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Newsletter
Santé! Naturopathic News From Dr. Sarah Cimperman
Santé means "to your health!" This French expression embodies the purpose of my monthly newsletter. My goal is to provide support for healthy lifestyles through articles, recipes, current research in holistic medicine and answers to your health questions.
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February 2010
Richard Kronmal, a biostatistician at the University of Washington, commented:
“Saying that statins reduce heart disease risk by lowering cholesterol is like saying that aspirin reduces heart disease risk by reducing headaches.”
The use of statins in the United States is reaching epidemic proportions, but many people are unaware that their side effects can be serious and their benefits questionable. In recognition of February as National Heart Awareness Month, this month’s article discusses this common approach to heart disease, as well as alternative options.
In good health,
Sarah Cimperman, ND
Article
The Statin Epidemic
Doctor’s Pick
Yoga Relieves Back Pain
Notes from the Office
Virtual Dispensary
The Naturopathic Gourmet
Highlights From the Blog
Quote:
“Saying that statins reduce heart disease risk by lowering cholesterol is like saying that aspirin reduces heart disease risk by reducing headaches.”
Richard Kronmal, biostatistician at the University of Washington
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The Statin Epidemic
By Sarah Cimperman, ND
Millions of people in the United States take statin medications to lower cholesterol and prevent heart disease. Some think that statins are the new wonder drug while others wonder whether the benefits outweigh the risks. With research studies uncovering questionable gain and serious side effects, critical concerns are justified. A thorough understanding of the way that statins work helps explain why they may not be the key to healthier hearts and longer lives.
Lower Levels of Cholesterol
Statins block the activity of enzyme HMG-CoA reductase, an essential step in the synthesis of cholesterol. Inhibition of this enzyme prevents the body from producing cholesterol, lowering levels in the blood.
Cholesterol has several important functions in the body and we can’t live without it. It is an antioxidant, a repair molecule and an essential component of all cell membranes. Cholesterol is used to make adrenal hormones that help our bodies deal with stress and regulate blood volume, and sex hormones, including estrogen, progesterone and testosterone. It is used to make bile, which aids the digestion and assimilation of dietary fats, and vitamin D, which increases absorption of calcium, builds strong bones, strengthens the immune system and provides protection against hypertension, autoimmune disease and cancer.
Cholesterol also accounts for approximately half the dry weight of the brain, where it plays a vital role in insulating neurons and allowing cells to communicate. When the body doesn’t make enough cholesterol, neurological problems can arise. Not surprisingly, side effects of statins include cognitive impairment, memory loss, mental confusion, difficulty concentrating, insomnia, personality changes, depression, anxiety, irritability and violent behavior.
Deficiency of Coenzyme Q10
Statins also inhibit the synthesis of coenzyme Q10, an antioxidant and essential cofactor in the production of energy inside cells. Because heart cells have such large energy requirements, they contain the highest concentrations of CoQ10. Deficiencies can weaken the heart and compromise cardiovascular function.
The deficiency of CoQ10 caused by statins can start soon after treatment begins. A study at Columbia University found that after only 14 days of treatment with atorvastatin (Lipitor), CoQ10 levels were reduced by 49 percent. Once CoQ10 is lacking, heart dysfunction can quickly follow, even in people who have no history of cardiovascular disease. A study published in the American Journal of Cardiology followed adults who were healthy aside from mildly elevated levels of cholesterol. After only 6 months of taking a low dose of Lipitor, 71 percent of participants developed early heart muscle dysfunction.
Some side effects of statins are related to the loss of CoQ10 in muscles and a reduced capacity for energy production. These include fatigue, shortness of breath, problems with mobility and balance, and muscular pain, weakness and atrophy. Severe reactions can lead to rhabdomyolsyis, destruction of skeletal muscle that is sometimes fatal. CoQ10 deficiency has also been linked to heart failure, hypertension and Parkinson's disease.
