories of people not being able to think straight once they’ve had multiple bypass surgery.
When I hear of a multiple bypass being done on an 88 year old, I wonder if it was really for the patient’s benefit or to help the surgeon pay for Christmas in Ibiza.
Since at age 88, the patient is on Medicare, no one – not the surgeon, the hospital or the anesthesiologist – will make enough to have Christmas in Baton Rouge, LA let alone Ibizia.
He was on a balloon assist (I believe that was the term) after the heart attack to help the heart pump, and I do believe the bypass was his only option. Very true about Medicare.
I am a physician also and it has upset me over the years with the lack of professional curtsy that is no longer available. Things have really changed in the past forty years.
Physicians are now required to be cookbook by the Federal Government. We HAVE to give out the guidelines that your father or received or be docked (return all charges from an admission, just because statins were not given) if caught on chart review plus fined. AND open the hospital and yourself to having every admission audited for paying back money and fines.
This can go into the millions of dollars quite quickly.
SO, it is necessary for the physician to write this. I once would have told the patient not to take them, but with the medico-legal climate, I could be sued for this, if they have a heart attack or stroke, even if they quit taking blood pressure medications and have a 220/150 blood pressure.
You are doing a service to everyone with the information on your blog. I personally follow it, but am restrained from utilizing it for my patients.
I am an ER doctor now, and really do not establish long term relationships with patients, but tell them to follow up with their regular doctor for further care.
Thanks for commenting. At least as an ER physician, I would assume you don’t have to initiate statin therapy. You can leave that to their regular docs.
Unfortunately we are required to start statins. If someone comes in with chest pain, they are given 40 mg of Zocor, per standard of care.
Jesus wept.
My doctor tried to put me on statins as a 37 year old healthy pregnant woman with no family history of heart disease and only slightly elevated cholesterol. I told her to stick it in her ear.
Brava! I can’t believe any doctor would put a pregnant patient on a drug that fundamentally alters a major metabolic and synthesis pathway. That one takes the cake. Wonder how my other pregnant patients this doc got to take them? And wonder about the kids who were in the womb at the time.
Good girl!!
~~~
Dr. Mike, I love your take no prisoners stance and your passion for truth. Thank you! And keep ’em comin’ 🙂
I have been a nurse for 30+ years. In my experience, most Drs don’t care what our very well educated pharmacists have to say, they practice according to the information given to them by the drug rep at a nice dinner. The drug rep, who may have a fine arts degree or who knows what, has been carefully educated by the drug company. And changing a suprapubic is easier than a regular Foley, but you must have the supplies. However, in your defense from the gentle reader, changing it in 4 weeks or 5 weeks is no big deal, you give no indication of the catheter not draining well. I’m very sorry about your father’s situation.
Just as there are many procedures Drs feel comfortable doing that nurses don’t, there are many that nurses do that docs don’t feel comfortable with. Or have little experience with. That’s why there is a specialization of labor. Had I know how to change my dad’s suprapubic catheter and had I had the supplies to do it with, I would have. But I failed in both respects.
I just wanted to remind you now that 2013 is winding down that you are one of my heroes. I’m 80, lost 145 pounds on Protein Power, and I maintain that loss. I have genetic heart-disease and, not surprisingly, had a big heart attack in July 2010.
One night in the hospital was enough to scare the hell out of me so I did the AMA (against medical advice) form in the morning and hobbled home.
Three-and-a-half years later, I’m toned, work out six-days-a-week (weight resistance), eat gobs of fatty meat and butter, and take not one drop of medication.
All that’s lacking in my life is a nice fit 80-year-old guy but you can’t help me with that one.
I am happy to learn of your great success. I wish I could help with the fit 80-yr-old guy, but I can’t. Maybe one of the readers here will, though.
This is infuriating and scary. Here you are, a physician, and actually kind of famous, and even you can’t get courtesy or service from healthcare system personnel. Doesn’t leave much hope for the rest of us. I agree with the poster who said the only way to get good care is to educate yourself and fight for it. I think if you have a health condition, you better do your homework and find out everything you can about it, because that is the only way you will know if your doctor knows everything he/she needs to know to provide you with proper care.
I was at a talk a while back given by Dr. Peter Langsjoen, an expert on CoQ10, and he said “Statins are the worst drug ever created. They are poison. If you have been given a prescription, throw them in the garbage, or give them to someone you don’t like”.
What a pain it is fighting Big Pharma!
My healthy 87 year old mother is on statins and it drives me crazy. Unfortunately I do not have the power to make her stop taking them.
As for myself I have politely declined my doctor’s recommendation for my 250+ cholesterol readings and happily did a heart Ct scan to put her at ease. My Coronary Calcium CT score = 0
My husband is also on statins. At 62 he has elevated cholesterol (220-ish? and a family history of heart disease. His heart Ct came in elevated which makes it more difficult to fight the recommendations. I do believe his severe tendonitis in both elbows might be a side effect, what do you think?
Hard to tell about the tendonitis without more history. Could be, I suppose.
Great Post Dr Eades.
Their has been a massive reaction in Australia since your i/v with the ABC science show.Now doctors here have noticed a spike in people trying to get off their statins..but..the Australian Heart Foundation are repeating the party line..evidence be damned.
“”I think the really disappointing and very serious issue is that incorrect information which, in our view, was brought out by the Catalyst program, can influence people into things which they shouldn’t be doing,”
http://www.abc.net.au/news/2013-12-03/survey-shows-patients-off-heart-drugs-after-abc-catalyst-program/5130670
Also, by the number of stories popping up “randomly” recently..it appears that big pharma is working its PR magic.
Like this one
“Taking statins or having a low-cholesterol diet could help lower the risk of breast cancer and make treatment more effective, according to scientists. ”
http://www.theaustralian.com.au/news/world/link-made-between-cholesterol-and-cancer/story-fnb64oi6-1226771546289#
I’m so frustrated by the whole statin thing I can’t tell you. My brother had a triple bypass at age 46. He’s now 60. He’s been on loads of statins since his 40’s. He can’t remember anything! For years I’ve been trying to get him off statins which has lead to many heated arguments, so I’ve stopped.
When our father who had Alzheimer’s and prostate cancer was at the end of his life we had to BEG his doctor to cancel the statins. We were trying to stop over medicating him. My brother was ok with this because he felt there was no need to protect him from a heart attack. We both had medical power of attorney and had to literally beg and request many times before it was granted.
Lastly-I’m 57 and have been about 40 pounds overweight my whole life. Since my mid 40’s Kaiser has wanted me on statins. I’ve refused all medication. I’ve switched doctors three times to make sure my wishes are followed. I’ve had every cardio test there is every couple of years and guess what, there’s never been evidence of any blockages in spite of my high cholesterol. My tryglycerides, blood sugars, and HDL have always been good. If I hadn’t been insistent I’d have been on a drug unnecessarily for over 10 years.
I have real concerns about the folks of my generation being loaded with “preventative” drugs for 20-30 years.
But hey, what do I know…I’m a chef!
Anyway, hope those of you with a voice get traction.
Go get an EBT scan of your heart and learn your calcium score. If it’s zero, then you have no worries and you can ease your mind.
Where I live, it’s not always easy to get this test or that test. I spent a year trying to get my endo to order a simple C-reactive protein test. And my former doctor wouldn’t order a C-peptide test when I was Dx’d with diabetes. I had to enroll in a clinical study at Joslin to get it.
They all use the same argument: “I wouldn’t treat any differently regardless of results of the test.”
If you manage to get a test by paying for it yourself (like NMR lipid test), they don’t know how to interpret the results.
Sad, but often true.
no imaging test is 100% perfect. Dont know your story, but In the face of risk factors and abnormal lipoprotein trafficking (,by NMR) i would NOT “have no worries and have my mind eased”. The absence of disease on imaging studies in this circumstance would only slow the aggressiveness of treatment, not obviate treatment at all. Find the nearest Board Certified Clinicla Lipidologitst at http://www.learnyourlipids.com (there are many NLA members listed, look for the Baord Ceritifed ones)
(Unless you’re in NY, where they’re restricted,) go join Life Extension Foundation (lef.org) (not so much for their magazine which has NEVER addressed Gary Taubes, and makes me really question their dedication to medical science) but for their lab test orders! I’m uninsured, so I have to manage my own health care. LEF sells lab test orders which you carry to your local lab (same one your doc writes a lab order to ‘LabCorp’ in my case) for the blood draw, and they send the results to you (and a copy to your doctor if you direct them too).
I made the mistake once, when I was getting thyroid meds prescribed for me of nearly running out, so calling my doc and asking him to write a refill scrip. His nurse said: not without a current blood test result. (Argh.) Since I was going to be out of pills in a week, I vacillated about ordering the lab test from LEF online, which would take a day to be mailed to GA from FLA, then getting the blood draw, then a couple days for the results to be mailed. So, I said, okay-sure, have the doc write the lab order: “Free T3, FreeT4 and TSH.” I picked up the order on the way to the lab, and to my HORROR, the lab charged me nearly $400! But since it was my fault I’d waited so long, I put it on a credit card.
When I got home, I price-checked LEF — those same three tests would have cost me only $83! Exact same lab, exact same tests – and a $300+ difference in price!
