Book review: “The Dark Side of Statins”

Ollie

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The Dark Side of Statins (2017), Duane Graveline, MD, MPH
(Also included is The Wonder of Cholesterol by Glyn Wainwright)

The author, Dr Duane Graveline was a former US Air Force and US Army Flight Surgeon, NASA Astronaut, and Family Doctor. In this book he relates his own statin story and his research into the side effects of statins over a 15 year period. His own statin-related issues began in 1999 and he died (the given causes: cardiorespiratory arrest, acute myocardial infarction, cardiac dysrhythmia, and peripheral neuropathy) in 2016 at the age of 85 as a result of his history of statin use.

The book provides a powerful mix of descriptive explanations, case reports, and scientific research references to inform readers – from lay people to expert. Whilst for the avid researcher of this topic, there is nothing spectacularly new, the information is all in one place, and there is more knowledge given on the effects on peripheral neuropathy – and much of that damage is below the threshold of clinical awareness – i.e. silently damaging the unsuspecting.

The book is suitable for those who have experienced adverse reactions to statin drugs and those who are family, friends, or caregivers of statin users, as well as for those facing the use of statins. As well as the technical aspects, there is discussion and guidance on dietary changes and supplements which may help in mitigating the more extreme damage done by statins to mitrochondria, CoQ10, dolichols, and the protective role of antioxidents.

However, whilst the book deals with problems, as far as diet is concerned, the author was a big fan of the Paleo diet, and states how ingrained in our physiology is the thoroughly tested construct pattern from our ancestors – that of a hunter-gather lifestyle.

{My experience as a reviewer: I had a heart attack 18 months ago, was immediately operated upon and received 3 stents. After initially taking statin drugs I weaned off them. Nine months ago, I had 3 more operations that placed 2 more stents around my heart. As a precaution against further problems (I had elevated levels of C-Reactive Protein), I was advised to resume statin use, although at a lower dose than that prescribed (see later bullet point) by the hospital cardiologist.}

Each chapter in the book includes a summary that covers the main points in easy to understand bullet points. These are given below (with my own paraphrasing, omissions and additions (as to what seemed important) to those given in the book text – you will have to read the book yourself to get to the details behind these main points).

The Wonder of Cholesterol is that our cells need cholesterol to function properly.

High cholesterol is more often associated with good health and longevity.

The rising obesity rates observed by the 1980s coincided with the widespread adoption of high-sugar, and low-fat formulations in processed foods.

Fat does not cause obesity or disease. It is excess sugars which create abdominal obesity.

Cholesterol levels are not measured, merely estimated from the quantity of very useful ‘lipid droplets’ circulating in our blood.

LDL cholesterol does many jobs, like transporting vital fat soluble vitamins, lipids, and proteins. Sugar-damaged LDL is not recognised by the organs that need these essential nutrients.

It doesn’t matter how high your total blood serum cholesterol is. What really counts is the damaged conditions of the LDL lipids.

As we age excessive amounts of free sugars in the blood may eventually cause damage quicker than the body can repair it. {in my case, as one example, degeneration is evident in the production of new skin cells which are ‘plastic’ (full of cellulite), instead of the ‘bright new unblemished skin of youth, to replace dead skin cells.}

HbA1c is a widely available blood test to check for sugar damage.

Cholesterol-lowering drugs can cause diabetes {when I was in a rehabilitation clinic for patients who had undergone heart surgery and/or angioplasty, I was struck by how many were also diabetics, and, of their relative youth}

Cholesterol is vital for brain and nervous system functions.

Behavioural changes, personality changes and dementias have all been associated with low levels of cholesterol.

Cholesterol lowering drugs known to cause adverse effects in anywhere from 10% to 30% of patients.

Cholesterol does not cause heart disease.

What has been taught since 1955 about the cause of atherosclerosis has been dead wrong.

New guidelines for LDL cholesterol are artificially low (individuals at high cardiovascular disease risk to attain <100mg/dL, and individuals at very high risk to attain <70mg/dL) and grossly unnatural for the human body.

There is no credible science that offers proof that lowering cholesterol levels to physiologically normal levels reduces cardiovascular risk.

Clinical trials challenge cholesterol causation, cholesterol lowering does not appear to have a significant role in cardiovascular disease control.

LDL cholesterol lowering is not the key in atherosclerosis treatment or prevention.

Cholesterol is nothing but an innocent bystander drawn into the plaques as part of a natural healing process.

