Statins: Rethinking Going On a "Miracle Drug."
Everybody knows when Joge Tsang is involved in tough singles tennis. Along with the thwacking of racquets on balls, his self-exhorting grunts of "Come on! Come on! Watch the ball!" resound over adjoining courts.
Joge is a highly competitive tennis player.
Born in Chunking, China and raised in Hawaii, he came to mainland America as a child when his parents brought him to New York City. He graduated from the University of Hawaii, was an arts teacher for many years, and is today retired and living in Holden, Mass.
Joge, 66, is as competitive on health issues as he is on the tennis court. After his cholesterol spiked in 2000 and then stubbornly stayed borderline high over the next few years, his doctor began urging him to take a statin to get it down. Finally, the doctor was insistent.
"I think you should go on a statin," he said flatly.
"Give me six months," Joge said. "I'll do something different."
Joge started to talk about what that something different might be, but the doctor would have none of it. "He didn't want to hear the details," Joge said.
At the time, his total cholesterol was 212 (LDL 157, HDL 55). He plunged into the research literature. Then he wrote his doctor a letter that made clear that this was a patient who thinks for himself and that he, and no one else, is in charge of his health.
Joge wrote: "At this stage in my life, I am still not convinced that I am a candidate for statins. First of all, I agree that my numbers are borderline, and if I were categorized as 'high risk' for CHD [chronic heart disease], I should take statins. Correct me if I'm wrong, BUT I feel that I am at 'low risk' for CHD."
Then, citing sources, he noted the major risk factors for CHD and pointed out that he had none of them: no established cardiovascular disease; no diabetes; no cigarettes; no "multiple risk factors of the metabolic syndrome;" and no "acute coronary syndromes."
Joge also suggested possible explanations for the rise in his cholesterol levels. He wrote: "A year ago, I decided to lift weights to build my upper body and improve my strength. Visually, I have bulked up and increased the size of my upper arms and pectorals. With this change, I also changed my dietary habits. I ate more protein, and perhaps I may have consumed too much saturated fats in the process. I snacked on daily portions of cheese, and ate more read meat. Currently I still lift weights."
The doctor stopped talking up statins.
Meanwhile, Joge prescribed for himself an overhaul of his diet: "No red meat, no eggs, no cheese -- and I love cheese. No potatoes. Whole-grain pastas. Chicken. Fish. Lay off stuff like butter."
In addition to the radical diet change, Joge began taking fish oil and flaxseed oil. He took two tablets each daily for a total of 4,000 mg. When he was next tested, a year later, his LDL cholesterol count fell to 137. That was in 2007. Now it is 127. Joge's diagnosis was right, his treatment was right, the outcome excellent. Patient " cured." Now he concentrates on his already strong tennis game.
I learned all this when I made the mistake of mentioning, with no little self-satisfaction, that I had recently started taking a statin to get my marginally high cholesterol down. (I wrote about this decision in an earlier blog.) I bragged that I had resisted pressures from two primary-care doctors for three years before deciding to go on a daily low dose (20 mg.) of Zokor. And then, ta-da, the proof of my self health-managing genius: "My total cholesterol fell from 220 to 147!"
I expected Joge to be impressed. Given that he had successfully lowered his cholesterol through diet and oil and flaxseed supplements, he wasn't. Instead, he told me his story and tactfully suggested that I rethink. The next time we met for tennis, he handed me a pile of research materials.
I read them, Joge, I read them, honest.
Another friend, Marybeth Home, who lives in Northhampton, Mass, was also less than blown away by my triumphant tale of slaying the great cholesterol monster with a generic (cheap) statin with rare side effects (safe). A teacher and certified nutritionist, she was not buying any of it.
Marybeth is a rare bird. She is a humanist to the core but one solidly grounded in reality. Her head may be in the stars but her feet are always on the ground. She is an idealist who is very much of a factualist. Always, she needs to see proof. She is a breast cancer survivor and she did it her way, through nutrition, without chemotherapy.
