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This amazing guest post was written by Dr. Sarah Brewer, a licensed Medical Doctor, a Registered Nutritionist, a Registered Nutritional Therapist! Check out her website here!

Are you taking a statin drug to lower your cholesterol levels? Or perhaps you’re taking one to reduce your long-term risk of a heart attack and stroke, even if your cholesterol is not raised.

To achieve these long-term benefits you need to take your statin for a significant length of time – but how beneficial are they?

A recent analysis of all the data from 27 clinical trials, involving over 174,000 people, showed that for every 1 mmol/L reduction in ‘bad’ LDL cholesterol achieved by taking a statin, the risk of a heart attack or stroke is reduced by 14% for women, and by 22% for men.

There were no increased risks of cancer and, when all factors were taken into account, those on statin therapy had a one in ten lower chance of dying during the study follow-up periods than those not taking a statin.

This all sounds like good news, so what’s the problem?

Statin Side Effects

Like all drugs, statins can cause side effects. A recent analysis of data from ninety studies, involving around 30 million people, identified 48 different, unintended consequences of taking a statin. Some of these were good unexpected effects, such as a lower risk of dementia, fractures and pneumonia.

Others were potentially harmful, however, including an increased risk of muscle side effects, raised liver enzymes and diabetes. Even so, it seemed that, overall, however, the absolute increased risks associated with taking a statin were small compared to the beneficial effects in protecting against heart attacks and strokes.

The maths seems to support being on a statin if you have a raised risk of cardiovascular disease, but people are stopping them because of unwanted side effects involving the muscles.

Between 5% and 10% of statin users develop muscle aches and pains (myalgia) or weakness (myopathy) and these are a common reason why so many people ditch their potentially life-saving statin medication. One study, involving over 85,000 people, found that 75% were no longer taking their statin after just two years.

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Don’t Stop Your Statin Suddenly

Suddenly stopping your statin is not a good idea. Researchers have found that even short periods of not taking your statin may actually increase your risk of a heart attack compared with those who have never taken them, although the reason for this rebound effect is not fully understood.

So what do you do if you develop these muscle side effects? Firstly, talk to your doctor as switching you to a different statin, or using a lower dose, may help.

Statins and Nutrient Status

There are also some nutritional approaches that may help you overcome muscle side effects and keep taking your statin treatment if you wish as some of the unwanted consequences of statin therapy appear to be related to their effects in lowering your levels of key nutrients, including Vitamin D, Co-enzyme Q0, Vitamin K and Vitamin E.

Taking supplements of these may help you avoid or overcome some troublesome statin side effects.

Statins And Vitamin D

Statins work by reducing the production of cholesterol in your liver so that your blood levels typically fall by at least a half within two to four weeks. This means you have less cholesterol available to act as a building block for making vitamin D.

Vitamin D is produced when ultra-violet rays interact with a substance called 7-dehydrocholesterol within your skin. As its name suggests, this substance is based on cholesterol and researchers have now realised that many people taking a statin are vitamin D deficient as a result.

One of the symptoms of low vitamin D levels is muscle pain, and another is muscle weakness, both of which are common side effects of statin therapy. The good news is that taking a vitamin D supplement can improve these statin-related muscle side effects if you are vitamin D deficient.

A study involving 134 people who were unable to take statins because of muscle pain found that 88% were able to tolerate them again once their vitamin D levels were brought back to normal with high dose supplements.  

Vitamin D is found in two main forms in the diet, as plant-based vitamin D2 (ergocalciferol), and vitamin D3 (cholecalciferol) which is derived from animals.

Vitamin D3 is most effective at maintaining human blood levels and is found in oily fish, fish liver oils, animal liver, fortified margarine, eggs, butter and fortified milk.

Recommended intakes of vitamin D are currently up for grabs as the old recommendations were based on its ability to boost dietary calcium absorption rather than the new understandings relating to heart health and immunity.

Guidelines are under review but a good intake is probably around 15mcg to 20 mcg for those who are not on a statin, and who see some sun (you can only make vitamin D3 when the UV index is greater than 3).

Vitamin D also has beneficial effects on your blood pressure, so supplements are definitely worthwhile if you are on statin therapy and your ability to make vitamin D3 is reduced.

The best dose will vary from person to person, but 50mcg (2,000 iu) is a typical recommendation. The suggested upper safe level for long-term use from supplements is 100mcg (4,000 iu). Find out more at MyLowerBloodPressure.com

Statins And Co-Enzyme Q10

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Statins work by switching off cholesterol production in the liver. To do this they block an enzyme (HMG-CoA reductase) which is also needed to make a vitamin-like substance called co-enzyme Q10. Taking a statin typically halves both your circulating cholesterol levels AND your co-enzyme Q10 (CoQ10) levels within 2 to 4 weeks. This is a big problem.

CoQ10 plays a vital role in energy production and is especially vital for your hardest working cells – those within your muscles. If muscle cells are unable to make all the energy they need, because of reduced CoQ10 levels, they may ache, cramp, or feel weak.

It therefore makes sense to combine a statin with a co-enzyme Q10 supplement to ensure your muscle cells don’t run low on energy.