I had this test recently and came back with a high score. I have since been to a cardiologist for further tests. I’ve already told him no statins. In researching the test, I came across this quote concerning the limitations of the test:
“CAD, especially in people below 50 years of age can be present without calcium (non-calcified plaque) and may not be detected by this exam.”
The above quote is from RadiologyInfo.org on their article on Cardiac CT for Calcium Scoring. It is near the bottom of the 3rd page of the article. Here is a link to the article:
http://www.radiologyinfo.org/en/info.cfm?pg=ct_calscoring
It can be, but it’s unlikely. And the calcium score is a much better diagnostic tool than a bunch of cholesterol measurements. I would be a little leery of the site you linked to because it treats all CT scanners equally. I wouldn’t get a calcium score on a standard CT scanner. Way too much radiation for a simple diagnostic scanning procedure. Look for an EBT scanner. They provide better resolution, reproducibility and very little radiation.
some have speculated that statins may cause temporary memory loss, but there is no solid evidence of this. anecdotes do not = evidence. Statins PREVENT dementia in large trials, and certainly do not cause alzheimers. Weight may not have anything to do need for statins. Given your family history,you need advanced lipoprotein analysis by a Board Certified Clinical Lipidologist (find one at http://www.learnyourlipids.com) using Health Diagnostics Labs testing (myhdl.com. i do NOT recommend other types of advanced testing, such as VAP or Berkeley.) See my comments below. when used appropriately statins are both safe and effective. period.
And that pesky black box warning of memory loss on all statins placed there by the FDA has no scientific validity?
“Statins PREVENT dimentia?” Statins “do not cause Alzheimers?” “When used appropriately statins are both safe and effective. period.?”
God help us all.
~~~
“See my comments below. when used appropriately statins are both safe and effective. period.”
Whoever said something like that to me, especially a doctor, would be immediately disqualified from giving me any advice. Ever. About anything. Even how to eliminate my golf slice.
Obama learned his lesson, and I hope you eventually will, too.
Wow, thanks!
What’s a EBT scan? I’ve had the one where they do a kind of MRI on my heart, where they inject a die and then take pictures of my heart and arteries. That came back all clear.
Sounds like you had a virtual angiogram. The EBT is non-invasive procedure that visualizes the plaque without exposing you to the radiation the virtual angiography does.
My husband is pre-diabetic his total cholesterol was less than 200 and doctor had him on statins, Got fatty liver disease and doctor took him off. He lost weight and liver stats better. Doctor put him back on statins and he was limping again. Today no statins. Medicare is calling to take simvastatin and he says no.
Watching TV found out ways for better lipid blood tests:
1. Take fiber night before
2. Start eating nuts and red wine for higher HDL (good)
3. Eat fish and stay away from red meat and eggs two days before test.
Happy without statins
Sorry for Dad and surprised as I am from Birmingham area, but my 90 year old mother was told to think about statins. I said no, no.
Be thankful he isn’t in a nursing home where MD’s are only obligated to “visit” once a month, where in the ‘visit’ is reduced now to “treating the chart” that is compiled by nursing staff that for whom english is a 2nd language. On top of that the MD’s now are sending (largely unsupervised in practice) NP’s in their place for their single “chart visit” monthly now with increasing frequency. I had one MD’s NP prescribe two highly nephrotoxic antibiotics empirically… no culture …which needlessly put my mom in acute renal failure. This isn’t about a single nursing home… this is what’s trending all over… she’s been in others here.
Love your posts on nutrition, protein etc. but these ridiculous anti statin diatribes unfortunately undermine your credibility.
“Keep up with the literature”?
Maybe YOU should.
Statins work and are safe. Period. This has been shown again and again, in men and women.. When I have time I can put together a longer reference list, but the most recent would be this paper. Accumulating Evidence for Statins in Primary Prevention Jennifer G. Robinson, MD, MPH EDITORIAL. JAMA Published online November 25, 2013 jama.com Downloaded From: http://jama.jamanetwork.com/ on 11/28/2013. ““Meta-analyses now provide extensive evidence that statins reduce cardiovascular events and total mortality in individuals at lower risk of cardiovascular events than has previously been appreciated, and do so with an excellent margin of safety.”
“2013 Cochrane meta-analysis (same issue of JAMA) of 18 primary prevention statin trials including 56 934 participants. The authors report that statins significantly reduce all-cause mortality (−14%), fatal and nonfatal cardiovascular disease (−22%), coronary heart disease (−27%), stroke (−22%), and coronary revascularization (−38%).
These risk reduction benefits occurred in the absence of an increased risk of cancer, myalgia, rhabdomyolysis, liver enzyme elevation, renal dysfunction, or arthritis.” Importantly, participants treated with statins were no more likely to discontinue treatment than the placebo group (12%).
This means that the adverse event rates were similar in both statin and placebo/control groups, and not just an artifact of those with adverse effects who stopped the statin. Only new onset diabetes was observed to occur frequently in the statin group, consistent with another meta-analysis of statin trials. “The most recent meta-analyses of statin trials that provide extensive evidence of statins reducing cardiovascular disease events and all-cause death when used for primary prevention with an excellent margin of safety were performed in individuals selected for likelihood of benefit and safe participation.
“In sum, the recent statin meta-analyses provide evidence that largely refutes the major criticisms against statins used for primary prevention. Statins are well tolerated in properly selected individuals. Statins reduce total mortality as well as atherosclerotic cardiovascular disease events in lower-risk individuals. Concerns about cost are no longer relevant with 5 of the currently available statins available as generic drugs. Indeed, recent analyses have found statins to be highly cost-effective and even cost-saving in lower-risk individuals, and can provide a large societal benefit.
The accumulated evidence should convince those with a philosophical aversion to statin therapy for primary prevention to reconsider their stance. Despite decades of exhortation for improvement, the high prevalence of poor lifestyle behaviors leading to elevated cardiovascular disease risk factors persists, with myocardial infarction and stroke remaining the leading causes of death in the United States.
Clearly, many more adults could benefit from evidence directed use of statins for primary prevention.”
Your Dad’s case is an unfortunate one. Because of the PROVEN efficacy of statin’s post-MI in reducing future cardiovascular outcomes, the “Get With Guidelines Program” and other have made getting statins on d/c a priority. Unfortunately whomever wrote/signed off on these orders was mistaken in hour Dad’s case. The system broke down. It’s not perfect. But the overall imperative to increase the rate of post-MI patients on statins still stands.
You list a LONG discontinued statin, Baycol (cerivastatin) in your table. The system “worked” here- after side effects were noted post marketing, the drug was removed and hasn’t returned. Also, somewhat surprisingly given the biochemistry, your statement “the lipid-soluble statins are more inclined to cause drug interactions, insulin resistance and probably diabetes.” is simply not true. All statins can cause diabetes (pitavastatin may be different from preliminary data) and the water soluble statins are no less likely to cause drug interactions or side effects.
As for the Cholesterol delusion, cholesterol doesn’t cause Herat disease/atherosclerosis, abnormal lipoprotein trafficking DOES. (Our friend Gary Taubes has some nice stuff up about this). And statins reduce events by helping to CORRECT abnormal lipoprotein trafficking (not by lowering lipid levels). But that’s another long post.
Keep up the good work, but please lighten up on bashing statins. Of course diet and exercise should always be first, but again. Statins work and are safe. Period.
Gregory S Pokrywka MD FACP FNLA NCMP
Prevention of Cardiovascular Disease and Women’s Menopausal Health
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Diplomate American Board Clinical Lipidology and Fellow, National Lipid Assn.
Certified Menopause Practitioner: North American Menopause Society
Director: Baltimore Lipid Center. Board Member, South East Lipid Assn.
Thanks for taking the time to write such a detailed comment.
I’m a couple of months behind on my JAMA reading, so I hadn’t seen the papers you referenced yet. I just pulled them, and, I’ve got to tell you, they don’t make it easy to track down the studies referenced. It can be done, but it takes some effort.
If you’ve been reading this blog for long, you’ll know that I’m not a big fan of meta-analyses. Too much cherry picking going on, and I don’t like the idea of taking a bunch of studies, none of which showed significant results, adding them together and through some statistical legerdemain make them all of a sudden add up to something noteworthy.
Which is what I suspect happened here.
Why?
This sentence kind of gives it away:
The way I parse that sentence is that it say “Meta-analysis now provide extensive evidence…” With emphasis on the word ‘now.’ I’m not sure that any of the individual studies by themselves “provide extensive evidence,” which is what I would consider a much stronger standard.
I don’t know if the standard meta-analysis fudgaroo has been done in the papers you cited because I haven’t tracked down and read the individual studies. But I will, I can assure you.
There are a few other little tidbits in the studies cited that give me great pause. The first thing that jumped out at me was this admission:
Hmmm. Not a sterling recommendation, if you ask me.
Sort of like the fox watching the hen house.
These studies may be fine, but what about the ones that may not have been so fine that the pharmaceutical companies chose not to publish. It would be nice to see a study on statins done independently instead of funded by a company that stands to gain if a positive study is published.
Here is another little hint I caught in one of these papers. Pay careful attention to the first part of the last sentence, the part I put in bold.
What a throw away line!
“Only new-onset diabetes was observed to occur frequently in the statin group…” The author tosses this off as if were the common cold. I don’t want to be taking anything or prescribing anything that causes new-onset diabetes.
In terms of the side effects being the same in both groups, the other paper has this to say:
Makes me wonder about a couple of things.
