Statin Side Effects - How to Reduce Them

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It is no surprise to us that cardiovascular disease tops the list of killers in the world. Every one of us knows at least one other person in our families that has been affected by a heart condition. In 2013, Stats Canada estimated this second leading cause of death to affect more than 2.4 million Canadians (1). This number is expected to increase over the next few decades as the effects of sedentary office jobs and unhealthy eating patterns takes its toll. Cardiovascular disease is a broad term that encompasses any disease affecting the heart and its blood vessels. This includes coronary artery disease, strokes, heart attacks, angina, and peripheral vascular disease. Many of us are aware of the dangers of heart attacks and strokes. We learn the early warning signs and are versed on how to manage the symptoms in case of emergency. However, many of us are less knowledgeable on the topic of peripheral vascular disease (PVD), a silent and potentially life-threatening disease that affects much more than just the heart. PVD affects the blood vessels outside of the heart, such as the legs, arms, fingers and toes. Similarly to other cardiovascular diseases, PVD involves the build up of cholesterol along the walls of artery, a process known as atherosclerosis. This narrows the opening and restricts blood flow through the vessels. While you may think this is less harmful than a heart attack, restricting blood flow to the hands, or even the brain, can significantly reduce function if the blockage is even just to a small degree. Symptoms of developing PVD include (2):

• painful cramping in legs and hips even after minimal activity such as climbing stairs
• leg numbness and tingling
• coldness of the limbs, or a change in colour of the limbs
• coldness of the limbs, or a change in colour of the limbs
• hair loss, shiny skin or slower nail growth on the limbs
• erectile dysfunction

It is important to note that many forms of PVD present with no symptoms. However, anyone with a family history of cardiovascular disease, should undergo a full assessment by the age of 65. This assessment should include a test of all pulses in the arms and legs, blood work for cholesterol and perhaps even diagnostic testing for cardiovascular efficiency (such as a stress test). Many medical doctors are quick to put their patients on cholesterol-lowering medications for preventative purposes, but are not always quick to explain the risks and side effects.

History of Statins

It is estimated that up to 90% of cardiovascular disease may be preventable (1). Research has long been focused on the development of drugs to help support heart function and prevent the build up of artery-clogging factors. The most common class of medications are Statins and include the drug names Lipitor, Crestor, Lescol and Altoprev (3). With the number of cardiovascular disease cases in the country, it is no surprise that Crestor ranks as the 2nd most prescribed medication according to 2015 WebMD (4). Back in the 1950’s, cholesterol and atherosclerosis were new terms in the research world. Scientists began to investigate how cholesterol was made in the body, and found that heart attacks were correlated with high levels of unhealthy LDL cholesterol and low levels of good HDL cholesterol (3). Other than what came in through the diet, cholesterol could be made by the liver to support the basic and essential hormone functions in the body. When dietary needs for cholesterol were met, liver function was suppressed naturally to prevent an overflow of cholesterol. The particular enzyme involved in making cholesterol in the liver is known as HMG-coA reductase. Researchers decided if there was to be a drug to reduce cholesterol, the best way to do it would be to inhibit this enzyme and suppress the liver’s ability to make cholesterol. Thus began the production of statins.

After many years of research and animal testing, the first statin hit the shelves in the late 1970’s. It was shown to reduce unhealthy LDL cholesterol without making any change to good HDL cholesterol. This definitely seemed like a win for the medical community. Today, statins have been tested in over 90 000 humans and followed for 5 years (3). The results are consistent in lowering cholesterol and have increased the lifespan of over 30 million people. However, most of these people are on statins for much longer than 5 years, and little is known of its long term effects. As Naturopathic Doctors, we see the medical benefit as well as the side effects and risks. It is important that we always consider these concerns when working with a patient on statins:

1. Muscle Pain

   This could also be classified as weakness, numbness and soreness in the muscles. It can range from mild discomfort to complete inability to perform daily tasks. This happens because the statin drugs cause small amounts of muscle breakdown in a process called rhabdomyolysis (3). Your doctor will run blood work to check levels of creatine kinase, an enzyme released when muscle breaks down. If your levels are high, your doctor may consider switching you to another statin.

2. Liver Damage

   As discussed, most cholesterol is made in the liver and the function of the statin drug is to decrease the production of cholesterol in the liver. This means the statin is directly targeting the liver and can result in inflammation and damage. While this effect might be rare, your doctor should periodically check your liver enzymes and educate you on the signs of liver disease. These can include low appetite, changes in colour of urine and stool, pain in the upper abdomen and yellowing of the eyes.

3. Increased Blood Sugar

   A mild increase in blood sugar has been noted in patients taking statin medications. This effect may or may not be significant, depending on the individuals family and personal history. Caution should be taken in those currently being treated for diabetes, as medication doses may have to be adjusted for statin use.

How An ND Can Help

1. Nutrition

   Very little medical support is given to the nutritional and prevention aspect of care, making thousands of patients reliable on medications with very little accountability in their day-to-day lives. As mentioned previously, the statin drug prevents the liver’s ability to produce cholesterol. It does not change anything about the amount of cholesterol coming into the body, nor does it improve the liver’s ability to detoxify the amount of cholesterol already existing in the body. A diet plan should be given to every person with high cholesterol, whether they are on medication or not. Many people think cholesterol only comes from eating fried and fatty foods. But our bodies are smarter than that. Cholesterol is essentially a storage form of fuel. Anything we consume in higher amounts than we are using, gets stored in the body as fat. Drinking too much alcohol or consuming high amounts of refined carbohydrates and sugars are equally responsible for increasing cholesterol levels.

2. Exercise

   This one goes without saying. Strengthening the heart includes a cardiovascular exercise plan and regular activity. Exercise supports circulation around the entire body, including the liver. This helps to eliminate toxins through the skin, bowels and bladder, all while burning off excess toxins stored in our fat tissue.

3. CoEnzyme Q10

   This antioxidant is present in the highest concentration in all muscles, and specifically the heart muscle. Statins are known to lower levels of CoQ10 and this may even contribute to muscle pain and breakdown that results (5). An ND will assess all medications you are on and consider if CoQ10 is a suitable addition to your treatment plan. 

4. Turmeric

   Atherosclerosis and cholesterol build up is an inflammatory process. Turmeric is a powerful liver stimulant and anti-inflammatory compound. It can help support the digestive tract while its bitter properties strengthen the gallbladder-liver connection and expel bile for fat digestion.

5. Olive Oil

   Who would have thought that consuming more fats would help to lower cholesterol? The truth is, we need cholesterol. Most of our hormones are derived from cholesterol, which means we need it to function every day. But we need the good kinds of oils in our diets to help us make the good kind of cholesterol. Olive oil is full of essential healthy fats that will stimulate our liver and help our body’s make more of the good cholesterol.

6. Vitamin B12

   Like everything else in the body, cholesterol has a specific set of steps for it to be made, and another set of steps for it to be broken down. Vitamin B12 is an important step in the breakdown of cholesterol, and without it, the entire production line comes to a halt. It is interesting to note that vegans and vegetarians may end up with high cholesterol even though they don’t eat meat. This is because their diets are often low in vitamin B12, which can inhibit the body’s ability to break down excess cholesterol. Get your B12 levels checked, this one is an easy fix!

As with all health concerns, cholesterol management is an individual thing. Each person requires their own set of guidelines specific to their dietary, cultural and lifestyle habits. Making these changes is not easy, but the beauty of natural medicine is that it works forever and teaches us so much more about our bodies.