Should you take a statin drug?

Posted on October 17, 2009. Filed under: 1 | Tags: , , , |

If your blood cholesterol level is too high or your LDL- (bad-guy) cholesterol is too high you should follow a health-promoting diet to lower it. As outlined in my Blog “Lower your cholesterol” you can lower your LDL-cholesterol by 20-40% by following a low-fat and low-cholesterol diet and using soluble fiber (oats or psyllium), soy protein, and plant sterols. It is safer to lower your LDL-cholesterol this way and by taking drugs. If you cannot get to the LDL-cholesterol levels recommended by your doctor you may need to take a statin drug. You should read my blog “How low should your cholesterol be” to decide how low you want your LDL-cholesterol value to be and whether you should take a statin or other type of drugs.

Statin drugs lower risk of heart attack by about 25%, especially for men who are less than 60 years old (1). However they have side effects. They may cause muscle aching in one out of  ten people (2) with serious damage to muscles occasionally (3)  as well as problems with muscle tendons  (4). They also can affect liver function and irritate the stomach. I have seen all of these side effects in my patients.  Not uncommonly they may cause neuropathy (nerve pain or tingling) (5), infrequently cause decreased cognition and very rarely they can cause serious neurological problems such as amyotrophic lateral sclerosis (Lou Gehrig’s disease)(6-8). Because they may accelerate loss of cognitive function as people age, I agree with some experts who recommend that people over age 70 should not take them unless there are extremely strong indications (progressive coronary heart disease)(1). Informed patients receive better health care and I think you should discuss your need with yours doctors (primary care doctor and cardiologist or specialist) before deciding to take a statin drug.

Statin drugs decrease levels of Co-enzyme Q10 in the blood and body tissues such as muscles and heart (1). This can cause muscle aching and impair heart pumping action. Taking a supplement of Co-enzyme Q10 may protect from these problems. I recommend that everyone who takes a statin drug take at least a 100 mg gel capsule of Co-enzyme Q10 twice daily. I have done research with the brand Q-Gel® and am convinced that it is the most effectively absorbed form of Co-enzyme Q10.                                                                                                                                                                            1.    Golomb BA. Implications of statin adverse effects in the elderly. Expert Opin Drug Saf 2005;4:389-97.

    2.    Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009;150:858-68.

    3.    Mohaupt MG, Karas RH, Babiychuk EB et al. Association between statin-associated myopathy and skeletal muscle damage. CMAJ 2009;181:E11-E18.

    4.    Marie I, Delafenetre H, Massy N, Thuillez C, Noblet C. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum 2008;59:367-72.

    5.    de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med 2006;64:334-8.

    6.    Muldoon MF, Ryan CM, Sereika SM, Flory JD, Manuck SB. Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004;117:823-9.

    7.    Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.

    8.    Edwards IR, Star K, Kiuru A. Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007;30:515-25.

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How low should your cholesterol be?