First, the last clause, the one about all the trials not having reported fully.
Wonder what it was they didn’t report.
And when I ran a quick look at the actual papers the two papers you cite referred to, I noticed that the patients admitted into these trials were screened for those who had side effects on statin drugs, which would mean the studies didn’t accept those who had previously had problems with statins. So it would make sense that those on statins and those on placebo would have the same level of side effects.
So, you see, even in the two papers you cited, which were basically flak pieces for the meta-analyses, there were enough give aways to anyone skilled at reading between the lines to make me think the actual studies upon which the meta-analyses were based aren’t very persuasive.
In terms of all-cause mortality, the most important factor, when I looked over the Cochrane data, here is what the authors had to say:
So, the meta-analysis showing a 14% reduction in all-cause mortality was really a combination of all the studies that showed zip along with one study – the JUPITER study – showing a decrease. Not what I would call a hearty recommendation, especially given the bad treatment the JUPITER study has received at the hands of a whole lot of people. Including me.
But, just for grins, let’s assume it’s not just the JUPITER trial but all the studies that show a reduction in all-cause mortality, what are we really talking about?.
Again, from the original papers, it looks like out of every 10,000 subjects taking a statin, 44 died while out of every 10,000 subjects on placebo, 51 died. Not a huge difference. But when you divide 7 (the difference in the number of deaths) by 44, you get the 14 percent the study quotes. And to prevent these 7 deaths out of 20,000 people, you would have them all taking a statin.
Sorry, but I can’t agree.
And, one other note, since the JUPITER trial was included in the 19 studies evaluated for the meta-analysis, it tells me that the studies weren’t even close to being comparable in how they were done.
As I’m sure you know, the JUPITER trial recruited patients with normal cholesterol levels and elevated C-reactive protein levels. How could this trial be comparable for statistical purposes with the rest of the trials?
1. Statin Therapy for Primary Prevention of Cardiovascular Disease. Taylor FC et al.
JAMA. 2013 Nov 25. doi: 10.1001/jama.2013.281348. [Epub ahead of print]
2. Accumulating Evidence for Statins in Primary Prevention. Robinson JG.
JAMA. 2013 Nov 25. doi: 10.1001/jama.2013.281355. [Epub ahead of print]
3. Statins for the primary prevention of cardiovascular disease. Taylor F, et al.
Cochrane Database Syst Rev. 2013 Jan 31;1:CD004816. doi: 10.1002/14651858.CD004816.pub5.
They are screening out people who have adverse reactions to statins (something most doctors don’t seem to be capable of in practice) then using these filtered populations to claim that statins are safe.
And even so, they have had to suppress the results of a large number of completed studies to make this claim.
Gregory S Pokrywka is right about one thing; water-soluble statins have a somewhat different spread of side-effects from fat-soluble ones, but shouldn’t be considered safe.
The debate on statins can continue, but it seems to me that in the properly chosen patient population they have demonstrated benefit.
EBT testing combined with NMR, and patient family history is important.
If all show CAD/ elevated CAD risk they they make sense.
The issue in my view is that to many prescribe them without proper assessment.
You are right. In a properly chosen patient population as long as that carefully chosen population is young men who have already had a heart attack. Other than that population, there is no evidence that statins are beneficial.
Read this article from Business Week from a few years ago.
Thank you, i have seen it. I did look at it again and noted it says that if you have heart disease, not if you have had a heart attack that a statin may make sense. Only way you know outside of an angiogram or IVUS is from a calcium score. Some like to use carotid artery imaging, but its correlation is not always good. If calcium score positive and shows your in a high risk category and have a family history with poor NMR LDLP while on a low carb diet, a statin if tolerated may have benefit.
The problem with statins is that Docs give them out based on an LDL-C score, and that in and of itself is not indicative of any degree of heart disease. Were Docs to screen as discussed statins would not be debatable.
Steve:
I have a sky-high coronary calcium score (~99th percentile). You would argue I might be a good candidate for statins? Would it matter if I had been on statins for a few years, had a lovely lipid profile, and the calcium just kept building.
Besides, who knows their family history of NMR LDLP? In principle, one’s genetic profile could matter a lot, but how is one to discover usseful attributes of ancestors?
Just so everyone knows where he is coming from:
DR POKRYWKA is director of the Baltimore Lipid Center and assistant professor at Johns Hopkins University School of Medicine in Baltimore, Maryland.
*He reports that he is on the speakers’ bureau for AstraZeneca, Daiichi Sankyo, GlaxoSmithKline, Lupin, LipoScience, and Merck Schering Plough.*
“Only new onset diabetes????” Gosh, forgive my lack of credentials and all, but there goes the cardiovascular Neighborhood. I’m just a lay reader, but I sure draw a very direct line from the process of metabolic syndrome and diabetes to CVD.
Give us clinical outcomes including quality of life as an endpoint, perioid, not surrogate markers and data massage and omissions
“Maybe YOU should. Statins work and are safe. Period. This has been shown again and again, in men and women..”
Let us take a moment of silence to ponder how many industry attached academic medical authorities opined in press and peer reviewed studies for decades that “it is well known that HRT prevents strokes, dementia and heart attacks.” Right until non industry independent review proved it in fact caused increased risks of these and breast cancer.
Statins are an even huger scandal, as the net is being cast for an even broader segment of the population, including children. For anyone who doubts the risk of harm and complete biochemical dysregulation caused by manipulating cholesterol levels, just gaze at this: http://www.howtoincreaseserotonin.com/hormone/ To see how critical cholesterol/LDL are to health maintenance.
(Ignore the web site, the chart is accurate, can’t vouch for anything else).
Our bodies make more or less LDL depending on what we need at different life stages (which is why women make more post meno, the adrenals make more estrogen when the ovaries, don’t). Interfering in this process is a perversion of science and health.
Sorry, that was a bad link for the image: Here’s a more direct one: http://drhardy.org/images/11-29-2008%2010-00-58%20PM.jpg
Dr Eades,
You can buy Clinistix in most pharmacies. Easy to use and much cheeper that
the UA done at the lab. Most of the labs use them use them anyway. Just
buy a tube of them and have them at home for your dad.
Good luck with your statin rant. It is very hard to convince people that
they are useless. I’m not even sure about younger males post heart attack .
Harold I Dobbs, M.D.
I tried to get these, but the pharmacies I tried didn’t have them. Didn’t know if they were just out or if it were some Michigan law preventing them from carrying them.
That sounds much better. I’ll ask for that next time. Thanks again.
I work for a PBM (prescription benefit management) company. I see every day just how many statins are prescribed. It is astounding. My own doctor wants to put me on a statin because of slightly elevated cholesterol. I am a 48 year old female with no family history of heart disease or similar problems. Based on what I see every day at work and my own personal research, I refused my doctor’s advice/order and instead am opting to modify my diet slightly and get more exercise.
Thank you for this blog – it confirms what I already thought was the right decision for me.
I was visiting a healthy 96-yr-old woman other day. Was surprised to hear her say something about being on a drug called Lipitor.
Looks like it hasn’t done her any harm.
I believe I read in Good Calories, Bad Calories that those with total cholesterol over 200 also scored better on cognitive tests. I hope I am giving credit to the correct source and welcome any correction.
I work in cardiothoracic surgery in a teaching institution. i want to d/c many orders i see for statins but am told that we put ourselves and the hospital at risk of malpractice suits if we send a pt home without an order for a statin. Where do these protocols come from!!?
the drug industry fattens wallets of those setting consensus guidelines, from law makers to academic medical “experts.” This is the death of the art of clinical medical practice as a partnership between doctor and patient. Doctors are permitted to continue to practice as long as they deliver drugs into the receptacle. That would be us. As many of us as they can get away with by buying and writing even more consensus guidelines that academic doctors are competing to put their names to for the money that is then “donated” to their institutions.
Agreed, Susan. I am a PA and as such have no authority to do anything about these protocols. All I know is that if I want to continue to work, I have to do as I am told. It really sucks. But I do make it clear to the pt that it would be a very good idea for their own health if they researched the drugs they are sent home on and realize that not everyone needs statins. (wink, wink, hint hint) I know it only works for some of them.
I think your father may suffer from a B12 deficiency. The serum B12 test is very inaccurate (one study showed 35% of deficiencies were missed). Has he ever had MMA and Hcy tests done? If his condition is due to B12 deficiency then it is going to take a lot more than the standard 1000 mcg injection done once per month to heal him. Start on daily injections with 5mg folic acid and a B50 complex twice daily. Hypokalemia is a possibility so increase potassium intake. Watch this documentary which includes footage of a pediatrician who can now walk with crutches: http://youtu.be/BvEizypoyO0
I am a pharmacist who was undiagnosed for 5 1/2 years. The book Could It Be B12?: An Epidemic of Misdiagnosis literally saved my life, as did the wonderful moderators at the Pernicious Anaemia Society.
Regards,
Susan
Thanks for the suggestion, but we’ve ruled that out. MD and I have had some phenomenal successes treating patients for B12 deficiencies, so those are always at the forefront of our minds. When my dad first developed this condition – adult MS – the first thing we thought of was B12 deficiency, so we sprang into action. Unfortunately, that wasn’t the situation in his case.
