Statins and Diabetes – What Doctors Don’t Tell You

Dr Jedha, Host

Hello wonderful people, Dr Jedha here and thanks for joining me today for an interesting discussion about statin medications. Statins are a medication where people often feel pressured by their doctors. Your cholesterol is high, you need to take a statin, that’s what you’ll likely be told. 

Statins are now the most commonly prescribed cholesterol-lowering drugs globally. While pharmaceutical companies have a vested interest to promote statin treatment as highly effective – a multi billion dollar interest – studies have shown otherwise. And it’s interesting because the effectiveness of statins remains one of the most highly debated topics. Of course, the majority of people are completely unaware of these debates, the controversial research, or the cardiology experts who have consistently rebutted the Big Pharma narrative that dominates the medical model. Because that’s just the thing right… there are all these dominant narratives in society, things that people treat as truths, but they’re not actually based on fact or solid science. 

One example of a dominant narrative, don’t eat more than 300 mg of cholesterol a day. This was once a dietary guideline, even though it was never based on fact. In 2015 it had to be removed from the dietary guidelines, quite simply because it was never based on fact and there was never any reason to limit cholesterol from foods in the diet. Foods high in cholesterol, like egg yolks, have little to no impact on blood cholesterol, as the liver is the master organ of cholesterol production and management. If you are a regular listener of the podcast, you’ll hear me discuss these dominant narratives in different areas of nutrition, fats, cholesterol, medications, red meat, etc. Studying sociology in my early years, which is the study of society and its structures and narratives, this is always something I’ve personally found very interesting and compelled to explore, or rather, ask questions about. And after doing so, it’s easy to draw the conclusion that just because something is a dominant narrative, doesn’t make it true, or based on fact or science. I see this all the time, false statements claimed as truths. Anyway, all that to say that the same rings true for statin medications. Is their effectiveness more fiction than fact? Well, that’s the ongoing debate.

Today’s episode is not to give you advice. But to give you information, to encourage you to think outside the square, to motivate you to always question things, especially when it comes to your own health, to assure you that it’s always ok to question your medical doctor because they’re not god and they are not the knower of all things, and most importantly, to empower you to be an advocate for your own health, one that makes informed choices and stands behind the goals you wish to achieve. 

If staying off medication is one of your goals, which I know for many people it is, then you’ll find this discussion interesting food for thought. And to help demonstrate some of the concepts we’ll cover today I’ve got a story to share from one of our members, Mary, who was almost put on statin medications for absolutely no reason at all. Unfortunately, this happens a lot. Thankfully for Mary, it didn’t, but it’s only because she got proactive, advocated for herself, and got the information she needed to have an intelligent conversation with her doctor. 

About 1 in 3 Americans take a statin drug every day. Between 2009 and 2019 statin use has more than doubled in the US. Like most medications, statins are overprescribed, which has been an ongoing concern. Likewise, there are ongoing concerns about their side effects, which can include muscle aches, fatigue, headache, and digestive issues as well as increased diabetes risk and possible cognitive impairment. 

Statins are often prescribed to people with diabetes and prediabetes with the goal to reduce the risk of heart attack and stroke events, or to prevent death from cardiovascular disease, supposedly. 

Statins work by inhibiting an enzyme that plays a central role in cholesterol synthesis in the body. The main purpose of statins is to lower total cholesterol, with a greater effect on LDL cholesterol, which often gets labelled as “bad” cholesterol. As we spoke about in episode 42, cholesterol is grossly misunderstood. There is no such thing as “bad” cholesterol. LDL is absolutely needed by the body, to transport molecules, nutrients etc to the body’s cells. I’m not going to cover all the ins and outs of cholesterol, so I’d encourage you to listen to episode 42 for that. But let’s focus on this LDL concept for a moment. 

Prolonged exposure to high LDL cholesterol is thought to accelerate atherosclerosis, or plaque buildup, which increases cardiovascular disease risk. But what’s very interesting is that studies have shown a weak link between LDL cholesterol and plaque accumulation. There have been new guidelines released this year, 2025, by the American Association of Clinical Endocrinology to manage high cholesterol in adults.

