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In fact, since being introduced in the late 80s, statins are now the most commonly prescribed cholesterol-lowering drugs globally.
However, while pharmaceutical companies have a vested interest to promote statin treatment as highly effective (a multi billion dollar interest), studies have shown otherwise. Therefore, the effectiveness of statins is also one of the most highly debated topics as well.
Here we seek to examine some of the myths and truths about statins and diabetes, and you may be surprised by what you learn.
Cholesterol and Heart Disease Myths
Cholesterol is one of the most misunderstood mechanisms in our body. One of the biggest myths we’ve all been led to believe is that having high cholesterol, and in particular, high LDL cholesterol will clog up our arteries and lead to heart attack or stroke.
According to leading cardiologist Dr. Aseem Malhotra this simply isn’t true.
In fact, according to Dr. Malhotra and physician Dr. Mark Hyman, studies show that 75% of people who have heart attacks have normal cholesterol – 75%!
In terms of a risk hierarchy for heart disease, LDL cholesterol actually comes down the list.
- Insulin resistance
- High blood pressure
- BMI – Body Mass Index
- LDL cholesterol
Certainly LDL is one risk factor, but there is a lot we still don’t understand about cholesterol. Simply because we’ve been looking at it all wrong for so many years.
What we do know is that one of the key drivers of heart disease is increased cellular inflammation throughout the body. It’s this cellular inflammation that damages vessels and downgrades your health.
If you have time, this conversation between Dr. Malhotra and Dr. Hyman is very interesting.
What Do Statins Do?
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 “bad” cholesterol.
Statins exert their influence on LDL by upgrading LDL receptors throughout the body. But interestingly, researchers suggest this mechanism also increases LDL receptors in the pancreas, within the cells, leading to toxic effects on the beta cells.
What’s even more interesting is that even though statins are meant to exert their benefits for heart health by reducing cholesterol, much of statins effectiveness is its ability to reduce inflammation, and has nothing to do with lowering cholesterol.
Research on Statins Effectiveness
In both population studies and clinical trials, statins have been shown to increase risk for type 2 diabetes, in a dose dependent manner, which means the higher the dose and the longer you take it, the more your risk increases.
Population studies show the risk ranges from 18% to 99%, while clinical trials (a stronger form of study), show the risk ranges from 9% to 12%.
Researchers suggest this difference is because participants in clinical trials are usually people with high total or LDL cholesterol. Whereas population studies look at the general population.
In any case, the risk of acquiring type 2 diabetes is significantly increased in those who take statins.
In terms of taking statins with type 2 diabetes, debates about effectiveness continue. Being that diabetes puts you in the ‘high risk’ population, researchers suggest that the effectiveness of taking the drug outweighs any risks.
However, Dr. Malhotra suggests the effect rate is so small they are barely worth considering. Or at least, the true effectiveness of statins is something you should be informed about, which in many cases patients are not.
Dr. Malhotra explains that as a type 2 diabetic given a statin, (industry funded) studies show a 48% relative risk reduction in having a cardiovascular event. You might think this sounds impressive, thinking: “I’ve got almost a 50% chance of avoiding a heart attack or stroke.”
While this sounds impressive, it actually means that you as an individual have a one in 77 chance of a cardiovascular event – which isn’t quite so impressive.
Dr. Malhotra emphasizes that being told you will die from not taking statins is entire nonsense.
If taking statins, the statistic of avoiding death is only one in 83 people over 5 years. And in terms of prolonging life, if you have no established heart disease, taking statins may prolong your life for 3 days. If you have established heart disease, it could be 6 days!
Here are a few more facts:
- Statins don’t work for everyone, they are only effective in 5 to 70% of people.
- If statins are ineffective, prescribing high-dose statins is not going to make any difference.
- For people where the drug isn’t effective, side effects can be harsh.
- To prevent one heart attack (myocardial infarction), physicians need to treat 50 people with statins.
- Liver damage – indicated by increasing liver enzymes, affects around 3% of people
- Muscle damage, cramps and pain (myotherapy) – affects up to 30% of people, with mild muscle pain affecting up to 10% of others.