In fact, a pharmaceutical patent was filed to do just that as long ago as 1990, specifically to combine a statin with Co-enzyme Q10 to prevent these common statin-associated muscle side effects.

Quite why this patent was never followed up is a bit of mystery! Taking CoQ10 supplements can maintain your blood levels of this important muscle nutrient without affecting the cholesterol-lowering action of your statin.

A trial involving 32 people with muscle side effects found that taking 100mg co-enzyme Q10 per day for 30 days decreased pain severity by 40%, while in the placebo group pain increased by 9%.

Dietary sources of co-enzyme Q10 include cell-based foods, especially meat, fish, whole grains, nuts and green vegetables. Average dietary intakes are estimated at just 3–5 mg daily among meat eaters and 1 mg daily among vegetarians, however.

How much co-enzyme Q10 do you need? The amount of CoQ10 your cells can make peaks at around the age of 20 years, then declines so that, by the age of 40, the amount present in heart muscle cells is up to 32% lower than when you were in your 20s, and by the age of 80 has halved again. Those taking a statin may make very little CoQ10 at all.

The usual recommended daily dose of Co-enzyme Q10 if you are on a statin is 100mg of the ‘body-ready’ form known as ubiquinol, or 200mg of the form known as ubiquinone. You can read more about these two forms and the best supplements to take at my Expert Health Reviews blog.

NB If you are taking a statin, tell your doctor promptly if you develop unexplained muscle pain, tenderness or weakness, as you may need a blood test to check your muscle cell health.

Statins And Vitamin K

Researchers and doctors from the United States and Japan recently shared their concerns about statins lowering vitamin K levels which, they argued, could increase the risk of hardening and furring up of the arteries (atherosclerosis) in some people.

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Vitamin K comes in several forms, of which Vitamin K1 is mostly involved in blood clotting and bone health, while vitamin K2 (but not Vitamin K1) helps to bind calcium within the circulation and protect blood vessels from calcification.

Ninety percent of your dietary intake is in the form of vitamin K1, and just 10% in the form of K2, so it’s important that you retain the ability to convert Vitamin K1 to Vitamin K2. Researchers looking at dietary intakes of over 16,000 women aged 49 – 70, for example, found that every 10mcg increase in dietary vitamin K2 intake is associated with a 9% reduction in the risk of developing coronary heart disease.

And yes, you guessed it; statins can inhibit Vitamin K2 formation which may accelerate coronary artery calcification and the progression of atherosclerosis in people who are Vitamin K2 deficient.

Dietary sources of Vitamin K1 include cauliflower, broccoli, and dark green leafy vegetables, but Vitamin K2 is found in animal-based foods such as egg yolk, liver and fish liver oils, meats and hard cheeses, and in fermented foods such as natto.

The recommended daily amount for vitamin K is 75 mcg to 80 mcg per day (which includes all forms). Vitamin K2 supplements are usually taken at doses of 75mcg to 300mcg a day. The suggested upper safe level for long-term use from supplements is 1000 mcg. Find out more about how vitamin K2 protects against heart disease and the best supplements to take at  www.MyLowerBloodPressure.com.   

Statins And Vitamin E

Vitamin E acts as an important fat-soluble antioxidant in the body to protect against hardening and furring up of the arteries (atherosclerosis), so good levels are vital for long-term health.

Because statins affect blood fat levels, they also lower blood levels of fat-soluble vitamin E by 17%. Lack of antioxidant protection is associated with an increased risk of atherosclerosis, so it’s a good idea to ensure you have a good intake. Although individual trials have shown conflicting results, a large analysis of the results of 15 trials suggests that people with the highest intake of vitamin E, from both diet and supplements, were 24% less likely to develop coronary heart disease than those with the lowest intakes.

Another recent analysis of 16 trials involving people taking vitamin E supplements found they significantly reduced the risk of a fatal heart attack by 16%.

Dietary sources of vitamin E include wheatgerm oil, avocado, wholegrain cereals, nuts and seeds. If you decide to take a supplement, the most effective are those that supply the natural source of vitamin E known as d-alpha tocopherol. The recommended daily amount for vitamin E is between 12 mg and 20 mg per day. The upper safe level for long-term use from supplements is suggested as 540mg (800 IU).

Conclusion

Statins are one of the most controversial medicines prescribed in Western medicine. The evidence suggests their benefits outweigh their potential harms, and if you are one of the lucky ones who do not experience muscle-related side effects, you should definitely continue to take them. You may wish to consider increasing your dietary intakes of the above nutrients to avoid deficiencies.

If you do develop statin-related muscle aches, weakness or cramps, don’t stop taking the statin suddenly as the rebound effect is best avoided. Instead, talk to your doctor about switching to a different statin, or to a lower dose.

Adjusting your diet, and taking supplements of Vitamin D, Co-enzyme Q10, Vitamin K and Vitamin E may help to overcome your symptoms and ensure you can continue obtaining the long-term benefits of statin therapy.

Are you on a statin, or are you determined to avoid them at all costs? Have you had to stop taking a statin because of side effects? Do share your experience in the comments below.

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Dr. Sarah Brewer
M.D.
Dr. Sarah Brewer, MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, FRSM, is a medical nutritionist, nutritional therapist and the author of over 60 popular health books.
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