So, I was looking over these guidelines and the evidence. Now, one of the recommendations is that LDL cholesterol targets should be below 70 mg/dL for people who have CVD or at increased risk for CVD. But, even according to the guidelines themselves, this recommendation is not based on solid evidence. The guidelines say this is a “conditional recommendation, based on low certainty of evidence.” Or in other words, targeting LDL-C to below 70 mg/dL does not reduce rate of death, death from CVD or stroke. In fact, and I quote: “the task force determined that achieving an LDL-C level of <70 mg/dL resulted in a trivial decrease in all-cause mortality and CV-related mortality.” They’re talking about death or CV-related death. When they say trivial, we’re talking perhaps 4-5 fewer deaths per 1000 individuals, perhaps, because again there is low quality evidence. Yet, even so, the task force favored this low LDL-C target goal as a clinical practice guidelines – based on no evidence! That just doesn’t make sense. For something so serious, you’d think the recommendation would be based on solid solid evidence right? Especially considering doctors will likely increase cholesterol-lowering medications to make patients achieve this target. Studies have shown the majority of people on high intensity statins still don’t reach LDL goals. That raises more questions, right.

The reality is, the true benefits of statins remain subject to debate. Some experts argue that the side effects are more serious than initially indicated, and the benefits may have been overstated to drive sales. Research shows that statins offer only low-modest benefits. Independent reviewers have highlighted the lack of evidence for using statins to prevent heart disease. In fact, in 2016, an independent panel of government-funded researchers, analyzed a large dataset and found the risk of dying from a cardiac event was just 0.2% lower in people taking statins – that’s not a big effect. It is well known that the majority of trials conducted for these drugs are sponsored by industry funding, pharmaceutical companies, which raises significant questions and concerns. And there are even leading cardiologists who have stood up making statements that cholesterol is nothing more than a diversion from the real issue, big food promoting diets high in sugar, and big pharma wanting to drive billion dollar sales. 

The point is, there are more questions than there are solid answers or evidence to suggest that statin medications are in actual fact beneficial. 

Another very important point is that statins raise diabetes risk, raising blood sugar and worsening insulin resistance. In 2012, the FDA issued a warning that statins increase a person’s risk of developing diabetes, citing several studies showing that statins were associated with high blood sugar. This warning prompted cautionary updates to statin drug safety labeling, notifying physicians and patients of the potential adverse effects.

One trial reported a 27% increase in diabetes risk for people taking statins for two years. Another large-scale analysis found that statins were associated with a 9% increase in risk of developing diabetes after four years. Researchers at the University College London and the University of Glasgow found there was a 12% increased risk over a 4 year period. Finland scientists found that men who were prescribed statins to lower cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. In post-menopausal women, studies suggest that any statin at any dose may increase diabetes risk after three years. These are certainly factors you need to keep in mind if living with prediabetes, that taking a statin could increase your risk of being diagnosed with type 2 diabetes. And since statins worsen insulin resistance and raise blood sugar, for both pre and t2diabetes, they can make treatment more difficult. 

According to the guidelines, people with diabetes are considered at moderate-to-high risk for cardiovascular disease. What that means is that some doctors will move quickly to prescribe medications, just because of the fact you have diabetes. But… that doesn’t mean medications should be automatically prescribed. A thorough assessment needs to be done. 

There are various risk estimation tools used by physicians to assess a person’s risk of CVD. That’s great, but if your LDL cholesterol comes back high, a physician will likely be quick to suggest you need to take medications. As we spoke about in episode 42, firstly LDL isn’t “bad,” we need it. And secondly, LDL can be large and fluffy posing no heart disease risk, or small and dense which may pose some risk. Even that fact is still questionable given studies have shown a weak link between LDL cholesterol and plaque accumulation. In any case, we also spoke about the fact there are various other tests that can be done to assess your risk. Asking your doctor for an extended lipid panel, which looks at the size and structure of your LDL particles, not just whether levels are high or not. The current guidelines also suggest that additional tests can be done. They aren’t conducted by default but you can request these from your doctor, and doing so can prevent the need to take medications. 

Let me give you a real world example. Mary, one of our members. When Mary joined us she said she had high cholesterol. Total, HDL, and LDL all high. Triglycerides and ratios very good. She said she wasn’t on medication for cholesterol nor did she plan to be. Now, every month we have member check ins where members can report their progress, ask questions, troubleshoot issues etc. Mary reported that her labs came back with high LDL. She got the call from her doctor who wanted to put her on a statin and that’s not what she wanted. 