She tries not to hurt my feelings. "Are you sure it's the right thing to do?" she asks.
But in the course of our visit, Marybeth gently lets me know that she has misgivings about statins. She is too polite to pelt me with anti-statin hard evidence, but a few days later she does write me an e-mail suggesting a number of resources that might be helpful to me.
Foremost among them is John A. McDougall, M.D. He is a physician and nutrition expert who has practiced medicine for 40 years. For the past thirty of those years, he has often spoken out against conventional wisdom in promoting health and treating disease.
Today, there is no more conventional wisdom than that high cholesterol is best treated with statins. Dr. McDougall says that so many physicians believe this that "we may as well put statins in the water." He is the founder and director of the McDougall Program which teaches better health through vegetarian cuisine.
He says that the typical well-treated patient in our "advanced society" is "fat, sick, and overmedicated." He contends that cholesterol-lowering drugs are over-promoted and that medical and pharmaceutical businesses "brag all the way to the bank about improvements of their customer's risk factors (incidental numbers forced to lower values by drugs)."
Dr. McDougall is not against statins across the board. He prescribes statins for very high-risk patients, such as those with a history of heart disease or stroke. His problem is that today's drug approach to disease treat the signs of disease, or risk factors, instead of the underlying cause. He says that high cholesterol is a risk factor, not a disease, and it is caused primarily by the high-fat Western diet.
On his website, drmcdougall.com, Dr. McDougall writes:
"During my forty years of medical practice, I have never seen anyone die of high cholesterol (and neither has any other doctor). Cholesterol is a risk factor -- this means that it is a sign that reflects: the richness of the person's diet, his or her ability to metabolize the rich foods, and most importantly, the overall health of the body. The cholesterol molecules, themselves, in the bloodstream are relatively non-toxic.
"If cholesterol, itself, were the problem, then their predictive value for heart attacks and strokes would be close to 100% -- high cholesterol would always mean sick arteries. However, I know many people with cholesterol levels over 300 mg/dl, with perfectly clean arteries --and just the opposite, people with levels below 170 mg/dl who have suffered a major heart attack. Furthermore, when the arteries of patients taking statins are studied over time, regression of the underlying disease, atherosclerosis, occurs in only a minority of patients, even if cholesterol drops profoundly under the influence of powerful medications.
"The underlying truth is: there is a strong correlation between the richness of a person's diet (reflected by cholesterol and saturated fat content of the food choices) and the level of cholesterol found in that person's blood. The richer the diet, the higher the blood cholesterol. The association continues: the higher the cholesterol in the blood, the more likely the disease will happen -- such as heart attacks, strokes, and a variety of cancers. The real culprit is the rich diet -- the elevated cholesterol is, more or less, a secondary finding.
"Because of the enthusiastic and dishonest promotion of these high-profit drugs, many patients actually believe they are 'cured' of their health problems -- as a result they may see no more need to make beneficial diet and lifestyle changes, which in truth make a far great difference than any medications. One recent analysis found smoking cessation and the use of plain aspirin to be much more cost effective than the prescription statins."
One person who has embraced the Dr. McDougall program, and who is glad she did, is Joanne Irwin who lives on Cape Cod, Mass. She is a 50-something or 60-something who looks and acts like a 40-something. Honored as a "Star McDougaller," she described what the program has done for her on Mcdougall.com:
"In July 2006, I met with a new physician who joined my Cape Cod medical group. Blood work showed my LDL (my bad cholesterol) had risen to 170 and my overall cholesterol to 246.... I felt baffled because I thought I exercised and ate well, and I also regularly read articles on health and nutrition. I saw the commonly advertised statins on my horizon -- drugs like Lipitor and Crestor that keep people perennially chained to the pharmaceutical companies. I pondered if I would become a statistic who suddenly drops dead from a heart attack. Heart attacks are rampant on my father's side of the family, but while he defied medical statistics (living to 93), I was not willing to take that gamble.