- Other associated side effects include brain damage, memory issues, and Parkinson’s-like symptoms.
Research on Statins and Increased Diabetes Risk
If you have prediabetes, this information is incredibly important for you.
For the past decade, more and more research has revealed that one side effect of statins is increased risk of diabetes. And of course, this risk is increased in those already at higher risk of diabetes – those with prediabetes.
This knowledge is now well established. So much so that in 2012, the FDA required pharmaceutical companies to list this side effect on the statin safety label, one of those side effects being that statins have been found to increase hemoglobin (HbA1C) and fasting blood glucose levels.
Studies show they may also impair insulin secretion and alter insulin sensitivity, which may also be responsible for the increased risk of diabetes that statins can cause.
Researchers suggest the adverse effects of statin therapy on insulin secretion amount to as much as 12%, and increased levels of insulin resistance by as much as 24%. And interestingly, the greatest reduction in insulin sensitivity was seen in healthy people, indicating these drugs can even push healthy people toward a prediabetes/diabetes diagnosis.
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Research on Statins and Type 2 Diabetes
One of the arguments for statins is they can help reduce the risk of cardiovascular events (heart attack and stroke), along with preventing microvascular damage that leads to diabetic complications.
In terms of microvascular damage, the evidence is very limited. Though granted, one study has shown there could be a lower incidence of retinopathy and neuropathy. But with only one study, we can’t really conclude any true benefit at this point.
Other diabetes research argues that the benefits outweigh the negative consequences, stressing that those who are at risk (people with diabetes) should always be prescribed statin medications, especially those with:
- primary elevations of LDL-C ≥190 mg/dL;
- age 40–75 years with diabetes and LDL-C 70–189 mg/dL
But with the risk reduction of taking statins being so small, how can researchers and health organizations suggest that the benefits outweigh the downfalls?
Dr. Malhotra suggests that it’s because physicians want to err on the side of caution. Dr. Hyman suggests it’s because much of the time physicians don’t have time to keep up with current research, so they follow popular headlines or trust what other physicians or organizations are recommending.
Overall, the truth is, there is still so much we don’t know and we don’t really know how effective many medications are.
Which Statins are Guilty?
All of them!
Pravastatin appears to have the lowest risk for provoking the development of diabetes. Whereas rosuvastatin, atorvastatin, simvastatin and other different statins show the highest risk.
Alternatives to Statins
Eat a low carb diet
There’s a reason why we encourage a low carb diet, because research shows it helps lower blood sugar and A1c and improve cholesterol.
Cardiologist Dr. Malhotra emphasizes that improving cholesterol is all about your diet! But not in the way you think.
We assume that to improve cholesterol we need to cut out fat, that eating low fat will help. But it’s quite the opposite.
The low fat industry is largely responsible for all this harm – increased rates of obesity, insulin resistance, metabolic syndrome and diabetes. Because the food industry has used the low fat craze to add a lot of sugar to foods. All that processed food is not designed for our natural biochemistry, leading us into sickness and disease.
The biggest myth is that it’s not fat that increases cholesterol, it’s high sugar and high carbs! This has now been well established in scientific research.
It’s also been established that low carb diets consistently decrease triglycerides and when you decrease triglycerides, guess what happens – HDL cholesterol (the “good” stuff) increases. The increase in fat intake actually helps with cholesterol. Following on from these improvements, there is often a decrease in total cholesterol and LDL, by as much as 24.8%.
And interestingly, while statins may reduce LDL cholesterol, there is no drug that reduces triglycerides or increases HDL (the good stuff). These are more important heart health indicators, and fortunately, making changes to your diet can influence both triglycerides and HDL!
Other diets have also been shown to help reduce LDL:
- A Mediterranean diet may reduce LDL by 5%–9%
- An ornish diet by 17%
- And diet and exercise combined may reduce LDL cholesterol by 14%–20%
The point is: making dietary and lifestyle changes can dramatically improve your heart health. But it won’t happen by eating low fat, high carb foods.
The body needs fat and needs cholesterol, for many important physiological functions.
Smoking is a huge risk factor in heart disease, so obviously, quitting the toxic stuff can dramatically reduce your risk.