A couple of years ago, I bought the book you mentioned in your comment. I try to read everything I can on vit B12 deficiency because it is so widespread. Probably half the people – if not more – in nursing homes right now are suffering from B12 deficiency. As I recall, the author’s father or grandfather (I can’t now remember which) had his vit B12 deficiency finally diagnosed at Henry Ford Hospital in Michigan. Strangely enough, that is the very hospital in which my dad got his statin description.
Thank you for your reply. I am so glad you interested in B12 deficiency as it does seem to fly under the radar for most health professionals.
Please have a look at http://www.pernicious-anaemia-society.org/ and http://www.b12d.org/ to further your knowledge. As a pharmacist, I refer my patients to these sites regularly and I hope you will do the same.
It is my dream to start a charity, like those above, to bring more attention to undiagnosed and undertreated B12 deficiency in Canada.
All the best to you and your father,
Susan
In 2009 Dr William Davis used statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides or = 60 mg/dL
http://www.ncbi.nlm.nih.gov/pubmed/19092644
Dr Davis says in order to reverse plaque one must get their LDL<60 mg/dL
Please explain how this can be achieved on a higher fat, non-plant based diet?
I think Dr. Williams has changed his mind since.
Not about LDL. His position is that if you have a calcium score of 1 or greater you have plaque and the ONLY way to regress it is to lower your LDL<60. He doesn't use statins anymore – he believes it can be done with Vit D and fish oil.
My question still remains – is plaque regression possible WITHOUT going on a low fat plant based diet??
I’m not sure. And I’m not sure that a low-fat, plant-based diet regresses it. What’s more important is stabilization of plaque. According to autopsy studies reported on by George Mann, the Masai had extensive plaque, but they never had heart attacks. It’s only when plaque is unstable and prone to rupture that it is problematic. I’ve had email correspondence with Dr. Davis on this, and he told me since he’s started patients on wheat-free, lower-carb diets he stills sees high cholesterol levels and elevated calcium scores, nut what he doesn’t see any more are heart attacks in these patients.
” since he’s started patients on wheat-free, lower-carb diets he stills sees high cholesterol levels and elevated calcium scores, nut what he doesn’t see any more are heart attacks in these patients.”
SO – he and his patients are betting their lives on the plaque not rupturing!
What happened to his 60-60-60 program to reverse plaque?
http://cureality.com/track/heart_disease/basic_lipids
Cureality suggests having a discussion with your doctor about achieving the Cureality 60/60/60 Basic Lipid goals.
LDL Cholesterol: 60 to 70 mg/dL
HDL Cholesterol: 60 mg/dL or higher
Triglycerides: 60mg/dL or lower
http://www.trackyourplaque.com/report/Lipoproteins/triglycerides_nutrition_riley.aspx
For correcting hypertriglyceridemia or high triglycerides, a diet with 50% carbohydrate, 20% protein, and 30% fat is a recommended starting point.
http://www.trackyourplaque.com/forum/topics.aspx?ID=14844
LDL-C
Goal – <100 mg/dL or <70 mg/dL if there are other risk factors for heart disease or diabetes.
SO –
I know all this. Why aren’t you directing these questions to Dr. Davis.
Plaque reversal is a surrogate end point, not the same thing as an improved clinical outcome.
It’s just another surrogate measure.
Yes, decalcification can take place using vitamin K2 in the
MK4 & MK7 form. But do your research as some people don’t tolerate the MK7 form very well. Long discussion on it on inspire.com
Excellent write up, its a shame that it has to affect real people. Maybe all practitioner should be given a prescription that they must read this and act on it!
or alternatively put themselves on a high dose of statins and experience the degenerating effects themselves, then decide if statins are still the perfect solution to a problem which seems to have been created so that the drug can have a use!
Oppps sorry all, my last message went out before I finished. The same physician I fired wanted to put me on statins that I refused. He circled the “High number” in red and told me “This is what we call the Widow maker, we need to put you on a statin”… Ignoring the fact that a diabetic complication is assumed to be hyperlipodemia as well.
Bruce Miller, To overlook such bad diabetes for such a long time is a shame! But don’t give up on your health yet. Try The Diabetes Cure –
https://www.rodalestore.com/diabetes/the-diabetes-cure.html?keycode=237725, written by a physician trained in conventional (US) and alternative medicine (Germany) – me. – All the best!
There is no such thing as a diabetes “cure” and any suggestion of one is quackery. By the time of diagnosis, most type 2 diabetics have lost 50% of their insulin producing pancreatic beta cell mass and it is not replaceable. Using the word “cure” and the cause “inflammation” is spurious and dishonest.
There are many causes, from statins to steroids to Cushing’s syndrome or subclinical hypercortisolemia to chronic infections that raise cortisol, thereby blood glucose and all its complications.
But in every case, type 1 or type 2, fat and protein do not raise blood glucose, they lower it, only carbohydrates raise it.
Diabetes cannot be cured, but its progress and damage can be reversed with strong carb restriction and avoidance of drugs or treatment of medical conditions that cause or perpetuate it.
I reversed advanced kidney damage and severe peripheral neuropathies and dyslipidemia (high TGL, low HDL) with carb restriction 15 years ago and have kept my glucose in low normal, non diabetic numbers with diet alone since then, no meds other than brief supplementation with alpha lipoic acid for residual numbness after my neuropathy pain disappeared.
This is the best, and maybe the only thing a diabetic needs to get control of the disease, written by a diabetic for other diabetics years ago: http://www.phlaunt.com/diabetes/flyer.pdf
Dr. Eades,
Did you elaborate anywhere about this statement that you made: “After about age 50, the higher the cholesterol, the greater the longevity. ” It sounds very amazing and I didn’t have time to read all the other comments above in which you might have dealt with it. (I get your postings a day late in my emails.) Please provide more info on that important sentence that is not at all the “common wisdom.” Also, I agree that the run around that you got while helping your father is, unfortunately, a sign of what lays ahead. Naomi
Those stats are in a couple of papers I can’t lay my hands on right now. I’ll try to dig them up when I get home (I’m traveling now) and post them.
@Naomi
Dr Eades is correct about “the higher the cholesterol, the greater the longevity”.
I have studied the scientific literature over a number of years and can confirm Dr Eades is correct about “the higher the cholesterol, the greater the longevity”.
I’ve posted the results of many scientific papers (around 100) on this subject at http://healthydietsandscience.blogspot.co.uk/search/label/Cholesterol%20and%20Mortality
Thanks for the link. I hadn’t seen that paper.
Your post was pinned at Pinterest; this is the first time I’ve read any of your posts. So glad to find someone else trumpeting the dangers of statins. Another aspect I recently ran across is the possibility of fat-soluble statins crossing the blood-brain barrier, thus causing the memory loss and cognitive function trouble some experience. Would like to find out more about that. I will be re-pinning your post!
Dear doctor Eades, I have been following your blog for a few months. When I read this story and issue about your father I soon had in mind my father’s story ( 79 years old ) who got a heart attack about 5 months ago. After discharge from hospital he had the same list of drugs as your father ( including cardioaspirin, statin drug, beta blocker and ACE agent drug. Specifically, the particular statin given to my father is named TORVAST, by Pfizer. He takes a daily dose of 80 mg. ) I identified myself and my concerns about this drug while reading your writing. Same inaccuracy at discharge as your cardiologists in USA. My father always had absolutely regular cholesterol levels in the blood, no need to take any statin at all. But he takes a large dose everyday since 5 months nonetheless. I tried to explain him this is just a standard procedure at hospital for every person who faced a heart attack but actually you don’t need to intake a drug like this if you have regular cholesterol levels. My father can’t comprehend my reasons and argumentations and he prefers to follow the medical prescriptions he got from the hospital, unfortunately. I hope your father is ok doctor Eades, have a nice Sunday you all in USA. It is always a pleasure to read your blog and learn something good from your articles. Cheers,Gianpaolo
Thanks for writing. I hope your father does okay.
As someone who’s 82 yo father is in a nursing home due to many years of statin use, I’m glad you were able to intervene in your dad’s care, Dr. Eades. I wish I knew years ago what I know now. Maybe my father wouldn’t be so incapacitated. Like many type II diabetics he was Rx’ed statins (at likely high doses) to suposedly prevent heart attacks/disease/strokes,etc. But it damaged his leg muscles and led to dementia. He also developed (I believe) statin-induced cardiomyopathy and atherosclerosis. He ended up getting surgery for heart valve replacement and triple bypass. Looks like those statins worked great at preventing plaque, huh? He was never really the same after. Then early this year, he had a stroke which he recovered from fairly well. But his dementia has gotten much worse as has his disability. Overall, another testament to the failure of statins. To the drug companies tho, a huge, profitable success!
Sorry to hear of your father’s condition. I truly feel your pain.
I know that, for various reasons, you would not want to give out free advice for a specific problem for some random person, but I wonder if you might direct me to resources which could help me make up my own mind.
I have a quandary. On my father’s side, there is a history of long life and few heart problems. On my mother’s, a history of congestive heart failure and, most terrifying to me, stroke. So, when my doctor suggested I begin statin therapy about 5 years ago, I readily assented. I am now 50 years old.
I had put off the therapy for years because, while my cholesterol count has been fairly high since at least my 20’s, I always had a very good HDL/LDL ratio. I still have a high ratio, though it had begun to decline somewhat in my 40’s. With the statin, my ratio is now stratospheric, which I suppose is a good thing.