Other Adverse Effects
Additional side effects associated with statin drugs include nausea, heartburn, abdominal cramps, diarrhea, constipation, headaches, asthma, skin rash, hair loss, impotence, inflammation of the pancreas, liver damage and malignancy.
A study published in the Journal of the American Medical Association found that all statins (as well as fibrates, another class of lipid-lowering drugs) caused cancer in animals, in some cases at doses comparable to those prescribed in humans. Another study, a randomized, placebo-controlled trial published in the New England Journal of Medicine, linked statin medications to an increased risk of breast cancer. Researchers followed 4159 men and women with normal cholesterol levels between the ages of 21 and 74 for an average of five years. Participants were divided into two groups: one was given pravastatin (Pravachol) and the other, a placebo. At the end of the study, 12 women in the pravastatin group had developed breast cancer while only one case occurred in the placebo group.
Questionable Benefits
The benefits of statins are as concerning as their risks and major studies have failed to show protective effects. A trial published early this year in the American Journal of Cardiology found that statin medications taken to lower cholesterol actually increased the risk of death. Researchers followed almost 300 adults diagnosed with heart failure for an average of 3.7 years, and in some cases up to 11.5 years. They found that participants taking statin drugs who had the lowest levels of low-density lipoprotein (LDL) cholesterol had the highest rates of mortality. Incidentally, higher levels of cholesterol were associated with a lower risk of death.
The reduction of cholesterol is widely believed to be beneficial in preventing heart disease, but only half of all people who suffer heart attacks and strokes have high cholesterol. A large review of 22 controlled trials published in the British Medical Journal found no correlation between cholesterol levels and heart disease.
The Journal of the American Medical Association published a trial that compared older adults with levels of cholesterol above 240 mg/dl to those with levels below 200 mg/dl. For four years, researchers at Yale University measured blood levels of total cholesterol and high-density lipoprotein (HDL) cholesterol in almost one thousand participants and tracked the rates of death from heart disease, death from any cause, and hospitalizations for heart attack and unstable angina. They found no differences between the two groups. People with high total cholesterol had as many heart attacks and died just as often as individuals with low total cholesterol.
Alternative Interventions
Lowering cholesterol is not the best way to prevent heart disease. The most effective lifestyle interventions include regular exercise, weight control, stress management and a healthy diet low in refined carbohydrates like sugar and flour, and high in antioxidant-rich fruits and vegetables. Supplemental nutrients can also improve outcomes. For example, fish oil can reduce inflammation, lower blood pressure, thin the blood to prevent blood clots, and decrease levels of triglycerides, slowing accumulation of atherosclerotic plaques that can block coronary arteries. Fish oil has also been shown to reduce the risk of heart attack, dangerous arrhythmias, stroke and death.
But before starting any new supplements or discontinuing any statin medications, schedule an appointment with your doctor and make a plan to evaluate your risk of cardiovascular disease and complications using indicators more reliable than cholesterol tests, like levels of homocysteine, an amino acid in the blood, and C-reactive protein, a measure of inflammation.
References
Al-Mallah MH et al. Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction. Cardiol J. 2009;16(3):227-33.
Charach G et al. Baseline low-density lipoprotein cholesterol levels and outcome in patients with heart failure. Am J Cardiol. 2010 Jan 1;105(1):100-4.
Coogan PF et al. Statin use and the risk of breast and prostate cancer. Epidemiology. 2002 May;13(3):262-7.
Gaist D et al. Statins and risk of polyneuropathy: a case-control study. Neurology. 2002 May 14;58(9):1333-7.
Krumholz HM et al. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA. 1994 Nov 2;272(17):1335-40.
Mancuso M et al. Coenzyme Q10 in neuromuscular and neurodegenerative disorders. Curr Drug Targets. 2010 Jan;11(1):111-21.
Molyneux SL et al. Coenzyme q10: is there a clinical role and a case for measurement? Clin Biochem Rev. 2008 May;29(2):71-82.
