Health column by Dr. Greg Feinsinger. Champion of Whole Food Plant Based Living and righteous person.
High total and bad cholesterol (LDL) are both major risk factors for atherosclerosis (hardening of the arteries/plaque). This disease can cause slowly-enlarging partial blockages in coronary arteries, which can result in angina (chest pain with exertion). When coronary plaque ruptures suddenly, the resultant blood clot totally blocks the artery, resulting in a heart attack, 20 percent of which are fatal. Atherosclerosis is also the cause of most strokes; peripheral vascular disease (blockages in the arteries in the legs), erectile disfunction, and of most kidney failure. It is also linked to dementia, including Alzheimer’s.
People who are on a plant-based, unprocessed food diet with no salt, sugar or added oil don’t get atherosclerosis. They have atherosclerosis-proof levels of total cholesterol (< 150) and LDL (<50). However, in people on a Western diet heart attacks are the most common cause of death, and strokes are the main cause of chronic disability.
Not everyone is willing to go on a total plant-based diet. Furthermore, some people have a genetic defect that causes their liver to make so much LDL that a plant-based diet isn’t enough to lower their LDL below the danger level. Lucky for these people, we have statin drugs. The first one, Mevacor (lovastatin) came out in 1987. Subsequently, other statins were developed: Lipitor (atorvastatin), Lescol (Fluvastatin), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin).
Statins lower cholesterol by blocking the liver enzyme needed to make it. Statin drugs also have beneficial effects beyond cholesterol lowering: they improve function of the endothelium, the organ that lines our arteries; they make plaque more stable—less apt to rupture; they decrease inflammation—which is often the driver of plaque formation and of plaque rupture; they help prevent clot formation. For all these reasons, Bale and Doneen in “Beat the Heart Attack Gene” state that anyone with plaque (as demonstrated by carotid IMT, coronary calcium score, or other method) should be on a statin.
Statins have been studied as much as any other class of drugs in the 32 years they’ve been available. They clearly reduce the incidence of heart attacks and strokes. However, no drug is perfect, and statins can have side effects, although the incidence is much lower than the misinformation on the internet suggests. Here are the most common ones that patients worry about:
- Muscle weakness and/or aching occurs in about 10 percent of statin users—especially if they have low vitamin D levels or untreated low thyroid. If you experience this side effect, add daily co-Q-10 (1 mg. per pound of body weight) plus 2000 units of D3. Trying a different statin often helps (some people who don’t tolerate any other statin will tolerate 1 mg. a day of Livalo, or a low dose of Crestor 3 times a week). Beware of the nocebo effect—if you read or hear negative things about statins and convince yourself you are going to have side effects, you probably will (the opposite of the placebo effect).
- Rhabdomyolysis is a very rare but serious condition involving muscle breakdown, for which statins are one among many causes, but if caught early permanent harm doesn’t occur. If you have significant muscle pain or weakness associated with dark urine, stop your statin and contact your provider immediately.
- Liver inflammation from statins is rare enough that the FDA no longer recommends that physicians check liver enzymes, other than a baseline to be sure that a patient’s liver is okay before they start a statin.
- About 1 out of 255 statin users will have a mild bump in blood sugar levels, and move from pre-diabetes to diabetes. The benefit of the statin still outweighs the risk from diabetes in these people (diabetics are especially prone to cardiovascular disease and most if not all should be on a statin).
- Transient mental confusion or brain fog has been reported, but whether it’s really related to statins is questionable. And studies show a lower incidence of dementia in statin users (what’s good for the heart is good for the brain).
Bottom line: If you have high cholesterol and/or atherosclerosis, the safest and most effective approach is to go on a plant-based, unprocessed food diet with no salt, sugar or added oil. If your cholesterol is still in the danger zone after a month or so, or if you’re unwilling to change your lifestyle, go on a statin if your doctor recommends it. The morbidity and mortality of untreated high cholesterol/atherosclerosis far outweigh any danger associated with statins.