Posted on October 17, 2009. Filed under: 1 | Tags: , , , , |

High blood cholesterol levels increase your risk for a heart attack or stroke. The best information is related to the low-density lipoprotein cholesterol level or the LDL-cholesterols (called the ‘bad guys) and cardiovascular risk. Many experts recommend that everyone should have a LDL-cholesterol value below 130 mg/dl (or a total cholesterol below 200 mg/dl). They recommend that the ideal LDL-cholesterol should be between 70 to 100 mg/dl for persons who do not have coronary heart disease (CHD). If you have CHD or have had a heart attack some experts recommend that your LDL-cholesterol should be below 70 mg/dl (total cholesterol below 140 mg/dl) (1;2). My research leads me to recommend that if you have CHD or have had a heart attack and are less than 70 years old your LDL-cholesterol should be between 60 and 80 mg/dl (total cholesterol of 130 to 150 mg/dl). Lower LDL-cholesterol levels may lead to more rapid loss of brain (cognitive) function as you get older (3). If you are over 70 years old, my research suggests that maintaining your LDL-cholesterol between 80-100 mg/dl (total cholesterol of approximately 150-170 mg/dl) is the prudent thing to do to sustain optimal brain (cognitive) function.
People with LDL-cholesterol values below 110 mg/dl (total cholesterol below 180 mg/dl) appear to have lower brain(cognitive) function than persons with LDL-cholesterol values above 110 mg/dl (3). The evidence that statin drugs decrease risk for heart attack for persons above the age of 70 years old is unclear (4). Some evidence indicates that statin drugs decrease brain (cognitive) function—perhaps by decreasing cholesterol available for to maintain the cholesterol levels required for the brain (4;5).
Reference List
1. Expert Panel. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). J Amer Med Assoc 2001;285:2486-97.
2. Keevil JG, Cullen MW, Gangnon R, McBride PE, Stein JH. Implications of cardiac risk and low-density lipoprotein cholesterol distributions in the United States for the diagnosis and treatment of dyslipidemia: data from National Health and Nutrition Examination Survey 1999 to 2002. Circulation 2007;115:1363-70.
3. Elias PK, Elias MF, D’Agostino RB, Sullivan LM, Wolf PA. Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosom Med 2005;67:24-30.
4. Golomb BA. Implications of statin adverse effects in the elderly. Expert Opin Drug Saf 2005;4:389-97.
5. Muldoon MF, Ryan CM, Sereika SM, Flory JD, Manuck SB. Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004;117:823-9.

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Orlistat (alli) does not cause liver disease

Posted on September 5, 2009. Filed under: 1, diet, obesity, weight | Tags: , , , |

Orlistat, the active component of alli, has been more extensively studied than any other drug approved for treatment of obesity. Over 30,000 individuals have participated in more than 100 clinical research studies. These studies have measured tests of liver function and have not indicated that orlistat is associated with adverse effects on the liver. In fact, medical doctors who specialize in liver disease have used orlistat for treatment of several types of liver disease. “Fatty liver disease”, accumulation of excessive fat in the liver is very common in overweight individuals. Liver specialists have tested orlistat for treatment of fatty liver and preliminary results from about a dozen studies suggest that orlistat decreases fat accumulation in the liver and improves chemical tests of liver function. Extremely rarely, several different types of liver problems have occurred when individuals have taken orlistat but, currently, there is no specific information indicating that orlistat has been related to these liver problems. There are several reasons that overweight persons could develop liver problems while on a weight-loss diet. Most overweight people have excessive fat in the liver; when they lose weight there often are mild, temporary changes in liver function. Overweight persons are a high risk for gallstones and when they lose weight they commonly form new gallstones. Use of weight loss herbal remedies, other drugs, or alcohol could contribute to liver problems. The current evidence indicates that it is extremely unlikely that individuals who do not have liver problems would be at risk for liver problems while using orlistat.

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Hypoglycemia follow-up

Posted on June 11, 2008. Filed under: 1 |

For persons with hypoglycemia, my research shows that the best way to smooth out the blood glucose is to eat a diet that makes muscles more sensitive to glucose. After meals, muscles use and store about 90% of the glucose. Many people with hypoglycemia produce too much insulin because their muscles are ‘lazy’ and require a great deal of insulin to utilize glucose. To have muscles in better shape, regular exercise such as brisk walking, and avoiding fat in the diet are the major goals. Fats block glucose uptake by muscles. So a low fat diet is very important. A diet higher in starches and fiber makes the muscles more sensitive to insulin. If muscles become accustomed to burning carbohydrate as fuel, they do it more efficiently. If they become accustomed to burning fat for fuel, the are inefficient at buring carbs. So starches and fiber are the best choices in the diet. Usually I recommend minimal sweets and fruit for about 6 weeks. Then fruit can be included without causing hypoglycemia. After a few months, fruits usually are not a problem but whole fruits are preferred to juice or canned fruits with lots of sugar. Raisins are an excellent choice from the beginning.

My High Fiber Fitness book outlines an excellent diet for persons with hypoglycemia. 