Newman TB and Hulley SB. Carcinogenicity of lipid-lowering drugs. JAMA, 1996 Jan 3;275(1):55-60.
Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome. BMJ. 1992 Jul 4;305(6844):15-9.
Rundek T et al. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 2004 Jun;61(6):889-92.
Ruijter W et al. Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ. 2009 Jan 8;338:a3083. doi: 10.1136/bmj.a3083.
Sacks FM et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996 Oct 3;335(14):1001-9.
Silver MA et al. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol. 2004 Nov 15;94(10):1306-10.
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Doctor’s Pick: Play in the Dirt
Spring may still feel far, far away. But you can brighten your outlook by planning to play in the dirt next month with the Lower East Side Ecology Center.
Mark your calender: the East River Park Stewardship Day is Saturday, March 27, 2010.
Come admire the first flowers of spring along the waterfront esplanade and volunteer to help with gardening projects from 11:00 a.m. to 2:00 p.m. The Lower East Side Ecology Center will provide gloves and tools. Dress for the tasks at hand and meet at the East 6th Street footbridge inside East River Park.
For more information, visit the LESEC website, call 212-477-4022 or send an email to info@lesecologycenter.org.
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Notes From the Office: Virtual Dispensary
I have partnered with Emerson Ecologics to provide my patients with products I recommend. I have sorted through hundreds of manufacturers and thousands of products to hand pick the most reputable companies, the most bioavailable forms of nutrients, the most effective formulas, and the most convenient dosages.
Find my top choices on Emerson’s Virtual Dispensary. Follow this link and enter your access code. Then create an account or log in to an existing account and you will be directed to the products I've picked. You can also use the search box at the top of the page to find other supplements and/or other sizes of the products I've recommended.
Click here to visit the Emerson Ecologics virtual dispensary.
If you are an established patient and do not have an access code, please contact me and I will provide you with one.
For future visits, find the link at the bottom of the home page of my website. If you log onto Emerson’s website without following this link, you will not be able to see my page of recommended products.
Speaking of my favorite products, this is something that almost everyone can benefit from stocking in their medicine cabinet during cold and flu season: Wise Woman Herbal’s Elderberry Syrup.
Elderberry has a long tradition of use as treatment for upper respiratory infections and a recent study published in Phytochemistry found it to be as effective against the H1N1 virus as Tamiflu and Amantadine. Elderberry activates immune system mediators and, like other berries, it is full of antioxidants.
Take elderberry syrup at the first signs of colds or flu to shorten the duration of illness. Ask your naturopathic doctor about the right dosage for you.
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The Naturopathic Gourmet
Stay tuned to my blog, The Naturopathic Gourmet, for sensual and sensational Valentine’s Day recipes that will be posted in the next week: vegetarian red wine risotto, and seared duck breast with raspberry balsamic sauce in an elegant five-course menu.
The most recent recipes already posted include:
Peach Sauvignon Sauce
Sauvignon Blanc is a great wine for making savory sauces because it is dry instead of sweet, fruity and slightly sour. I paired this sauce with a jerk-rubbed pork loin, but it would also work well with grilled chicken breast, halibut or tofu triangles, seasoned with a dry rub of ground thyme, allspice and chili peppers.
Carrot Ginger Soup
This warming soup is easy to throw together for a quick dinner yet elegant enough for a special meal.
Three Alarm Chili
This chili has three different layers of heat from three different chili peppers: ancho, jalapeno and chipotle.
To read these recipes, visit my blog at
http://naturopathicgourmet.blogspot.com
To find a specific recipe, scroll down to see the archive menu on the right side of the screen.
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This monthly newsletter is published by Dr. Sarah Cimperman and is available free for everyone. Those who would like to receive a monthly email with the link can email
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Please Note
I never accept commission or compensation of any kind for my recommendations. If I recommend a book or website or service, it is because I believe it is of exceptional quality and interest to my readers.
Copyright 2010 Sarah Cimperman, ND
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