How Statins Work – And Why They’re Not Enough

To talk about statins, we first need to talk a little about cholesterol. When you hear the word cholesterol, it is referring to one of two sorts.

First, there is blood cholesterol. Most of it comes from the liver. The liver produces cholesterol because our bodies need it for all kinds of reasons. Cholesterol helps our cells do their jobs. It is also an integral part of several hormones. We would not exist without blood cholesterol, but then again, neither would heart disease.

How Statins Work, and Are They Enough?

There's cholesterol in your blood (blood, or serum, cholesterol), and cholesterol you eat (dietary cholesterol).

Blood cholesterol is also the number we’re referring to when we say, “My cholesterol level is . . .”

Here’s one really important point: Our liver manufactures all the cholesterol we need.

The second type of cholesterol is dietary cholesterol. This is the cholesterol we eat. Major sources include egg yolks, organ meats like liver, and shrimp.

If we eat too much dietary cholesterol, we can raise our blood cholesterol somewhat, but what really sends our blood cholesterol soaring are saturated fats and trans fats. Foods full of saturated fat include red meat, butter, cheese, cream, whole milk, palm oil, and coconut oil. Foods with trans fats include anything that has partially hydrogenated oils in its ingredient list, such as many store-bought cakes, pies, and cookies as well as biscuits, donuts, and some margarines.

Lifestyle Changes

To improve our blood cholesterol levels, physicians often prescribe lifestyle changes focused on three key rules:

  1. eat a lot less saturated and trans fat,
  2. lose excess weight, and
  3. eat more foods that actually lower blood cholesterol. They are foods rich in soluble fiber like beans (also known as legumes), yams, oats, barley, berries, Brussels sprouts, and many other fruits and vegetables.

Statins, and How Statins Work

Doctors also prescribe, usually if lifestyle changes are falling short, drugs like statins. Brand names include Lipitor, Crestor, Mevacor, Pravacol, and Zocor. Statins have been clearly shown to reduce blood cholesterol and prevent atherosclerosis, or heart disease. They work by reducing the liver’s production of cholesterol. They block an enzyme called HMG CoA Reductase that the liver uses to make cholesterol.

But other things are happening in the liver that statins do not affect. In addition to producing cholesterol, the liver helps clear excess cholesterol from the blood. It has tiny receptors that “capture” LDL bad cholesterol particles that are floating around. Like vacuum cleaners, these receptors “suck” this excess cholesterol up and out of the blood, which means there’s much less cholesterol seeping into our artery walls, building plaque.

The problem is, a diet full of saturated fats, trans fat, and dietary cholesterol reduces the number and effectiveness of these LDL receptors. And there’s nothing statins can do to counteract this process.

Statins + Lifestyle

That’s why it is so critical to combine statin therapy with an excellent diet like the Pritikin Eating Plan. Researchers at UCLA showed that partnering the Pritikin Program of diet and exercise with statin drugs was far more effective than statins alone. The scientists followed 93 men and women who had decided to come to the Pritikin Longevity Center. Before coming, they’d been on statins for several months. They had lowered their blood cholesterol on average 20%. But after three weeks at the Center, they were able to reduce their cholesterol an additional 19%. (1)

What Statins Don’t Do

It’s also important to keep in mind that statins address just one risk factor for heart disease — high cholesterol levels. There are many other risk factors that statins do not touch, like high blood sugar, insulin resistance, belly fat, high blood pressure, and high triglycerides (blood fats).

“To attack all these risk factors, your best bet is a healthy lifestyle like Pritikin,” points out Dr. Danine Fruge, Medical Director at Pritikin.

Side Effects

Following the Pritikin Program might also mean you can reduce – maybe even eliminate – your dependency on statins. That’s a very good thing because statins, like all drugs, can have side effects.

  • Myopathies

    Some people experience myopathies (muscle pain), usually characterized by moderate discomfort upon motion, frequently in the hip and thigh area.

  • Myositis

    A more serious form, called myositis (inflammation of the muscles) occurs in a very small percentage of people who take statins. It’s fortunate it’s rare. Myositis can have life-long impacts that are devastating, recently reported the non-profit Myositis Organization. Patients struggle with movements as simple as lifting their arms over their heads or getting up from chairs.

  • Liver Damage

    Also rare but concerning, statin use may trigger a rise in enzymes that signal liver inflammation. Symptoms include fatigue, stomach pain, appetite loss, yellowing of skin or eyes, or dark-colored urine.

  • Type 2 Diabetes

    Of late, statin use has also been linked with rising blood sugar levels and increased risk of type 2 diabetes.(2) In fact, the Food and Drug Administration (FDA) has issued a warning on statin labels about blood sugar levels and diabetes (3).

  • Cognitive Impairment

    Some people complain of cognitive struggles with statin use, for example, fuzzy thinking and forgetfulness. But the science is not yet strong enough to confirm this side effect. The good news: These symptoms are generally not serious and are reversible when the statin is stopped or patients change to another statin.

Statin Use During a Heart Attack

If you’ve had a heart attack or are dealing with any other type of acute coronary event, such as interventions like bypass surgery or angioplasty, chances are your physician will prescribe a statin during and immediately after the event, and for good reason. It is generally accepted in the medical community that statins may have some value independent of lowering LDL cholesterol, probably anti-inflammatory in nature.

But doctors do not have clear answers to the following: What statin is best? What dosage? How long should the patient be on it? Usually, high doses are prescribed immediately after the event and are then tapered to doses necessary to maintain target values (usually LDL levels below 70 and non-HDL levels below 80).

“There is much about statins we physicians do not know,” states Dr. Ronald Scheib, MD, FACC, FACP, former Chief of Section of Cardiovascular Medicine at the Miami Heart Institute. “We do know that toxicity is a clear danger.

Risks Versus Benefits

“When it comes to statins, as with all drugs, we must constantly weigh the risks versus the benefits, and we must factor in questions regarding primary care (prevention of a heart attack) versus secondary care (optimal care after a heart attack has occurred).”

“There is one thing,” adds Dr. Danine Fruge, Medical Director at Pritikin, “that we are very sure of. A healthy lifestyle should be the base on which further therapies are built. Yes, statins can lower blood cholesterol. But if you rely solely on statins for good overall health, chances are you will not get good overall health. Statins will not help you shed weight. Statins will not help you become more physically fit. Statins will not lower your risk of diabetes, high blood pressure, many cancers, arthritis, and gall bladder disease.

“For all the above, plus optimal levels of blood cholesterol, plus a much better quality of life, a healthy lifestyle is the answer. And the Pritikin lifestyle is the ideal answer.”

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