We have learned in the past decade that statins are also powerful anti-inflammatory agents. Many now believe that it is the anti-inflammatory effect of statins that is beneficial in atherosclerosis control.

Forward thinking doctors are cutting statin doses in an effort to get the described anti-inflammatory effects without seriously interfering with mavolonate pathway function, the cause of many adverse reactions.

The JUPITER findings demonstrated for the first time cardiovascular benefit from statin therapy on the basis of an elevated hs-CRP (high sensitivity CRP – a measure of inflammation level) level, independent of cholesterol.

Lower LDL and higher HDL have been of no benefit to the patients in clinical trials.

Mechanism of statin drug benefit.

The idea of statin use for high risk people, but at non-cholesterol lowering doses (low level). Even at a relatively low dose of a statin, inflammation is suppressed substantially (a study, and repeated several times, confirmed that 10mg versus 80mg Lipitor on hs-CRP levels reported that the lower dose (10mg) gave 70% of the value of the higher dose). {the hospital cardiologist has me on a high dose combined, or enhanced, statin of the second highest potency – however, I’m taking a single statin at a reduced dosage, and of a lower potency on medical advice}

Any cardiovascular risk benefits from statins has no relationship to cholesterol reduction.

In addition to blockading cholesterol production, dolichols, CoQ10, selenoproteins and rho are equally diminished by the effects of statins.

Like aspirin, statins reduce the production of the blood clotting agent thromboxane, also, aspirin has shown benefits in both primary and secondary prevention of heart attacks and strokes.

Ora Shovman in 2012 published report concluded that inflammation was the cause of atherosclerosis. (He first introduced the concept in 2002.)

Studies are needed to see whether statin sensitive people can tolerate low dose statins without the often debilitating side effects from higher doses (as low as 2-3mg of the stronger statins).

To be continued …
 
The Dark Side of Statins book review continued …

Overview of stain adverse effects.

The full range of statin side effects goes far beyond cognitive dysfunction to include behavioural and emotional disorders, chronic nerve and muscle damage and an ALS (Amyotropic Lateral Sclerosis) – like muscular degenerative disorder.

The author had his first episode of Transient Global Amnesia (TGA) six weeks after starting using Lipor. The brain is dependent upon cholesterol for the formation and functioning of memory.

Statins speed up the natural process of mitochondrial mutations.

Statins deplete CoQ10 and few people realize how important CoQ10 is.

By the time we reach 50 we are almost completely dependent upon dietary intake of CoQ10.

We must repair thousands of mitochondrial DNA mutations daily in our bodies from the normal process of converting food to energy.

CoQ10 has a powerful antioxidant role.

Statins block the synthesis of CoQ10 and dolichols and contribute directly to the premature, common chronic ills of aging.

The inevitable effect of lowered CoQ10 and dolichols by statins is increased mitochondrial DNA damage.

Statin drugs, side effects and review.

Cholesterol is essential for brain and memory function. The cholesterol that the brain needs is produced in the brain itself by glial cells reduced by stains as in the rest of the body. Without sufficient availability of cholesterol, memory must falter. It is inevitable!

The author’s experience of two episodes of TGA came on abruptly, temporarily blocking any memories of events stretching back decades.

For every case of TGA reported, hundreds of cases of statin associated confusion, disorientation, and increased forgetfulness have occurred.

Many cases of statin associated cognitive impairment are misdiagnosed as Alzheimer’s disease or other forms of dementia.

Statin problems are far more than cognitive, and all statins are involved.

The pathway to cholesterol synthesis is also shared by important biochemical substances including CoQ10, dolichols, and selenoproteins.

Non-cholesterol factors such as inflammation are now implicated as a major source of atherosclerosis.

Trans-fats, oxycholerol, omega-3/6 imbalance, cigarette smoking and hidden chronic infections are well known inflammation triggers.

The reason many of the side effects become permanent in some people is mitochondrial mutations.

To give statins without also giving CoQ10 is to invite disaster {although the amount has to be controlled as CoQ10 reduces the effect of blood thinners – like any ingredient of a recipe (in this case of medications and dietary supplements), if you change the amount of one ingredient it is likely to have a knock-on effect on the performance of other ingredients, leading to a different final outcome (e.g. a perfect puffed-up soufflé, or one that collapses) – what is required is a balance of all of ingredients to get the desired result}.

Dolichols, statins and personality change; the altered emotional and behavioural reactions associated with statin use are likely explained by altered neuropeptide formation.