Mary shared her lab metrics, and they were all looking good. A1c almost normal, exceptional HDL in the higher ranges, fantastic triglycerides, perfect Chol/HDL ratio, excellent Trig/HDL ratio. While her total cholesterol was high, her HDL was contributing to that with a high number. Basically, apart from the LDL being a bit high, all factors suggested she had minimal cardiovascular risk. So, I provided Mary with some papers to read and materials to provide to her doctor. I also suggested she should mention all the positive factors – good HDL and triglycerides, great ratios, low/normal BMI, good A1c (and any other positives she had) to justify her good health. Then, if the doctor still remained concerned about the LDL, she should ask for additional tests. In addition, I suggested Mary hold strong in her choice to avoid medications, because before doing any further tests, no solid conclusions could be drawn. All factors needed to be taken into consideration rather than ‘reacting’ to one value, the LDL, on one test.

So what happened? 

Mary went back to the doctor and declined the statin medication. Using the info provided to her and the suggestions on how to talk to her doctor, she had the discussion about her good health and requested to run more tests. Her doctor ordered a scan to check her cardiac calcium score. Guess what it came back at? ZERO! 

Interestingly, when reading the guidelines I noted something related to the test Mary had, the cardiac calcium score or CAC and I quote: “a CAC of zero associated with a reduced risk of CV-related mortality, may support a person at intermediate risk in not starting lipid-lowering medication.” So that was the case with Mary, if she didn’t have the CAC test, she would have been put on statins for no reason, with a CAC of zero she has no heart disease risk. This is just one living example of this, demonstrating that medical doctors may be quick to prescribe statins, and many other medications, often without considering the whole picture. That’s why it’s important to stand strong in your goals, for instance, Mary did not want to take medications so she advocated for her own health. 

Now, I want to say that guidelines consistently emphasize patient-centered care as the number one factor that all physicians and healthcare providers should abide by. So what does that mean? It means that your goals and needs come first. If, like Mary, you didn’t want to take medication, then it’s your doctor’s responsibility to engage in discussion about this, conduct more tests if necessary, and to provide enough information that you can make an informed decision. The guidelines state to: “Engage in shared decision making regarding treatment.” It is not up to them to make a decision, ultimately it is up to you, and the decision should be a shared one, not just pushed or pressured upon you. The guidelines also list the various other tests that can be used to further assess risk, that CAC score, like Mary had, a 2D-3D carotid and femoral ultrasound, Lpa, Apo(B), or hsCRP – all of which can help provide more input to assist with the decision making process. 

Secondly, throughout all the guidelines, it always states to emphasize the importance of diet, exercise and lifestyle. But in reality, we know that’s not happening enough. What we know is that blood cholesterol levels are just one part of cardiac risk, and a fixation on cholesterol, especially LDL cholesterol leads to doctors writing more prescriptions without first asking more questions about whether it is truly a risk factor, or what else might be done, for example, encouraging nutrition and lifestyle changes. And we know, nutrition is important for improving cholesterol, your overall nutrition plan that is – our members consistently achieving normal cholesterol levels. 

And an important part of improving cholesterol is to treat your diabetes. High blood sugar, high insulin levels and insulin resistance change the way your body metabolises nutrients, and this alters how the body produces and processes cholesterol. So you need to focus on achieving and maintaining blood sugar and A1c at a healthy level as well, that’s really important for cholesterol too. 

At the end of the day, the goal today isn’t to be for or against statins. Yes, the debates are certainly there and the science for benefits is overall lacking. That’s why it’s important to ask questions and it’s important to make the right decision for you. Like Mary, start with the full picture, not a single lab value. If your doctor suggests medication, ask about the pros and cons, ask about risk clarification with further tests and make sure nutrition and lifestyle is front and center. Remember, shared decision-making is a guideline, a responsibility of doctors and healthcare providers. Pressure should never be involved. If you’re already on a statin, book a review, have a discussion, and see whether it’s really necessary for you. 

I hope you’ve found today’s episode food for thought. Medications can sometimes be necessary and helpful, but the reality is they are overprescribed unnecessarily, and that’s something to always keep in mind when pursuing treatment. Overall, the research consistently shows that nutrition and lifestyle changes outperform medication. 

That’s all for now. 

Dr Jedha, over and out!