Category Archives: statin

Can CoEnzyme-Q10 combat statin side-effects?

A new study (1) confirms long-standing concerns about the side-effects of cholesterol-lowering statins. The study suggests that statin drugs can cause significant problems with energy levels and general fatigue, especially in women.

Statins are routinely prescribed to individuals with raised cholesterol levels and are among the most widely prescribed drugs in the UK. These drugs lower cholesterol levels by inhibiting a liver enzyme (HMG-CoA reductase) which plays a role in cholesterol production. Unfortunately this enzyme is also important for the production of Co-enzyme Q10. CoQ10 is a nutrient found in almost every cell in the body and is essential for energy production in the muscles.

The study, published in Archives of Internal Medicine, followed a group of individuals who were randomised to take one of two statins (simvastatin at 20 mg per day or pravastatin at 40 mg per day) or placebo for six months. Participants were rated at regular intervals through the study for their perceived fatigue on exertion, general fatigue and energy levels.

Overall, statins did indeed appear to cause a significant change in energy and worsen fatigue on exertion. Women were more affected than men.

In fact, 40% of the women receiving statins reported either a reduction in energy or a worsening of fatigue on exertion. 10% of the women reported that both of these issues were ‘much worse’.

Nuts contain CoQ10
Nuts contain Co-Enzyme Q10 (CoQ10) which is beneficial towards energy levels

Co-enzyme Q10 is essential for the ‘battery’ in each cell to power our muscles and organs. It is not surprising that depletion of CoQ10 can cause muscle weakness and fatigue. CoQ10 is also vital for heart function. According to one recent study (2), 71% of healthy people develop heart rhythm abnormalities when given statins.

It is important for those taking statins to be aware of the side-effects such as fatigue and muscle weakness, as these symptoms may only appear after some months or years after beginning statin treatment.

The good news is that those taking statins may be able to protect themselves from these side-effects by including good sources of CoQ10 in their diet. The richest dietary sources of this nutrient are organ meats such as liver and kidney, as these are the bodily organs that naturally store high levels of CoQ10. Other sources include oily fish, eggs, nuts and spinach.

For many individuals, dietary sources of CoQ10 may be inadequate to combat the draining effect of statins. In these cases I would recommend would be to supplementing 50 – 100 mg of CoQ10 each day.

Written by Nadia Mason, BSc MBANT NTCC CNHC

References

1. Golomb BA, et al. Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial. Arch Int Med epub 11 June 2012

2. Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. (2004) Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol, 94(10):1306-10.

3. Image courtesy of Zole4

 

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Review looks at ways to tackle high blood fat levels

High triglyceride levels, hypertriglyceridemia, and to some extent high levels of certain types of cholesterol are considered a risk for metabolic syndrome (which I have written about in detail here).  To recap:

Metabolic syndrome is a group of risk factors for heart disease, stroke and type 2 diabetes.  According to the US National Heart Lung and Blood Institute, having metabolic syndrome doubles a person’s risk of heart disease and quintuples their risk of developing type 2 diabetes.

An individual is considered to have metabolic syndrome if they have three or more of the following:

*Excess abdominal obesity (carrying weight around the stomach, as measured by waist circumference)

*High triglyceride levels (blood fats)

*Low levels of HDL cholesterol (good cholesterol)

*High blood pressure

*High blood sugar levels or type 2 diabetes

Hyperlipidemia is used to describe high levels of cholesterol and high levels of triglycerides, or blood fats.

Most doctors will prescribe statins, or other lipid (fat) lowering medicines to people in at risk categories, however, as I have previously mentioned statins may not be the answer and the widespread use of statins has been questioned.  Also there is increasing evidence for natural alternatives to statin medications.

A newly published review paper (1) has explored some of the alternatives to medication, mainly plant sterols/stanols, long chain omega 3 fatty acids, fibre and nuts, and urges the medical community to begin using these alternatives as a viable option with their patients.  The paper challenges current medical guidelines by emphasising the fact that there are viable ‘nutritional’ interventions that can be used during all stages of treatment of hyperlipidemia.

In their paper the scientists write “Functional foods and nutraceuticals are not merely lifestyle interventions. Similar to pharmaceutical agents, FFN [functional foods and nutraceuticals] contain bioactive substances that, when administered at therapeutic doses, target and modulate biological processes that foster the development of disease. Thus, the gap that currently exists between FFN research and the medical community needs to be closed such that FFN can be implemented into clinical guidelines so that treatments for hyperlipidemia can be optimized throughout all stages of therapy”.  As stated above, the ‘alternative’ food/nutritional approaches to lowering blood fat levels work via complex pathways in the body, they are not merely ‘faddy’ approaches and there is considerable scientific research to validate their use (1) their effects go beyond that of simply providing the body with nutrition.

The review paper goes into detail describing the biochemical pathways through which natural agents can have a positive impact in the body.  With regards the long chain omega 3 fatty acids the authors highlight that the triglyceride-lowering effects of omega 3 fatty acids have been thoroughly researched and that studies consistently show that supplements (2-4g per day) can reduce circulating triglyceride levels by up to 34% in patients with high levels.  Research has also shown that these fatty acids can reduce the risk of mortality (death).  The paper also looks at the evidence that dietary fibre and nuts can also play a role in lowering blood fat levels(1).