It is the almost unlimited range of protein structural options that gives humans their tremendous range of behavioural and emotional reactions.

Proteins are synthesized within the membranes of the endoplasmic rectilium within each of our cells…

Amino acids are linked together into a peptide with each peptide responsible for a diverse range of functions.

This entire process is orchestrated by doilchol in the form of dolichol phosphate.

The peptide assembly process is greatly influenced by statin drug use due to the inevitability of dolichol inhibitions, secondary to reductase blockage of the mevalonate pathway by statins.

The national priority to lower cholesterol completely disregarded the important consequences of collateral damage from statin drugs.

In the heart of every cell, sacchanides (sugars) are attached to proteins and lipids to give a far broader range of diversity and information transfer than other protein or lipid alone in a process called glycolysis.

This attachment of sugars, thus glycotysis is completely dependent upon dolichol’s orchestration.

Adding a stain provides an inevitable inhibition of dolichol.

Statin damage is often additive to pre-existing impairment of glycolysis from aging, disease and poor nutrition.

Dolichols may well be fully as important as CoQ10.

The effects of dolichols takes place in the endoplasmic reticulum and Golgi apparatus.

There is no number to measure dolichol deficiency as we have for cholesterol or CoQ10. One must judge dolichol effect clinically on the basis of signs and symptoms.

For the purpose of mitochondrial maintenance, dolichols are absolutely vital to correct the daily load of oxidative damage our DNA must face.

CoQ10 helps to minimise oxidative damage because of its antioxidant effect and dolichols correct the damage missed by our CoQ10 defence. On a normal day we have tens of thousands of DNA errors to prevent and/or correct.

Statin drugs having the effect of inhibiting both CoQ10 and dolichols, directly impact our natural antioxidant defences.

Neutrophils, macrophages and natural killer cells are the first line of defence against injury and infection. They use glycoprotein matching to identify protein cells.

B-lymphocytes produce our antibodies and our T-lymphocytes engulf and destroy invaders, this function is dependent upon proper glycoprotein identification.

There is no disputing the ability of statin drugs to inhibit dolichol synthesis, therefore impacts on the mechanisms of glycoprotein action are inevitable.

Dolichols supervised attachments of sugars to the growing peptide chain is of major concern for one combination gives love, another hate, with hundreds of subtle values inbetween.

Fully 20% of the total adverse reports for statin drugs include such symptoms as aggressiveness, hostility, sensitivity, suicidal ideation, suicides, homicidal ideation, and ‘road rage’ type behaviours.

To be continued …


Edit: spelling
 
The Dark Side of Statins book review continued …

From CoQ10 inhibition to mitochondrial mutations; one of the most serious side effects of stain drugs is their tendency to increase mitochondrial mutations, therefore contributing to premature aging, and every cell comes equipped with mitochondria, the energy producer of the cell.

Increased mitochondrial mutations, for which the disastrous adverse response is the predictable consequence of CoQ10 and dolichol inhibition.

After the age of 50 we become increasingly unable to synthesize CoQ10.

CoQ10 is found only in very small amounts in the average diet.

Tens of thousands of mitochondrial mutations occur every day.

CoQ10 is a component of the body’s antioxidant system.

Thousands of DNA lesions occur daily despite our oxidation system.

The gradual build up of these DNA errors can result in progressive loss of functional DNA.

Mevalonate blockage of varying degrees is inevitable when statins are used.

The consequences of CoQ10 and dolichol inhibition is mitochondrial damage plus increased oxidative damage and DNA mutations.

The logical consequence of this is premature aging and progressive development of such chronic conditions of aging as muscle weakness, burning pain and incoordination, and faulty memory.

The symptoms are cognitive, emotional, neuropathic, myopathic and neurodegenerative, and in reality there is much overlap.

And over all these is the frequent presentation of tiredness and easy fatigability, pointing directly at deficient energy. With inefficient mitochondrial damage, fatigue (the end result of a lack of adenosine triphosphate (ATP)), becomes inevitable. {since my heart arterial operations last year, followed, a few months later, by a couple of couple of operations under anaesthetics, one of which was a general, I have been in a constant state of feeling tired, especially after any either, physical, or significant mental activity. Now, this may be a recovery effect of these interventions, or it may be the effects of statins, or both combined.}

The cognitive manifestations of statins may be just episodes of Transient Global Amnesia, or progressive confusion, disorientation and forgetfulness or progressive dementia.