"Fortunately for me, my physician advocates a plant-based diet. Citing current research, he asked me if I would consider giving up beef, pork, lamb and dairy (while keeping chicken and fish to a minimum), emphasizing their negative effects on health. Since I was willing to to do anything to naturally lower my numbers and remain free of the phamaceutical stranglehold, I agreed to give it a try....
"Four months after my doctor suggested I change my diet (and three months after being on a totally plant-based diet), I returned to have my lipid numbers rechecked. My LDL decreased to 69 (from 170) and my overall cholesterol dropped to 174 (from 246). You should have been there to hear the hoots of joy in that office."
Marybeth also recommended Dr. David G. Williams, a specialist in natural healing. Until 1985, Dr. Williams operated one of the largest non-invasive alternative medicine practices in central Texas. That same year he started Alternatives, an alternative medicine newsletter. Today, 23 years later, Alternatives has 300,000 subscribers and is America's longest-running alternative medicine newsletter. Primarily, Dr. Williams' therapies use and build upon the body's innate healing capabilities.
He flatly declares that lowering your cholesterol counts will not help you avoid heart disease. He backs this up by citing three statistical facts: 1) More than 60% of all heart attacks occur in people with normal cholesterol levels. 2) The majority of people with high cholesterol never suffer heart attacks. 3) Half of all heart attack victims have none of the standard risk factors (ie. smoking, obesity, genetics, high cholesterol.
Following is an excerpt from his newsletter:
"Doctors are pressuring patients to take statin medications. Patients are scrambling to lower their cholesterol. The result is an onslaught of new illness—from nerve damage to depression—all triggered by a lack of protective cholesterol. The fact is, lowering your cholesterol does not stop heart disease...
"Doctors are finally having second thoughts about cholesterol’s role in heart disease. The reason has been obvious for years. Cholesterol-lowering drugs have failed to make a dent in heart attack rates. And not one study has been able to show that these drugs do anything to lengthen a person’s lifespan. Yet, 20 percent of all Americans over 55 currently take a cholesterol drug and most M.D.s believe more people should be on them. But these doctors are barking up the wrong tree…
"Cholesterol is innocent. I’ve been proclaiming cholesterol’s innocence since 1992, and plenty of convincing research confirms this. The real culprit is inflammation in the arteries, not cholesterol. Finally, the American Heart Association is beginning to agree. They’ve found that people with heart disease all have one factor in common, and it isn’t high cholesterol. It’s inflammation in their arteries.
"WARNING: Are you already on a statin drug to lower your cholesterol? You’re probably aware of the importance of Coenzyme Q10 (CoQ10) for your heart. But what you may not know is that if you’re taking a statin drug to lower your cholesterol, your heart is being depleted of this important nutrient. CoQ10 supplies the energy for your heart’s pumping action. Studies overwhelmingly show that any and all statin drugs create dangerous CoQ10 deficiencies that can lead to heart failure."
Some readers of this blog have also expressed their concerns about statins. Here is one such comment:Dear George,
Thanks for your blog post regarding your going on Simvastatin. The VA just mailed me my first bottle, and I'm scared to begin taking it after reading about the side effects. I came across an organization called The International Network of Cholesterol Skeptics which has members who are scientists and medical professionals who are very skeptical about the use of statins, and claim there is no proof that high cholesterol levels cause heart disease. Well if I start having irregular blood tests like abnormal liver tests after being on this new drug, or have muscle pain, I'm going off it immediately. Keep us posted on your progress! - Connie
The following reader comment is downright frightening:
Do NOT take the statins as advised by your doctor. My father died because of statins one year ago. He definitely had cardiac disease, he had open heart surgery and angioplasty twice and had taken other blood thinners before. But the real problems started 3-4 years after taking statin drug Lipitor. He started developing strange symptoms such as unexplained dizziness, problems with balance and motion and sudden memory lapses. It was a downward spiral, which resulted in his having to get a shunt installed in his brain so that excessive cerebral fluid could be drained.