Reduce your alcohol intake
While a glass of red wine may have some heart healthy benefits, consuming alcohol in larger quantities than is recommended can cause harm to the body, including raising cholesterol levels.
Alcohol doesn’t help with keeping blood sugar levels under control either, so if you currently consume too much, it’s definitely time to cut down.
Engage in regular physical activity
Insulin resistance is a key driver of heart disease and exercise is very effective at helping to increase insulin sensitivity, therefore reducing your level of insulin resistance.
Exercise also specifically helps with heart health. When researchers reviewed 42 studies, they found regular exercise improves blood pressure and lowers LDL cholesterol, while improving HDL cholesterol.
Proven Supplements to Lower Cholesterol
You can give your body a metabolism-boost with the aid of supplements proven to help lower LDL cholesterol levels in people with type 2 diabetes.
Dr. Hyman suggests the following supplements:
- Fish oil
- Plant sterols
- Red rice yeast
Plus we’ve done research on two more effective supplements:
- Psyllium husk
In a placebo-controlled study, type 2 diabetic patients with elevated blood triglycerides were advised to consume fish oil supplements (2 g twice a day). At the end of the study, the results showed a decrease in triglycerides by 20-30%.
Fish oil supplementation has been shown to improve the elasticity of artery walls, may have the potential to reduce risk of coronary artery disease by 10%, has been shown to significantly improve insulin sensitivity and helps reduce inflammation.
Plant sterols taken at a dosage of 2/g per day inhibit cholesterol absorption and have been shown to reduce LDL cholesterol by 8-10%. Reviews have concluded that taking a dosage range of 2 to 3.3 g/ day reduces LDL by up to 12%.
Red rice yeast
A review of 10 clinical trials found that the effectiveness of statins and red rice yeast was the same. They both lowered LDL cholesterol in similar proportions.
Another review of 20 clinical trials suggests the average reduction is 39.3 mg/dL (1.02 mmol/L). However, the safety of red yeast rice is still under question, as it does have liver side effects in up to 5% of people.
In patients with moderate hypercholesterolaemia, taking 3.4 g of psyllium at mealtimes, 3 times per day reduced total cholesterol levels by 14.8%, LDL by 20.2% and the ratio of LDL/HDL by 14.8%.
When reviewers evaluated 8 clinical trials and the effect of psyllium husks on cholesterol levels, they concluded that 10.2 g psyllium per day reduced total cholesterol by 4.2%, LDL by 7% and lowered the ratio of LDL/HDL by 6%.
It’s also been shown to help reduce the amount of statins required by patients and still produce the same outcomes.
Psyllium husk is also beneficial for reducing blood sugar levels, including morning levels.
In rats, berberine has been shown to reduce LDL cholesterol by an average 28%.
A review of several clinical trials in humans confirms that taking berberine alone is more effective than taking lipid lowering drugs. And not surprisingly, taking lipid lowering drugs + berberine was more effective than taking lipid lowering drugs on their own.
Berberine is also beneficial for reducing blood sugar levels.
Get the right cholesterol tests
A basic cholesterol test is largely outdated. You must check for particle size and particle number by asking your doctor to do a particle size test.
If the test reveals large, fluffy particles, you’re in the safe zone, no matter how “high” your cholesterol may seem. Whereas if it comes back with small dense particles, then that is a definite concern that warrants further investigation and the potential for intensive lifestyle intervention and perhaps the possibility of medication.
Read more about cholesterol and tests here.
This information on statins for diabetes and prediabetes is not intended to be a prescription for what you should do. It is here to help inform you about the pros and cons, to help you determine what’s right for you.
According to the research outlined above, and the opinions of experts such as cardiologist Dr. Aseem Malhotra and physician Dr. Mark Hyman, statins have much less effect than they promise. Though, according to other researchers, the small benefits they offer still outweigh the downfalls.
Given that diet and lifestyle changes can improve cholesterol, weighing up the pros and cons is something you should do very carefully.
If you are currently taking statins, you should not stop taking them without consulting your doctor.
However, based on the evidence, if you believe they are not right for you, there are alternative options to explore that can help you improve your cholesterol profile.
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