Muscle, heart and brain cells have hundreds of mitochondria because of their metabolic demand.

Mitochondrial mutations – could Mevalonate help?

Statins cause mevalonate blockage and this appears to be the source of many of the side effects of statins. This blockage has been reverted in many studies by adding Mevalonate.

Mevalonate given at the same reasonable time period (immediate?) after adding a statin may offer a possible statin treatment option.

Anti-oxidation and mitochondrial damage.

Our antioxidant system minimizes the oxidative damage to mitochondrial DNA.

Oxidation is a chemical reaction that often produces damaging free radicals.

Antioxidants help remove free radicals.

The inhibitory effect of statin drugs on CoQ10 may damage DNA.

The function of antioxidant systems is to keep oxidants at an optimal level.

Damage to DNA can cause mutations.

Antioxidants have both independent and interdependent effects.

Just because a substance is an antioxidant, it does not necessarily mean that it is vital to the body’s antioxidant function.

Because of its high metabolic rate, the brain is particularly vulnerable to oxidative injury.

There is no way to predict how an individual will respond to progressive mitochondrial deterioration triggered by statins.

Aging and mitochondrial mutations.

Our antioxidant system minimizes the oxidative damage to mitochondrial DNA.

CoQ10 is the principal antioxidant to mitochondrial function.

Dolichols are critical to the synthesis of glycoproteins.

Thousands of mitochondrial DNA errors must be corrected daily and is orchestrated by dolichols.

The mitochondrial theory of aging proposes that aging is primarily the result of accumulated oxidative damage over time to mitochondrial membranes and DNA.

In some statin users the negative side effects include the following: mitochondrial mutations leading to permanent myopathy, neuropathy and neurogenerative diseases, lack of energy leading to chronic fatigue {I am certainly feeling fatigue} and congestive heart failure {which apparently I have}, and a lack of cell wall integrity, leading to myopathy, rhabdomylosis, neuropathy and hepatitis.

Mitochondrial damage in aging.

With lack of availability of sufficient CoQ10 and glutathione, rapid mitrochondrial mutation can be expected.

Oxidative damage is implicated in many human age-related diseases.

With age, mitochondrial function declines and mitochondrial DNA (mtDNA) mutations decrease.

Studies show that mtDNA abnormalities are involved in aging processes in human muscles.

In diseases such as Alzheimer’s oxidative stress and oxidative damage is felt to play a key role in the loss of memory, and the progression to dementia.

Mitochondrial impairment is increasingly implicated in the side effects of stains.

In a study, the combination of statins and type 2 diabetes drugs yielded the greatest effects on mitochondrial mutations.

The oxidation process of making energy requires vitamins B3 and B2, minerals, lots of CoQ10, and the presence of oxygen.

To be continued …
 
The Dark Side of Statins book review continued …

Mitochondrial mutation and dietary supplements.

Studies of chronic fatigue show the progressive loss of the ability of mitochondria to produce high-energy molecules for cell function.

Our anti-oxidation capacity gradually deteriorates as we age.

Among the many side effects of statins is the same direct assault on our mitochondrial DNA produced by natural aging.

One side effect of stain therapy is premature aging.

Currently there is no conventional medical, or pharmaceutical treatment for the prevention and treatment of mitochondrial mutations.

What is considered useful and appropriate for fatigue and aging therapy by nutritional researchers, may also be relevant for statin damage.

CoQ10 is critical for mitochondrial maintenance as an anti-oxidant and as part of the energy producing complexes.

Vitamin C is a powerful antioxidant at high doses. {to just below bowel tolerance}

Selenium is an anti-oxidant that has critical roles in mitochondrial maintenance, muscular metabolism and brain function, and is vital in general metabolism and thyroid function. Note: Selenium toxicity can occur with amounts over 400 micrograms daily for adults.

Lecithin is a major component of the membrane of cells.

Omega-3 and 6 essential fatty acids cannot be synthesized by the body so requirements must come from diet or dietary supplements.

D-Ribose improves the capacity of skeletal muscles to recover after exercise.

Tocotrienols (vitamin E family) increase CoQ10 and dolichols and mimic the anti-inflammatory effects of statins.

Magnesium activates 76% of the enzymes in the body.

Alpha-Lipoic-Acid directly recycles and extends the metabolic lifespans of Vitamin C, glutathione, Vitamin E and CoQ10.