But, a couple of years ago, I began to experience a need to urinate during the night, sometimes several times. It was intermittent, and for some reason, seemed to peak when I was traveling for business – I still have no idea why, unless it has something to do with jet lag upsetting my internal clock, or eating fast food. I finally got around to mentioning it to my primary care physician and he performed a urinalysis which showed some small amount of blood – I think he must have performed one during the previous year which did not come up positive, so it would appear this was a recent change. I was sent to a urologist who suspected an infection, and prescribed antibiotics. They definitely appeared to improve the nighttime urges so I guess I probably had an infection of sorts. But, the small amount of blood remained.
It is a low level, and they see no evident reason for it, so we are monitoring it, but the docs suspect right now that I have had some sort of infection which damaged the membranes in my kidneys, and this is probably just going to be a low level chronic condition of no particular cause for concern.
Anyway, my statin is Crestor, 10 mg. I have been sort of worried that this could have been the cause, and wonder if I am doing the right thing in taking it. I have seen some indications on this site and elsewhere that hematuria can result from statin therapy. I get blood tests every 3 months to assure proper kidney function and they’ve never seen a problem with the enzymes, or whatever it is they test for, in it. But, still…?
It happens that my insurance is now wanting to push me to a generic statin, and in January, I need to make a decision about how to go forward. I can continue the Crestor and, with a coupon from the maker, pay a slightly elevated rate. Or, I can go to Lipitor which is now generic, and pay very little in a co-pay. Your site suggests the latter is fat soluble, and therefore perhaps more fraught with whatever danger there may be. So, I am thinking of suggesting the other water soluble one on your list, pravastatin, which looks like it has gone generic, too.
I really do not know what to do. On the one hand, the statin may not really be helping me in any way. And, it may be causing this other problem I have developed. On the other, I really want to play it safe for heart trouble, due to at least 1/2 family history. The things I am trying to reason out right now are: 1) Could the statin be responsible for the hematuria? 2) Should I continue taking it? 3) Assuming I do continue taking it, is there one which is preferred specifically for the potential impacts on kidney function?
Any info toward which you could direct me to help make this decision would be appreciated, with no liability or blame on your part. I do not intend to make my decision solely on the recommendation of any one person, but based on my own weighing of the benefits and hazards from as many sources as I can find.
First, it’s not that I mind giving free advice. This entire blog is free and is, I hope, full of worthwhile information.
The reason I can’t treat people over the internet is that medical boards frown on it. One the main rules of medicine is, first, examine the patient, which is difficult to do online.
Before I could even venture a guess in your case, I would have to have much more information.
What I can tell you is that there is no evidence that a statin will make a 50 year old man who has never had a heart attack live any longer.
Understand, but that is not really what I am after. If there is no harm from taking a statin, then it becomes a sort of Pascal’s wager – you might as well take it just to cover all bases.
What I am concerned about is whether the medicine might actually be causing harm, and I could be better off without it. So, what I’m really after is information on the side effects – something more detailed than the terse admonitions on the fold-out sheets that come with the medication, which might lend credence to my suspicion that the medication itself could have been responsible for my recent sanguinary
experience. So, I was just hoping that maybe you might have info or links which could aid me in researching that. Thanks in advance for any tips you might provide.
Not quite a Pascal’s wager because with statins there are downside consequences.
Statins cause muscle pain, tenderness and weakness in many more people than the studies show. Why? Because the studies often pre-screen for statin-induced symptoms so they recruit subjects who don’t have them.
There have been reports of liver problems, some of them fatal. Which is why any doc worth his/her salt routinely checks liver enzymes on statin patients.
Then there is the rhabdomyolysis, which can lead to kidney failure, often with fatal results.
Many drugs have bad side effects, but they are routinely given anyway because the reward outweighs the risk. With statins there is no such reward. Studies have never shown a benefit in terms of preventing early death by taking statins except for in one small group – young men who have already had a heart attack. For older men in general or young men who haven’t had a heart attack or women of any age or condition, there is no benefit in terms of a decrease in all-cause mortality by taking statins.
Susan, In one sense you are right: Even with the best of efforts, one will not lose one’s diabetic genes. But if the markers of diabetes type 2 – mainly hemoglobin A1c – are dropping below the definition for diabetes, I would call it a cure – what would you call it? Especially if it is accompanied by weight loss, more energy, less risk for heart disease, stroke and so on. It is a cure.
You have not read the newest scientific literature if you deny that inflammation is at the heart of diabetes and the metabolic syndrome. Basically, we can live a lifestyle that is inflammatory and end up with diabetes, or we live an anti-inflammatory lifestyle, and improve well-being and risk factors.
You are also mistaken when you state that fat has nothing to do with sugar: Sugars can be stored in the form of fat, and fat can be converted back into sugars.
In one point I agree with you: I find the title of my book “The Diabetes Cure” somewhat pompous. I had suggested the more modest “My Diabetes Cure” – but the title is a publisher’s decision, and I now have to live with it.
Contrary to the inflammatory advertisement, I have written a thoughtful book about diabetes type 2, with thoroughly researched facts, in a mixture of sound conventional medicine and hope-inducing self-help alternative medicine.
I like your little flyer: Cutting down on carbohydrates is one good idea! My book discusses forty-nine more ways to improve one’s diabetic metabolic state.
Alexa Fleckenstein M.D., physician, author.
Alexa,
I definitely would not call it a cure. This would be more like in remission.
If you don’t adhere to the protocol that reduced BS, etc. your diabetes symptoms will come roaring back.
So a cure no but I will take a remission – that will prevent and can even turn around some damage caused by the diabetes.
And I am a diabetic and have read extensively and this subject.
Laura
Dr. Fleckenstein, you seem to be confused about how diabetes develops and how its control can lead to low normal blood glucose and A1c (A1c is a very sloppy measure of control, post meal testing is the only reliable measure). Inflammation is a result, not “the cause” of diabetes. Both result from various processes. Association is not causation.
What you call a cure is merely tightly controlled diabetes. It’s what I have had for over a decade, and it lasts until I eat a carby meal or two.
This has nothing to do with “diabetic genes” but with the loss of beta cell mass and the resultant inability to maintain those normal glucose numbers (and plenty of people with what’s mislabeled “pre diabetes” or IGT get diabetic complications of the retina, kidneys and nerves) no cure is achieved and this becomes evident if such a person eats a high glycemic meal. But the process and progression can be halted. This can be confused for “cure” by those unfamiliar with the various underlying processes and causes that can lead to diabetes.
Unlike true non diabetics, who will stay within a narrow range of about 85-105 no matter what they eat, the diabetic (and those labeled “pre diabetic” will spike well above that, especially in the first hour post meal. Fasting glucose does not rise until years after folks have been in the diabetic range post meal, typically, hence the severity of pancreatic damage by the time of diagnosis. I have been diabetic for decades and have never had a diagnostic fasting glucose test, for example.
It’s not “my litte flyer” it’s the single most important tool any diabetic needs. Fat and protein do not raise glucose levels. That does not equate to never converting to glucose, just not to glucose elevations. Only dietary carbohydrates raise glucose levels post meal, and restricting them is pretty much all it takes to get diabetes tightly controlled, period.
And it’s free, no doctors, meds, required.
I would characterize the book title and the use of the word “cure” as pompous so much as factually, scientifically inaccurate, as are pretty much all your assertions here.
I highly recommend that you read Dr. Richard Bernstein’s Diabetes Solution for an engineer turned M.D.’s insights to the science behind diabetic control. Nothing more motivated, focused and instructive than a long time type 1 diabetic with an engineering education and precision coupled with an M.D.
Nuff said, I think.
Correction: “would NOT characterize… as pompous…”
To avoid any confusion, that link to the blood sugar flyer web site and the collection of information there is something I find valuable and informative.
I have no personal connection to the web site, nor any commercial nor personal interests in anything online, other than self help empowerment and information sharing.
Sorry to read of your father’s health issues, and the troubles being experienced with testing. I imagine you are right, the situation will be growing more difficult in the future.
Your story reminds me of what happened to my grandfather. He was on his death bed, withered away not able to leave the bed,and barely could talk. There were some heart medications for him though that for some odd reason it was felt he should continue to take. One was a blood thinner, and the other I believe Lipitor. The poor guy had an intestinal blockage by this point (along with cancer that had spread), couldn’t eat and barely could drink, and yet each day he was given his heart medicines I recall.
Strange but not untypical. There is much lack of thinking in hospitalized patients. When they are admitted, they come in on whatever medicines they’ve been taking, and their docs simply write the orders for them to continue. The nurses take it from there and make sure the patient gets the meds every day.
It would have been nice if the long-winded pro-statin doctor above had also disclosed any ties to the drug companies….
From a bio at this link:
http://www.reachmd.com/xmradioguest.aspx?pid=1394
“Dr. Pokrywka serves on the National Lecture Bureaus of multiple pharmaceutical companies.”
As a lab clerk/receptionist in the Minneapolis area, I was so surprised how much trouble that was for you to get a urine test done! We always have doctors stop in with specimens (of their family) that just write out an order and it’s no trouble to bill the insurance or the clinic the doctor is from. Sorry for all that hassel! It’s a shame some hospitals/clinics are like that.
Great post by the way!!
Thanks.
