Why healthy people should avoid statins
If you are a healthy person who was told to take cholesterol lowering medication based solely on your lab results, I’m writing this for you. As an Internal Medicine doctor practicing Integrative and Functional Medicine, I often see patients for this exact scenario. Keep in mind that this article is directed towards healthy people (i.e., no history of heart attack/heart disease, stroke, peripheral vascular disease, diabetes, autoimmune conditions, or any other medical condition that can increase cardiovascular risk). I do believe that understanding statin side effects is important for everyone because of how commonly these drugs are prescribed.
Many patients that I see intuitively understand that their cholesterol levels are best optimized with diet and lifestyle changes. What they don’t realize, is how incredibly problematic statin drugs are. This article will discuss some of the key statin side effects – something you need to know about in order to make an informed decision about statin use.
What statins do
Statins are very effective at bringing down elevated cholesterol levels – something that often stems from modifiable diet and lifestyle factors. How do statins work? They block the enzyme pathway involved in manufacturing cholesterol in the liver. Blocking this pathway (via blockade of the HMG-coenzyme A reductase enzyme) leads to many downstream effects. Some of these effects are positive, such as reducing inflammation and stabilizing arterial plaque. The problem is that other downstream effects of statin drugs are disease and/or symptom promoting, such as insulin resistance, weight gain, diabetes, muscle pain, and cognitive effects.
Why you should care
Statin use has increased dramatically in the US, especially since the 2013 American College of Cardiology/American Heart Association revised their cholesterol treatment guidelines. One study of US citizens over the age of 40 studied statin usage trends and demonstrated that between 2008 and 2019, the annual number of statin prescriptions increased from 461 million to 818 million.
What high cholesterol means
I view abnormal cholesterol results as a warning sign. As strange as this may sound, an abnormal cholesterol level in an otherwise healthy person is one of the kindest ways to have an important health message delivered to you. It may seem like a curse, but it is truly a blessing if you choose to listen. The message, especially in cases when high triglycerides are present in addition to elevated cholesterol, is that you are likely eating a Standard American Diet (also known as the “SAD” diet). What you are putting in your mouth and the way you are living has put you on a path towards ill health. Should you choose to ignore the message and continue your current diet and lifestyle, there will most likely be consequences.
Would you do this to your car?
When a dashboard warning light goes on in your car, you know what you need to do. I don’t know anyone who would consider it a nuisance and clip the wire to the warning light. That would make no sense. Obviously, you would fix the problem yourself if you fix cars, or take it to the mechanic if you can’t fix it yourself. Starting on a cholesterol lowering drug and continuing the same illness promoting diet and lifestyle that led to the high cholesterol does nothing to address the underlying cause – it only improves the numbers. It would be like ignoring the warning light on your car’s dashboard and then being surprised when your car breaks down from neglected maintenance.
A comprehensive approach to foundational health with diet and lifestyle modification, on the other hand, makes a lot of sense and works to promote increased energy, vitality, wellness and at the same time optimizes cholesterol levels.
Statin side effects – my top picks
There are hundreds of statin related adverse effects documented in the peer-reviewed literature. I’m only giving you the common ones. Please keep in mind that adverse effects from statins are not a rare occurrence and, in my clinical experience, are the rule – not the exception. They are commonly missed if not considered or actively looked for. Here is a short list of some common statin adverse effects – but don’t take my word for it, you can check out the references listed as links at the end of this article if you would like to see the proof.
- Increased Diabetes Risk
- Exertional Fatigue and Muscle Pain – Potential for muscle injury
- Nutrient Depletion, including CoQ10 and Selenium
- Cognitive Effects, Worsening of Dementia and Other Neurological Effects
- Endocrine/Hormonal Effects, Infertility and Sexual Dysfunction
Take home message
Statins can be lifesaving in people with active cardiovascular disease (heart disease, stroke, peripheral vascular disease) and are important therapeutic options for many other diagnoses. For otherwise healthy people who only have an abnormal cholesterol found on a blood test however, I recommend that you understand the potential side effects of statins. This way, you can have an informed conversation with your PCP about the risks and benefits before starting any therapy. Lastly, know that Integrative and Functional diet and lifestyle modifications for hyperlipidemia/high cholesterol are effective stand-alone therapies for abnormal cholesterol in the majority of motivated patients.
Sharon Goldberg is a Santa Fe based Integrative and Functional Medicine Physician who specializes in personalized preventive and wellness focused patient care. She is Board Certified in Internal Medicine since 2000 and has advanced training in Tropical Medicine and Hygiene. She has over two decades of practice experience working with both complex chronic illness and disease prevention. She is a medical educator, peer reviewer and coauthor of integrative and prevention related clinical research.
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References and selected abstracts
Increased diabetes risk
Mansi, Ishak A., et al. “Association of statin therapy initiation with diabetes progression: a retrospective matched-cohort study.” JAMA internal medicine 181.12 (2021): 1562-1574. This was a large retrospective cohort study of 83 022 matched pairs of statin users and nonusers from the VA health system that found that diabetes progression was significantly higher among patients with diabetes who used statins than among patients with diabetes who did not use statins. The authors concluded that “Statin use was associated with diabetes progression in patients with diabetes—statin users had a higher likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased number of glucose-lowering medication classes.”
Exertional Fatigue and Muscle Pain – Muscle Injury
There have been rare reports of immune-mediated necrotizing myopathy (IMNM), an autoimmune myopathy, associated with statin use that generally does not resolve after discontinuation of statins. IMNM presents as proximal muscle weakness and elevated serum creatine kinase and is generally treated with immunosuppressive agents.
Endocrine effects, infertility and sexual dysfunction + general toxicity
Omolaoye, Temidayo S., et al. “Statins and male fertility: is there a cause for concern?” Toxics 10.10 (2022): 627.“…the findings have shown that some forms of statins can cause testicular dysfunction owing to their ability to reduce testosterone production.”
Nutrient depletion, including CoQ10 and Selenium
Raizner, Albert E., and Miguel A. Quiñones. “Coenzyme Q10 for patients with cardiovascular disease: JACC Focus Seminar.” Journal of the American College of Cardiology 77.5 (2021): 609-619. “Coenzyme Q10 (CoQ10) is a naturally occurring compound that is found in animals and all humans. It has a fundamental role in cellular energy production. Although it is produced in the body, tissue deficiency can occur due to medications such as statins, which inhibit the mevalonate pathway.”
Cognitive Impairment and effects
ALS (Amyotrophic Lateral Sclerosis)
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