Pyroloquinoline quinone (PQQ) is being touted not only for its antioxicidant protection in the fight against radicals, but also its potential use for mitochondrial growth. Dietary sources of PQQ include many fruits (particularly rich are papaya and kiwi fruit) and vegetables (particularly rich are celery, parsley) and egg yolks and Natto. Also, PQQ is available as a dietary supplement.

Mitochondrial mutations: diet.

Our paleolithic days ended 10,000 years ago, but our bodies and metabolic functions are literally the same as they were when our ancestors gave up the hunter-gatherer existence.

The diet of our pre-agricultural ancestors consisted of meats (including fish), insects, eggs, vegetables, fruits and nuts.

The diet of the Greenland Inuit, who have a relative absence of heart disease, is essentially fish and seal meat.

The blood samples of the Inuit were loaded with EPAs.

Highly active, short-lived creatures have high levels of DHA. Large, slow and long-lived creatures have low DHA values.

In our natural Paleolithic state, our dietary intake of omega-6 to omega-3 was about 1:1. The ratio is now estimated to be 10, 20, or even 30:1.

Food preservation and processing methods have diminished omega-3 because its unsaturated state makes it far more sensitive to oxidative change.

Folic acid, B6 and B12 have a vital contribution to the proper metabolism of homocysteine.

Many vitamins including B-complex, are often unable to function without adequate amounts of minerals, such as zinc, magnesium, silica, and copper, and even other vitamins.

Avoid canning. Freeze for storage. Do not overcook. These guidelines will give you optimum preservation of B6 and folic acid. B12 is much more stable and tolerant of heat.

To be continued …
 
The Dark Side of Statins book review continued …

The statin damage gene.

Many people have a generic variant that greatly increases sensitivity to statins. More than 20% of the population in the US and Europe may be effected.

The toxicity of statins is dose and concentration dependant.

Individuals who cannot tolerate a higher dose of a statin when they could originally tolerate a lower dose, may no longer be able to tolerate a lower dose once they develop statin-induced myopathy.

Cester, the strongest statin, is 16x more powerful than Lescal, the weakest at the same dose (Roughly equipotent doses of statins: Flurastatin 80mg, Pravastatin 40mg, Lovastatin 20mg, Simvastatin 20mg, Atorstatin 10mg, Rosuvastatin 5mg).

More than 25% of the US and European populations may be found to carry generic factors that place individuals at risk for statin-induced myopathy.

The special case of statin – associated ALS.

Statin drugs have the ability to cause neuronal degeneration.

Statins also cause the induction of abnormal tau protein phosphorylation (a precursor for Alzheimer type disease such as ALS).

Patients, who are at the risk of ALS, may have this condition occur more quickly in the presence of stains.

We are seeing a spectrum of clinical conditions brought on by statin use, ranging from pain and weakness of motor neuropathy and myopathy to primary lateral sclerosis (PLS) and atypical ALS.

Being placed on Statin drugs is a rather more recent cause of Peripheral Neuropathy.

Neuropathy, short for peripheral neuropathy, simply means a malfunction of the peripheral nervous system that occurs without any inflammation of the nerves.

There are many long-standing causes of neuropathy, including diabetes, kidney problems, and alcoholism.

Loss of ability to feel heat or cold, muscle weakness, numbness, tingling and prickling sensations, burning pain (especially at night) and/or sensitivity to touch, loss of balance and incoordination are frequent symptoms of neuropathy. Even in its mild form people may experience a feeling of tiredness, difficulty in rising from a low chair, shortness of breath or difficulty walking (a staggering). {Now, this is where it gets interesting, and for that matter more difficult to assess, are some of these ‘normal’ age related effects, or are they caused by statins (prematurely bringing on age-related issues)? I certainly have found that I’m weaker, but is this because of lack of the right kind of exercise, of not doing what I did before? I have noticed an occasional stagger, drifting off line a few times recently, which was not there before. Certainly, there is an overall feeling of tiredness (Is this just part of the recovery process of a number of operations in a relatively short period of time?). But, is this an effect caused by over-exercising with insufficient recovery time in-between, there are so many possibilities … }

An individual who is a long-term user of statin drugs – 2yrs or more – has a substantially greater risk of developing peripheral neuropathy than a person who does not take stain drugs.

Some individuals may improve in time after stopping the statin, the general impression from most doctors involved in trying to treat this condition is that it is resistant to all forms of treatment.

The findings are that much of this statin associated nerve damage is below the threshold of clinical awareness, silently damaging unsuspecting patients.

This may help, or not. There is a lot to think about.
 
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