In this blog entry I learned about the medical discharge protocol of prescribing meds, including statins. Having learned from their trauma, most patients likely would adhere to the ‘customized’ protocol to prevent a recurrence of their specific medical event.
The eat low-fat to stay healthy mantra is so ingrained in our culture, inculcated and reinforced at the earliest age. My young kids’ swimming coach, herself a bit over-weighted, frequently emailed out dietary advices to parents to make sure to feed children low-fat and whole grains to stay fit. She then cites diet guidelines from AHA, USDA, and assorted swimming associations for authoritative support. I shake my head and feed my kids (8 and 10) loads of wholesome animal fat, cheese, fatty cuts of meat, veggies and nil carbs.
Please keep up your blogging. You insights really make a big impact. I hope your father gets better.
Thanks. I hope he does, too.
Hi Dr. Mike,
Three things. First, I am so sorry to hear of your awful experience with your dad, and the statin question.
Second, when my mother in law was 99 yrs old, she was prescribed a statin by her family doctor, luckily with her being deaf she depends on me to explain what the doctor had said. And I didn’t tell her as she would have taken the statin. I threw the prescription away. She was also given a diet sheet to follow which was cautioning her not to eat much fat etc. I threw that out too. Mom is now 101, still going strong, still eating her cheese, fish and chips, bacon and eggs. Couldn’t believe that doctor. Not our dr. anymore.
Third. Dr. Malcolm Kendricks latest blog is a great follow up to yours today. You probably have already seen it, but others may not have.
Keep up the good work. I have learned so much from you.
Maureen Harding
I forgot the link to Dr. Kendrick’s blog:
http://drmalcolmkendrick.org/2013/12/09/a-farewell-to-statins-part-two/#comments
Thanks. I did read this. And I saw the Medscape video before I read his blog. I contemplated posting on the video but was too depressed over it. Maybe I’ll still do it. It beggars belief.
My husband insists on taking red yeast rice no matter what I suggest differently. Would this supplement be considered water soluble?
As I said earlier, I don’t know much about red yeast rice, so I can’t tell you. If I had to guess, I would say water soluble, but I don’t really know.
Thank yo for that. Through books, videos and your blog I have educated myself on the use of statins. I won’t touch this stuff with a ten foot pole. I even got my husband off of it after he complained about muscle pain in his legs. A couple weeks later, he was free of pain. He said he would not take statins anymore if I so strongly believed that it was causing his health to deteriorate.
Dr, Eades, I have a very quick question for you. How soon after stopping a statin would results be apparent?
My sister is on Simvastatin and I’ve requested that she be taken off that drug (I have POA for her). If the statin were affecting her negatively, how soon might we see improvements?
Thank you so much!
There is no one-size-fits-all answer to that question. Some people continue with symptoms for years, others get over them in a matter of days. Probably depends upon whether the statins in question are lipid soluble or water soluble. I would imagine the symptoms would clear up more quickly after discontinuing a water-soluble statin than an oil-soluble one.
Good news! I was able to get my sister’s new doctor to discontinue the statin. And not only that, I got her to discontinue the anti-depressant and the muscle relaxant (which was given to her for reasons no one can explain to me).
Thank you so much for continuing to write about the dangers of statins. I’ve been trying to get her off the statin for years now, but could never convince her old doctor to do so. Your posts finally convinced me that I absolutely had to do something drastic. It took a trip back to Michigan to interview 3 potential doctors, but we finally found one who is open-minded and willing to discuss new ideas.
Congrats on finding someone to help.
Perhaps I should add that my sister is 64 years old. She’s on 20 mg Simvastatin and her cholesterol numbers are:
Total: 148
Triglycerides: 155
HDL: 49
LDL: 68
VLDL 31
Granted, not great numbers. She’s pre-diabetic and lives in a group home, so the chances of getting her on a true low-carb/high-fat diet is next to impossible. They count sugar grams, but nothing else. On a typical day, she still gets more than 100 grams of carbs.
I’m going to request of her doctor that she not take the statin anymore, and if the doctor wants to repeat the tests in April when my sister is due for her physical, we could reassess at that time.
I’m wondering whether if she stops the statin now, is there enough time between now and April for the negative side effects to start wearing off? They also have her on an anti-depressant, which was just increased. She’s starting to mumble to herself incessantly, and is losing strength in her arms and legs. Not all of this is necessarily due to the statin, but I just wonder how much IS due to the statin.
I’m thinking that on such a low dose that her cholesterol numbers wouldn’t go through the roof without the statin.
Thanks again!
Hi Dr. Eades,
Like many who follow low carb, I have very high hdl and high overall cholesterol. I hope you will comment on the recent study from Duke Cancer Institute regarding an alleged relationship between high cholesterol and breast cancer.
http://www.dukehealth.org/health_library/news/high-cholesterol-fuels-the-growth-and-spread-of-breast-cancer
This is a mouse study. They are extrapolating the findings to humans, which is a dangerous thing to do. Will take many years before we know the human answer on this one.
What would you recommend for someone with familial hypercholesterolemia who can’t tolerate statins?
I don’t know. It would depend upon the type. This would be a situation in which a lipidologist would be helpful.
Dr. Eades,
I’ve been researching statins for a while and have decided to discontinue all statin medications I’ve tried. None of them even budge my numbers. My preventive cardiologist does not know what to do with my numbers. He has basically told me to wait for these psk9 shots that are potentially helpful for people like me with a diagnosis of FH. My NMR Liposcience profile reads
LDL-P 2478 nmol/L
My tris are pretty good at 65 mg/dL, HDL-C -52
small LDL-P is 1147 nmol/L and they sized them at 20.6 which is bordering on line for pattern B.
Anyway, needless to say CVD is a huge heredity problem in the fam, but everyone has followed the heart diet. So– they think I’m nuts, but I’m going to try your protein power life plan at the intervention level.
Incidentally those small LDLs were scored very high as being insulin resistant. My doctor is pretty forward thinking guy and he said give your diet a shot 😉 my guess is I’m pretty inflamed and oxidized as I have been eating the SAD. Thanks, I’ll check back in with some better numbers hopefully after diet change….
Keep us all posted.
Lee Anne, I had a similar situation. Maximum amount of Lipitor in a clinical trial and LDL didn’t budge. The lipid expert at Harvard said I was taking up more cholesterol from my diet than most people. Also, I was on a LC diet (with more dietary cholesterol), and the others were on a low-fat diet, which I refused to follow. I also refused the statin after the study was concluded.
Then when Zetia came out (it keeps dietary cholesterol from being taken up), I tried that. Total cholesterol went from 400 to 160. Then adding a statin brought it well below 100.
This all makes sense to me. If you have plenty of cholesterol in your diet, you won’t make it yourself, so a drug that keeps you from making cholesterol won’t have any effect. If you take a drug that keeps dietary cholesterol from being taken up, then your body will make some and the statin will reduce that production.
I’m not urging you to take Zetia or. The one study that has been published shows that it does reduce blood cholesterol levels more than a statin alone; however, it didn’t show that there was a reduction in mortality, and there was some evidence that it increased plaque. There’s currently a study in progress to see its effect on mortality. But I thought you might be interested in mechanisms. I’m not urging you to reduce cholesterol levels either.
My labs are similar to yours except my TGs are higher (still in normal range, but high for someone on a LC diet). So if you discover anything interesting, I’d been interested.
Oops. I meant 260, not 160.
Prolactinoma causes elevated triglycerides, may otherwise be asymptomatic. Subclinical hyercortisolism is a frequent unsuspected cause in estimates from 3-20% of all type 2 diabetics and raises bg and TGLs, and one can have central hypothyroidism, which may appear normal on screening tests. Or all three.
Worth checking out.
Author Susan:
Please contact me at BernsteinDiabetes@gmail.com
TY
Good Doc Eades, so sorry to hear of your fragile, beloved dad’s nearly deadly experience. He’s a lucky man- and you too, to have had him raise you.
I took my dad off his poisonous statin 3.5 years ago- a.m.a. I’m not a physician, but a very well read biochemist. My dad is old, 88.5, but he is doing better now- before, it had been a revolving door at the E.R. He will pass sooner rather than later, but I’m pretty certain now the cause of death will NOT be the greed of Big Pharma via Lipitor.
O.T., I read an article in NYT mag about a mystery illness and the diagnosis turning out to be that it was caused by ACE inhibitor Lisinopril. “Gut-Wrenching” Lisa Sanders, MD, Nov. 15, 2013.
I’ve had difficulty with elevated b.p. and I think working towards lowering it is desirable. Malcolm Kendrick has a recent post along these lines, and what the target b.p. might more reasonably be. Ferreting out the underlying cause or causes is where to start I think, and not first giving me Lisinopril and only treating a symptom- that med was something that made me nearly as sick as the woman in the story. It was serendipitous that I read the NYT article, but not so that I read your posts- religiously. Thank you for all the hard work and thoughtfulness and patience that you put into your genius blog. I hope that you know that you are improving the lives of many- virtually all you will never meet. We don’t get to thank you in person. I can’t thank you enough.
Thanks very much. I appreciate it.
After my physical last month, my PCP requested that I start taking a statin . Nothing new to me as various doctors over the past 6 years have requested it. Six years ago, before learning of PP, I was on a statin for 2 weeks and had the worst calf/toe cramps ever and stopped taking them. I told my PCP this and he did something no other doctor has ever done when I’ve told them this. He put it in my chart that I am allergic to statins. I smile every time a nurse goes over my chart with me at appointments.