The doctors had NO idea what caused the problems or excessive fluid. But after reading about the side effects of statins, I insisted to my parents that he stop taking statins and start taking Ayurvedic medicines (Alternative herbal ancient science of medicine from India). Well George, two months after stopping statins, my father recovered to almost 95% of his old self. He had no balance problems, his appetite recovered and he felt and looked great.
And then disaster struck, he went out for a walk, stumbled on a rock and got a cut on his head. The cut was quite small , looked like it would only require a stitch or two. But thanks to the statins in his system, within five minutes there was massive internal hemorrhaging inside his brain. He effectively went into a coma and died two days later. In his last moments, I saw the vital signs dropping one by one, and guess all of us including the doctor were shocked to see that it was his heart that was the absolute last organ in his body to fail!
He spent years taking terrible drugs like statins in fear of his heart failing and in the end, he died because of the very statins that were supposed to save him and his heart remained strong even when he stopped statins.So my heartfelt advice to you is , please don't take statins. Continue your health program eating right, exercising, and most important of all being stress free. If interested in alternatives, I recommend http://www.mapi.com/ who has several good medicines for heart health. Hope you stay healthy and happy and enjoy many more years of content life.
With all this, here I am still taking my daily half tablet(20 mg.) of simvastatin (the generic version of Zokor). What am I, some kind of idiot? Maybe. But without doubt I am just like millions of other people who rely on their doctor's advice. I have two primary care providers, one with the VA and one private, and both, citing current research, advised me to go on a statin.
I have been on simvastatin for about six months now, but the more I read and the more I talk to friends like Jogi and Marybeth, the more I question whether a statin is right for me. I no longer get on bended knee before my bottle of simvastatin tablets.
The research is here all right. But now that we know that Big Pharma has been ghostwriting articles for peer-reviewed journals and having respected medical names put their names on them, how can we trust such "research"?
My cholesterol numbers are down dramatically, but doesn't that mean that I am being treated for a symptom and not a disease? Shouldn't statins be given only to people with a history of stroke or heart disease or with other high-risk factors? Like Joge, I am definitely not high-risk. Not obese. Not diabetic. No heart disease.
Like every drug, statins have side effects. I have not experienced any -- yet. That does not mean that I won't. There may be unknown side effects. Statins have the medical establishment -- not to mention Big Pharma billions --behind them. For many years, so did HRT (hormone replacement therapy). Today we know that HRT, after being taken by millions of women over many years, does little or no good and can even be harmful for many women. Will the same be true of statins some day?
And why do the desired levels of cholesterol for Americans who are at moderate to high risk for heart disease keep going down? Why do the recommendations always call for more intensive drug treatment for moderately high and high-risk patients? Could the fact that the new guidelines will mean millions more of Americans on statins have anything to do with it?
Yes, the frequent new guidelines -- every couple of years or so -- are always preceded by clinical trials indicating the current cholesterol goals are not aggressive enough. But some of these trials have been compromised by unstated conflicts of interests, such as researchers with consulting contracts with pharmaceutical companies.
Finally, there seems not much doubt that the massive use of statins in the U.S. is more because of carpet marketing to consumers than because of proven health benefits. Check this hilarious spoof of a typical prescription drug ad."Ask your doctor if [insert brand here]is right for you" is a phrase imprinted on maybe a couple of hundred million American brains.
And ask we do. And doctors, being human and wishing to please and wanting to DO something for their patients, write out a prescription. Many do so with a pen bearing a drug company logo, and after having a free lunch delivered to the office by a drug company, and with plans to attend an all-expenses-paid medical training seminar at a golf resort.
I recently had blood taken. In a few weeks, I have an appointment with my VA provider, whom I greatly respect and who does a great job taking care of my precious bod. She is a good listener. Among other things, I will be talking to her about cholesterol, statins, side effects, and whether a low-risk guy like me should really be on a statin. I may even suggest that she take a look at a certain blog raising questions about these very things.
I'll let you know if I get thrown out.
So long and keep moving