This week I can't help but wonder why so many of my patients are on statin drugs (cholesterol medication) - and when did they become so widely prescribed in Lafayette LA?

According to medicine.net, Statins are a class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. (The other source of cholesterol in the blood is dietary cholesterol.) Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG-CoA reductase inhibitors.

Side effects from long-term use of HMG-CoA Reductase Inhibitors in Lafayette LA are: muscle pain, peripheral neuropathy, cognitive function, elevated blood glucose levels, drowsiness, difficulty sleeping (and the list goes on from there). Is it becoming apparent how our attempt to "quickly-fix" one problem creates another? How is that healthy (or legal) to prescribe and administer a statin drug for high cholesterol and then turn a blind-eye when that patient becomes diabetic, develops neuropathy, experiences memory loss, etc.? It's legal in the USA - because when you develop diabetes, neuropathy or experience memory loss - there's a pill for that too.

As I dove deeper into the current research and clinical trials available, I came across the amazing work of Dr. Kelly Rogan, MD. She says that sometimes pharmaceutical companies broaden the eligible candidates of a pre-existing product by re-wording its benefits. Recent changes in guidelines put forth by the American Heart Association and the American College of Cardiology aim to expand the recommendations of lipid-modifying statins to include those for whom there is a stated "10-year risk of 7.5 percent or more" of cardiac events, based on a calculator that now eliminates LDL (good cholesterol!) targets.

Many "forward-thinking" clinicians have come forth to express their concerns about the impact of this expansion of prescription treatment to 70 million patients, including Dr. Redberg and John Abramson, for the New York Times, stating:

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them.

There is an undeniable "lag" between the availability of paradigm-shifting data and actual implementation. Misconceptions about dietary cholesterol and saturated fat (drivers of heart disease) still linger, despite widespread abandonment of this perspective.

Based on alarming rates of cardiovascular disease, despite the "baby boomer generation" of statin users - studies now demonstrate that patients presenting to the hospital with heart attacks don't have elevated total cholesterol. YOU READ THAT CORRECTLY. What patients actually have (66% of the time) is something called "Metabolic Syndrome," or, a combination of findings such as obesity, high triglycerides, low HDL, and insulin resistance. This phenomenon is DRIVEN by SUGAR and trans-fat, not dietary, naturally-occurring saturated fat, and not by a lack of statins. Even worse, research shows metabolic syndrome to worsen by statin drugs in women more than men. The only demographic that has been documented through clinical trial to benefit from statin drugs are men who have had a previous heart attack. Yet, statin drugs are THE single most widely prescribed medication in the USA regardless of the clinical data.

Contrary to what is demonstrated in industry studies, intolerable side effects occurred in 20 percent of those treated with statins in an eight-year retrospective cohort study. Given the total lack of demonstrated benefit in women - women now report suffering from decreased cognitive function, cataracts, sexual dysfunction, depression, muscle pain, and now, diabetes.

Brain and Hormone Sabotage

Cell membranes are where all of the action is at including receptor function and trafficking of nutrients and toxic elements. Cholesterol is also the precursor to vitamin D, and to pregnenolone and the sex hormones that derive from it, making it critical for appropriate production, feedback, and balance. There are significant risks to depression when these relationships are out of balance:

Perhaps related to these vital functions, perhaps to others yet undiscovered, low cholesterol has also been linked to suicide and depression. (Kunugi et al, Biol Psych, 1997) (Modai at al, J Clin Psych, 1994) ( Lindberg et al, BMJ, 1992) In patients hospitalized for affective episodes, significantly more patients than controls were noted to have low plasma cholesterol. Another looking at the Melbourne Women's Midlife Health Project suggested that improved performance on memory testing was achieved with increased total cholesterol in women longitudinally monitored.

Controlling for multiple confounding variables, 300 women in Sweden were found to be significantly more depressed when they had the lowest percentage of total cholesterol in the cohort. This is a concerning correlation, no?

Better Medicine for Healthier Brains and Hearts

Cardiovascular disease is a multi-factorial inflammatory problem with different drivers in different people. Lifestyle medicine is the best and most sophisticated intervention, and the only one indicated here, with no exceptions for women. This begins with good old exercise and diet and avoiding sugar. This is a naturally high fat approach with a focus on organic, grass-fed meats, wild fish, eggs, nuts, and seeds. Slight increases in cholesterol may occur, but are consistent with beneficial properties and more importantly an improvement in inflammatory markers. Dietary (healthy/good) fat is NOT the enemy.

We all know, intuitively, that exercise is a critical answer to the burning question of how do we heal ourselves, and particularly, in a population concerned about cardiovascular disease. An Interheart study demonstrated that 90 percent of first cardiac events could be prevented by lifestyle modification. The known and validated benefits of exercise, however, may be eclipsed by use of a statin drug.

What are the parameters that relate to metabolic syndrome and associated inflammation? Unfortunately, none are considered when the American Heart Association plans "new benefits/indications" for statin drugs. These include:

• fasting insulin
• hemoglobin A1C
• homocysteine
• NMR or VAP lipid profiles which screen for particle density
• hsCRP
• fasting glucose

Balancing thyroid function is an important and vastly overlooked variable, particularly in women, because of its role in the enzymatic processing of LDL (good) cholesterol in the liver - i.e., you don't have a "cholesterol problem" if you also have a "thyroid problem," which is grossly overlooked by most conventional physicians.

Strategic implementation of activated B vitamins such as B12 and folate and vitamin D can also mitigate inflammatory compounds such as homocysteine and hsCRP.

Truthfully what we have here is a situation of an over-prescribed medication that is now being recommended to healthy people which will only make them sicker! All while simple, health-fortifying lifestyle changes have been proven to be effective and globally transformative, in ways no prescription medications could ever hope to be.

Gone are the days of just "accepting" the label given to you by a doctor and accepting your written prescription as punishment, on your way out of the office. You have got to be your own investigator, do your research, ask questions and make sure statin drugs are "really" the right fit for You.

The good news is that every single day is the chance to start AGAIN. Be the Best You in Lafayette.

Have a great week!

By Francesca Marino D.C.