Just because you had a reaction to 1 statin doesn’t mean you’re allergic to all statins.
Which statin did you have a reaction to?
It doesn’t mean it’s an allergy, either. More like a warning shot to stay away from the class of drugs. It’s hard to recall the last time so many people were put on a drug with such meager benefits in both individuals and the population for so much needless risk of harm.
So evocative of the decades of claims for Premarin, until WHI proved that all those benefits turned out to be lies, and only higher risks were proven.
Since 3 of the statins are derived from mold it’s quite possible that Jeri’s reaction was to the mold. Did the doctor try her on a non mold derived statin? If the doctor did and she still had a reaction then it’s a true allergic reaction to the drug itself.
Lovastatin, marketed as Mevacor, was isolated from a strain of Aspergillus terreus, a fungus. The other fermentation-derived statins are simvastatin and pravastatin. The synthetic statins include fluvastatin, atorvastatin and rosuvastatin.
Also – was she advised to take CoQ-10 along with the statin?
LOL – Missed my point entirely. With this on my record, two things are resolved: 1. I won’t be given anymore prescriptions for statins (that I shred), and 2. the doctor can’t have consequences for me refusing to take them. That’s all I care about.
However, I think Charles may have the actual reason for my reaction as I do believe it was Lovastatin and I have various plant allergies. No, the cardiologist did not advise me to take any supplements along with the statin.
You think a typical allergy manifests, ironically, as calf and toe cramps? Huh.
I think you’ve just raised an interesting point about how ubiquitous all sorts of adverse reactions to statins truly are, even ones folks don’t suspect. Statins lower your ability to make endogenous steroids, so one would expect allergies to worsen, along with a lot of other things.
Jeri, Your reaction sounds less like an allergy to me – more like the effects we expect from statins. Whatever we call it, I am glad the doctor put down that you have an “allergy” – you should not take any statins again, even granted that they are differences.
Heart attacks come from wrong lifestyles, not from high cholesterol. Change your lifestyle even minimally, with a bit of movement during your day, and no sugary/starchy foods, and you will see the problem melting away …
Good luck!
Alexa Fleckenstein M.D., physician, author.
I have changed my lifestyle and eating habits. I low carb but I’m not perfect. My lipid profile is much better than it has been in the past. My doctor was alarmed by the 16 point increase in my total cholesterol this time. I wasn’t because my HDL went up by 14 (exercise really does work!).
I agree that my reaction to the statin was a bad reaction and not a true allergy, which is why I smile every time the nurses are confirming my medical history at appointments. I am familiar with weird allergies though – can’t eat watermelon due to being highly allergic to ragweed pollen (an oral allergy syndrome). I’m sure some doctor down the road will question the allergy to statins. I’ll cross that bridge when it comes. For now, I’ll just keep smiling.
Has your LDL gone up? Have you had either a NMR or VAP test? Higher HDL is NOT necessarily cardio protective!
http://www.nytimes.com/2012/05/17/health/research/hdl-good-cholesterol-found-not-to-cut-heart-risk.html?_r=0
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419820/
“or a biomarker directly involved in disease pathogenesis, we expect a genetic variant that modulates the biomarker to likewise confer risk of disease. We tested this hypothesis for two plasma biomarkers: LDL and HDL cholesterol. SNPs affecting LDL cholesterol were consistently related to risk of myocardial infarction. However, we unexpectedly found that LIPG Asn396Ser, a genetic variant that specifically and substantially increases plasma HDL cholesterol, did not reduce risk of myocardial infarction. A genetic score combining 14 variants exclusively related to HDL cholesterol also showed no association with risk of myocardial infarction.”
Not sure someone mentioned the book here already – but James A. Duke’s newest book “Herbistatins – Herbal Alternatives to Synthetic Statins – Edible Herbs That Raise the Good HDL and Lower the Bad LDL Cholesterol” will be out soon. Anybody looking for a greener alternative might find some answers there.
Alexa Fleckenstein M.D., physician, author.
No need to buy another book
Simply research berebrine, amla, citrus bergamont, artichoke extract
1) http://blog.case.edu/yxr10/2005/1/19/nm1135.pdf
Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins
2) http://www.nutritionaloutlook.com/article/cholesterol-control-3-13607
Cholesterol Control: Bergamot, Berberine, and Amla May Help
3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792547/
Amlamax™ in the Management of Dyslipidemia in Humans
4) http://www.lef.org/magazine/mag2008/nov2008_Preventing-Cardiovascular-Disease-Naturally_01.htm
5) http://www.naturalhealthadvisory.com/daily/cholesterol-control/plant-extract-helps-lower-ldl-naturally-without-the-statin-side-effects/
6) http://www.ncbi.nlm.nih.gov/pubmed/19821306
Artichoke leaf extract for treating hypercholesterolaemia.
James Duke is one of the foremost herbal expert in this country. He is the author of The Green Pharmacy – a bestseller for many years, in several new editions. His knowledge contains more than what a few (even good) websites can offer. He has insights and gives vision and background (plus has great humor).
And I don’t think we should shut down discourse by assuming the other person has a shut mind. We are all challenged to get out of our comfort zone – and often it isn’t easy.
Alexa Fleckenstein M.D., physician, author.
This is my definition of a closed mind
“Any time I see mention of cholesterol lowering as a goal or LDL as “bad” cholesterol, I take a pass on what’s clearly faulty information.”
Not closed, just full of a whole lot of independent study of many years duration.
It’s a total perversion of human biology and nature to lower critical building material in our bodies to levels impossible and extremely undesirable and foreign to normal human functioning. After, of course, making up a fake “normal” moving target that sells drugs but does not promote health.
One only has to look at the nations study of cholesterol and LDL levels and their complete and total non correlation with mortality in various countries.
Triglycerides are worth lowering due to their superior prediction of CVD, but not with drugs, with diet, very easily achieved in most. The same changes tend to raise HDL, too. Ratios become very favorable, disregarding the numbers.
Charles Grashow, Last time I checked there are voices out there – backed by science – that claim that the “bad” cholesterol is manufactured to protect the lining of our vessels. Problem is our lifestyle that leads to sick vessels.
In my view, cholesterol is not the villain. It is just a marker connoting a bad lifestyle (and has probably less to do with fats, but with sugars, and not moving enough). Let’s not treat the messenger that announces that our lifestyle is wrong. Let’s treat our lifestyle!
Alexa Fleckenstein M.D., physician, author.
@Dr Fleckenstein
“Last time I checked there are voices out there – backed by science – that claim that the “bad” cholesterol is manufactured to protect the lining of our vessels.”
There are also voices – backed by science – that say the opposite.!
SO – the question is who you choose to believe.
For example
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1985/brown-goldstein-lecture.pdf
When LDL-cholesterol levels are below 100 mg/dl (equivalent to a total plasma cholesterol level of 170 mg/dl), heart attacks are rare. When LDL-cholesterol levels are above 200 mg/dl (equivalent to a total plasma cholesterol level of -280 mg/dl),heart attacks are frequent. Controversy arises over the middle ground, i.e.,individuals with plasma LDL-cholesterol levels between 100 and 200 mg/dl (total plasma cholesterol of 170 to 280mg/dl). This is the, range in which the vast bulk of heart attacks occur. Somewhere within this range there is a threshold value of cholesterol at which heart attacks begin to become more frequent. In this middle ground how much of the heart attack burden is attributable to plasma cholesterol? There is no definitive answer. In addition to cholesterol, heart attacks in this group are aggravated by smoking, hypertension, stress, diabetes mellitus, and poorly understood genetic factors. However, it seems reasonable to propose that plasma cholesterol does have something to do with heart attacks in these subjects, and that the incidence of heart attacks would be reduced if plasma cholesterol could be lowered .
The LDL receptor studies lend experimental support to the epidemiologists’ suggestion that the levels of plasma cholesterol usually seen’ in Western industrialized societies are inappropriately high (9). This support derives from knowledge of the affinity of the LDL receptor for LDL. The receptor binds LDL optimally when the lipoprotein is present at a cholesterol concentration of 2.5 mg/dl (28). In view of the 10 to 1 gradient between concentrations of LDL in plasma and interstitial fluid, a level of LDL-cholesterol in plasma of 25 mg/dl would be sufficient to nourish body cells with cholesterol (118). This is roughly one-fifth of the level usually seen in Western societies (Fig. 16 and ref.119). Several lines of evidence suggest that plasma levels of LDL-cholesterol in the range of 25-60 mg/dl (total plasma cholesterol of 110 to 150 mg/dl) might indeed be physiologic for human beings. First, in other mammalian species that do not develop atherosclerosis, the plasma LDL-cholesterol level is generally less than 80 mg/dl (Fig. 16 and ref. 120). In these animals the affinity of the LDL receptor for their own LDL is roughly the same as the affinity of the human LDL receptor for human LDL, implying that these species are designed by evolution to have similar plasma LDL levels (9,119). Second, the LDL level in newborn humans is approximately 30 mg/dl (121), well within the range that seems to be appropriate for receptor binding (Fig. 16). Third, when humans are raised on a low fat diet, the plasma LDL-cholesterol tends to stay in the range of 50 to 80 mg/dl. It only reaches levels above 100 mg/dl in individuals who consume a diet rich in saturated animal fats and cholesterol that is customarily ingested in Western societies (116)
Are you kidding, Charles Grashow? A citation from 1985?? That is exactly where we are not anymore.