Rightly the authors also write “The purpose of this commentary is not to discourage the use of pharmaceuticals. Such interventions are an invaluable part of global healthcare systems. The present aim is to emphasize that not only do specific FFN target biological processes that propagate hyperlipidemia, but that certain FFN can serve as beneficial adjunctive treatments which enhance pharmacotherapy”.  The authors go on to describe how there are good studies which show that combining these ‘alternative’ treatments with pharmaceutical agents can provide better results than using the medicines alone – they call for further research in this area and recognise that the medical community would need training in order to utilise such combined therapy “Nonetheless, the advent of combination FFN/prescription therapies will require that physicians undergo additional nutritional training and likely enhance dietitians’ role in executing patient treatment regimens, especially when whole foods are utilized as vehicles for administering FFN”.

 

They conclude that “Despite clinical studies showing that therapeutic dosages of FFN effectively target and modulate biological processes that foster the development of hyperlipidemia, FFN continue to be overshadowed by prescription medications as patients progress through consecutive stages of treatment. Research demonstrates that specific FFN are efficacious adjuncts to pharmacotherapy for the treatment of hyperlipidemia. Hence, it is imperative that developments in FFN research are incorporated into current clinical guidelines that are used for treating HC [hypercholesterolemia] and HTG [hypertriglyceridemia]. In the wake of current prevalence rates of hyperlipidemia amongst people with metabolic syndrome FFN can serve as efficacious adjuncts to pharmo-therapy during all stages of treatment

It is my hope that more of the medical community begin to realise how effective certain nutrients can be in preventing and treating disease.  If you are currently receiving medical treatment for high blood fat/cholesterol levels you may want to talk to your doctor about the possibility of beginning omega 3 supplements and adding plant sterol/stanol products into your diet.

(1)Christopher PF Marinangeli CPF & Jones  PJH.  2010.  Plant sterols, marine-derived omega-3 fatty acids and other functional ingredients: a new frontier for treating hyperlipidemia.  Nutrition & Metabolism.   7:76doi:10.1186/1743-7075-7-76

 

Written by Ani Kowal

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More evidence questions the use of widespread use of statins

Statins are commonly prescribed as cholesterol lowering agents and many individuals take them in the belief that they will reduce their risk of heart disease.  Statins are considered by some as among the most successful drugs of all time and have been credited with preventing millions of heart attacks and strokes.  However, there are many people who prefer not to take statins due to potential side-effects which include possible liver and kidney problems and a possible increased risk of cancer. 

A recently published study (1) by British researchers calls into question the expanded use of statins such in patients who do not have heart disease but may develop it.  The study was a meta-analysis, which reviews all previous published scientific evidence, which found scant evidence that statins saved lives in the short term in groups without heart disease.

The authors of the study wrote that (1)There is little evidence that statins reduce the risk of dying from any cause in individuals without heart disease,” “This, along with harms caused by statins in some subgroups, have called into question the benefit of statins in primary prevention [prevention of the development of heart disease].”  They conclude that “The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors

Previously I have written about a few natural ways to reduce cholesterol and also about the possible cholesterol reducing effects of artichoke leaf extract

One of the studies (2) I mentioned stated that:

Lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL-Cholesterol in proportions similar to standard therapy with simvastatin. Pending confirmation in larger trials, this multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins

Recently (3,4,5) further studies have found that red yeast rice might be useful in patients who have either a statin intolerance or who, for other reasons, have chosen not to take statins.  A small study this year (3) looked at the use of red yeast rice versus pravastatin medication in patients who were unable to tolerate other statins because of myalgia (muscle pain).  Individuals were assigned to red yeast rice supplement 2,400 mg twice daily or pravastatin 20 mg twice daily for 12 weeks and all subjects were enrolled in a 12-week therapeutic lifestyle change program.  The results showed that red yeast rice was tolerated as well as pravastatin and achieved a comparable reduction (of around 30%) of low-density lipoprotein cholesterol (‘bad’ cholesterol) in a population previously intolerant to statins.  The other two studies also found that re yeast rice decreased LDL cholesterol levels and may be considered a treatment option in patients intolerant to statin therapy.  

The studies were small and so firm conclusions over the use of this supplement cannot be drawn.  However, evidence for many alternatives to statins are coming to light and, in conjunction with lifestyle changes which include increased daily activity and exercise, cannot be discounted.  Chinese red yeast rice is a dietary supplement which contains a variety of components such as monacolins, unsaturated fatty acids, and phytosterols which may be capable of lowering low-density lipoprotein (LDL) cholesterol.

If you decide to try any supplement for cholesterol lowering I would encourage you to check with your medical doctor prior to beginning the regimen.  If you are already taking any medications for heart disease, cholesterol or any condition it is crucial to check with your prescribing doctor before taking a supplement.

(1)de Lorgeril M et al.  2010.  Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy.  A Critical Reappraisal.  Arch Intern Med.  170(12):1032-1036.

(2) Becker DJ et al.  2008.  Simvastatin vs Therapeutic Lifestyle Changes and Supplements: Randomized Primary Prevention Trial.  Mayo Clin Proc.  83:758-764

(3) Halbert SC et al.  2010.  Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol.  105(2):198-204.

(4) Venero CV et al.  2010.  Lipid-lowering efficacy of red yeast rice in a population intolerant to statins.  Am J Cardiol.  105(5):664-6.

(5) Becker DJ et al.  2010.  Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial.  Ann Intern Med.  150(12):830-9, W147-9.

Written by Ani Kowal

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