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Reactive hypoglycemia

Posted on May 20, 2008. Filed under: 1, diet, diet, nutrition, weight | Tags: |

Recently a young lady e-mailed me about the management of reactive hypoglycemia. This condition causes the blood glucose to drop to low levels between meals and cause weakness or shakiness. We have been doing research on this for many years and have successfully treated many dozens of people. Here are some caveats. It is not necessary to have a glucose tolerance test– I obtained a hemoglobin A1c to confirm low blood glucose. The hemoglobin A1c (HbA1c) gives an estimated average of the blood glucose over the last 6 weeks. If a person has been having low blood glucose values between meals the HbA1c values is a few tenths of a point below the normal range.

Usual causes: diabetes in the familly and a tendency to diabetes; previous stomach surgery of a stomach that empties too fast; and idiopathic (meaning we don’t know exactly why). Rare causes are an underactive adrenal gland or pituitary gland.

Diet and exercise are the best and most effective treatment. High fiber foods– like oatmeal, beans, whole grain products– and starchy foods– rice, pasta, potatoes– work very well. Soy foods like edamame, tofu, soy nuts, and soy milk also help. Initially people need to avoid sugar, sweets, and fruit. However, after a few weeks people can resume using whole fruit but not fruit juice. Raisins are a good snack between meals. Avoid high fat animal products such as sausage, bacon, high fat beef and pork and select white meat of chicken or turkey for protein choices.

Since a tendency towards diabetes is present in about half of US adults the above diet, exercise and, if overweight, getting to a healthy weight are very helpful.  

Like many conditions, your health is in your hands. Best wishes.

Jim (NutDoc)

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Soy Health Benefits

Posted on April 22, 2008. Filed under: 1 |

Recently a friend directed me to a website claiming that soy was hazardous to your health and provided NO health benefits. This is totally false.

Soy foods are among the healthiest foods you can place on the table. Our research goes back almost 20 years and we published a report about the cholesterol lowering effects of soy protein in the New England Journal of Medicine in 1995. Subsequently the FDA approved a health claim relating soy protein to a protection from heart disease.

Soy protein lowers blood cholesterol. Intake of three servings per day (1 cup soy milk, 1/4 cup soy nuts, 1/2 cup edamame (green soybeans), 3 oz tofu, or 1/3 cup soybeans are serving sizes) can lower the bad guy LDL cholesterol by 6% and risk for heart disease by 8 to 12%. Soy protein also lowers blood triglycerides about 8% and RAISES HDL (good guy) cholesterol by about 3%.

My recent unpublished meta-analysis of soy protein effects on blood pressure indicates that three servings of soy protein reduces blood pressure by 3mm Hg systolic and 2 mm Hg diastolic. This reduction would lower risk for heart attack by about 8 to 12% and risk of stroke by 15%. Thus, soy lowers your risk for heart attack and stroke by more than any other single food you can eat.

Soy protects the kidney of persons with diabetes and actually reverses kidney disease in diabetic persons.

Soy infant formula is safe for male and female children and has NO long-term adverse effects.

Soy does not affect thyroid function and does not pose a problem for persons who require thyroid hormone replacement.

The association between soy and breast cancer is still being debated. It is my feeling, based on a critical and thorough review of the literature that soy protein intake is protective from breast cancer but more data is required. Soy appears to protect from prostate cancer and reverse the prostate cancer process.

Soy appears to protect bones from osteoporosis but more research is required.

Soy improves blood sugar control for persons with diabetes and may protect from diabetes. It also appears to have benefits in protecting from obesity.

SO, what are the side effects. Some persons are not accustomed to the taste of soy foods and may have difficulting starting to use soy foods. Soy foods may increase gas production but this is temporary and improves over time.

Soy, like peanuts, may be associated with allergy. Allergy to soy is less common than allergy to peanuts.

In summary, soy foods offer more health benefits than any other single food, in my opinion. Other than the occasional soy allergy, there are not serious side effects to enjoying soy foods.

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