Interesting article though. But the conclusions from basic science how cholesterol functions does not translate easily into recommendations that makes people healthier. What this article deducts (not proves!) is that if we keep the cholesterol numbers down, we get healthier people. 30 years later we know that 1), this is not easily done, 2) treating the numbers leads to nowhere.
Alexa Fleckenstein M.D., physician, author.
http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf
Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL’s? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB and an inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation.
http://circ.ahajournals.org/content/116/16/1832.full.pdf
@Dr Fleckenstein
http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf
“Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL’s? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB andan inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation.”
Thank you. I will be waiting for the book to come out!
Dr Eades, Thank you so much for your timely post. My doctor recently gave me an Rx for a statin, but I didn’t fill it. Diet hasn’t made much difference, so I am going to get more aggressive with foods and start supplements. My daughter, an R.N., said if she were my doctor she would fire me! Luckily, my doctor is more tolerant of my herbal alternatives.
I am so sorry about your father. My family went through something similar with my mother several years ago, so I know how upsetting it can be. We didn’t have any family member remotely “medical” at the time, and it was all terribly confusing. I would have thought it would be somewhat easier for a doctor, but your article shows otherwise. It must be even more upsetting to KNOW that things aren’t being done right! I wish you and your family well.
Thanks very much.
Mary said – “Diet hasn’t made much difference, so I am going to get more aggressive with foods and start supplements.”
How are you going to get more aggressive with food and what supplements are you considering taking?
Also – did you doctor do a VAP and/or NMR test? If yes what was your LDL-P and small LDL-P?
Any time I see mention of cholesterol lowering as a goal or LDL as “bad” cholesterol, I take a pass on what’s clearly faulty information.
Since you have a closed mind a conversation with you is a waste of my valuable time.
You are wasting your time, though my mind isn’t closed.
Just in case I failed to post this link or some have missed it, this is the good stuff your body needs LDL to produce. Left alone to work the way human biology intends, your body makes the LDL you need to stay alive and in balance. http://www.cushings-help.com/downloads/steroid01.02.07.pdf
Hyperinsulinemia leads to lower steroidogenesis and lower cortisol binding globulin, a transport protein essential to human survival and homeostasis.
I think the chart explains why post menopausal women produce more LDL; the ovaries aren’t making estrogen, so the adrenals have to step up their production.
It also explains why some men develop gynecomastia and muscle loss on statins.
And more, as you allow your eye to follow the chart. The only thing worse than taking a statin is taking it while also following low fat and sodium dietary guidelines.
My cousin recently told me that her 93 year old mother had to move to an assisted living facility due to her short term memory loss. My cousin had been going over every day to make sure her mother took her medication. She then said, “She doesn’t take a lot of medication. She has one for cholesterol.”
I was surprised, and replied, “There’s no evidence that statins provide any benefit for women.”
She said, “It’s really helped her cholesterol levels.”
I felt that the subject was closed, but to me it looks like this:
A 93 year old woman is taking a statin drug to lower her cholesterol. (Although it provides no benefit, and higher cholesterol may result in a longer life.) She now has short-term memory loss (which is associated with statin drugs) and had to move out of her home into a facility where they can be sure she takes the statin drug….
I’d like to say something more to my cousin, but I’m not a doctor, and the drug was prescribed by a doctor. (And my cousin used to be a drug rep, so she believes in the value of these drugs.)
Absolutely insane. But very common. I can’t imagine how this will be looked back upon in 50 years.
I am 56 and have been off statins for 4 years now–after having really scary side effects that led to tests to determine if I had MS or ALS but turned out to be “just” side effects of the statins. I had been taking varying doses of either Liptor or Crestor for about 7-8 years. I did have very high cholesterol but no high blood pressure, diabetes, only slightly overweight, non-smoker etc. It took me a full year off statins to be fairly normal again and up to six-eight months ago I still had some mild, infrequent occurrences of some side-effects. Now they seem to have finally diminished to the point of being gone. I have learned to live with the idea that we don’t know the long term effects of the statins and I feel lucky that even with the horrible and very scary experience I had, that I have “recovered” from the statin use generally and am feeling great. It is all a very long story that doesn’t need to be told here, but I do have a question.
In the last couple of years, since being off the statins, I have gained a little more weight that, with my age, seems to be easier to put on and harder to take off than ever before. But I have launched into life changes, reduced caloric intake focused largely on lower sugar/carb intake, as well as doing regular exercise–and actually sticking to it and even enjoying it. And the weight is slowly starting to drop. But I have been feeling a bit weird in the last couple of days and have experienced some increase in muscle twitching, neuropathy and some mild equilibrium issues that reminded me of the side effects I had from the statins. These sent me to the computer where I found this site. I was wondering about if statins are fat or water soluble and I saw your chart that some I was on the longest are fat soluble. I was wondering if by starting to burn more fat than I had been, is it possible some residual statin may being released or something. Can you tell me is this even possible? I am assuming that if I recovered from all of this before, that even if something is being released, hopefully it will be less troublesome than what I already went through dealing with the side effects. I would appreciate any thoughts you might have about this. Thanks.
I don’t think you are releasing any stored statins, because I don’t think statins are stored in fatty tissue. However, I couldn’t possibly comment on your situation without doing some labs and an examination. Google Duane Graveline or go to spacedoc.com. Dr. Graveline is a font of information about statin side effects and residual problems.
Virginia,
I could not find anything specific about storing statins in fat tissue. But if they are fat soluble, they should be stored in fat tissue. So I agree with Dr. Eades that you should be seen by a physician because your symptoms deserve some attention – but you might be right with your astute observation.
All the best!
Alexa Fleckenstein M.D., physician, author of The Diabetes Cure
Per CHEST guidelines, all patients with MI should be initiated on a statin. I work for a hospital, it is not at all unheard of and is actually a standard of care that an 86 year old would be put on a statin at discharge. Atorvastatin is our agent of choice, and we almost exclusively start all patients with MI at 20-40mg QHS. Fat soluble statins have actually been shown to be of benefit to the elderly since they are able to cross the blood brain barrier and seem to have a protective effect on the brain. Again, I am a hospital physician and this scenario is exactly what should’ve happened upon discharge. Read your guidelines.
If a patient was to have myopathy, we can switch them to rosuvastatin. That being said, the amount of patients who return with rhabdo from a statin are almost nonexistent.
As far as I’m aware, there are no RCTs showing any decrease in all-cause mortality in men over 65 or women of any age who take statins. If you’ve got info on RTCs (not observational studies) showing something different, then I would love to see it.
This was GREAT…. Its scary to think we have reflexive medical care. Thank you.
Dear Doctors –
I already knew a lot about Statins, but came across your item in a general ‘internet search’ on the subject. I’m glad I did, because there was additional information I hadn’t been aware of.
Something that REALLY struck me was the background you provided on cholesterol and cell walls: “…cholesterol is the key element in the formation of cell membranes, which are the protective coat for the cells, it may be that blocking cholesterol’s production will weaken the protective barrier and allow the entry of toxins or carcinogens that were previously excluded. “
Some time ago I’d learned about how the Flu virus needs to penetrate cell walls and ‘take over’ cells to reproduce the Flu – if the virus CAN'T do that, it quickly dies off.
Everything I’ve seen indicates that the Covid virus has to do exactly that same thing, if it is to successfully propagate.
Could it be that weakening of cell walls by UNNEEDED use of Statins in a substantial percentage of older Americans – aside from other ‘co-morbidities related to age’ explains why THEY suffered substantially HIGHER rates of: a) getting Covid; and b) having substantially more serious consequences from Covid …BY COMPARISON TO younger Americans (other than those with other serious health problems)?
My own personal experience – both with my FORMER ‘primary care provider and the INCOMPETENT cardiologist he set me up with – they were VERY MUCH inclined to just ‘prescribe heart health soluitions’ according to ‘what this PIECE of PAPER says’ than paying ANY attention to observations or measurements of my ACTUAL health conditions!
At least a year ago, I saw a tabulation of data comparing “Death Rate per 1 million” for Covid in the
U.S. with four (4) other nations that had SUBSTANTIALLY LOWER lower rates: India, Costa Rica, Australia, and South Korea.
For my own curiosity, ‘drawing a line’ for Deaths reported from beginning of the Covid Pandemic to Feb 5, 2021 (otherwise the numbers are always changing with time) and calculating what the number of Deaths in the U.S. WOULD HAVE been if the U.S. had experienced the LOWER Death Rates of those four nations – indicated that the U.S. suffered ADDITIONAL DEATHS between 450,000 to 465,000 (in round numbers) due to factors of relative COMPETENCE (or LACK thereof) in U.S. practices in ‘public health.’
I wonder – HOW MUCH of that increase in U.S. Deaths was due to UNNECESSARY, ROUTINE prescription of Statins to Americans …SIMPLY because that is what ‘Big Pharma’ was PROMOTING to physicians here …by comparison to what prescription rates of Statins may have been IN THOSE OTHER nations?
That’s a question I think NEEDS TO BE PROPERLY evaluated.
Strangely enough (or maybe not so strangely) there is a case being made that statins both prevent and treat Covid-19.