Pre-diabetes: An explanation for explosive coronary plaque growth

1. June 2006 William Davis (0)
Art's first CT heart scan in March, 2006 yielded a concerning score of 1336. He felt fine--no chest discomfort, no breathlessness, etc.

Art agreed to take the statin cholesterol drug his primary care doctor prescribed. He also agreed to take the fish oil, niacin, and some of the nutritional supplements that we advised. But Art just couldn't bring himself to make the commitment to lose weight.

At the start of his program, Art--at 5 ft. 8 inches--was 40 lbs overweight (212 lb). This was important since his blood sugar wavered in the pre-diabetic range, going as high as 130 mg. (The American Diabetes Assn. defines diabetes as a blood glucose of 126 mg or greater.)

One year later, Art's lipid and lipoprotein values were corrected to perfection. But he still weighed in at a hefty 209 lbs--essentially no change. His blood sugar likewise hovered in the 120's.

I felt Art need to be prodded, so I asked him to undergo another heart scan. His score: 1935--a 600 point increase, or 45%!

Only now has Art begun to comprehend to power of diabetes and pre-diabetes to fan the flames of plaque growth. Recent published data, in fact, show that the majority of recently diagnosed diabetics already have well-established coronary artery disease.

Don't let this happen to you. Do not dismiss diabetic patterns as they will catch up to you. If Art can lose the 30-40 lbs in the abdominal weight that is creating the diabetic pattern, he will likely succeed in stopping plaque growth. Otherwise, it's just a matter of time before his heart attack, stent, or bypass.
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Statin drugs and Coenzyme Q10

Statin drugs and Coenzyme Q10

17. September 2007 William Davis (10)
I am continually impressed at how few of my colleagues take advantage of a wonderful nutritional supplement, Coenzyme Q10 (CoQ10).

Despite some of the recent backlash against statin agents, I do believe that they serve a role. I take issue with the pharmaceutical industry's endless advertising and force-feeding of drugs to the public and to physicians. Nonetheless, statin agents do serve a purpose.

If you go to your doctor with a fever of 103 degrees, coughing up thick yellow sputum, and you are struggling to breathe, would you refuse an antibiotic for pneumonia? Probably not. But an antibiotic for a sore throat may be a different matter.

So it goes with the statin drugs, too. An otherwise healthy 50-year-old woman with an LDL cholesterol of 140 mg/dl probably does not need a statin drug. A 35-year-old man with heterozygous hypercholesterolemia with an LDL cholesterol of 280 mg/dl, who will develop his first heart attack within the next 2 or 3 years, does need these drugs. The rub, of course, is deciding who in between also needs them.

Let's just accept that some people do indeed need a statin drug for one reason or another. How common are the muscle aches?



In my experience, muscle aches are inevitable. The longer you take a statin drug, the more likely you will develop them. The higher the dose, the more likely.

Thankfully, for most people muscle aches are more of a nuisance than a real danger. Usually, a reduced dose of the drug, periodic breaks from the drug (we often advise one or two weeks off every three months), or a change to another agent helps.

However, in my view, coenzyme Q10 provides a virtual antidote to most of the muscle aches and weakness. A recent review was published in the Journal of the American College of Cardiologist that concluded that there was insufficient evidence to support the use of CoQ10 for this purpose. Obviously, the authors do not use CoQ10 in everyday practice. If they did, they would have no doubt whatsoever that CoQ10 provides the majority of people with complete relief of the muscle complaints.

Time and time again, I have witnessed complete relief from muscle aches and muscle weakness from statin drugs using CoQ10. However, in our experience, a dose of at least 100 mg per day needs to be maintained. Occasionally, a higher dose will be necessary, e.g., 300 mg per day. The preparation also must--MUST--be an oil-based gelcap to work (just like vitamin D). The capsules that contain powder are so poorly absorbed that they usually fail to yield the needed effects.

Pictured is the Sam's Club (Members' Mark brand) that has served us well, providing reliable effects at a reasonable price. (CoQ10 is expensive, no matter where you buy it. That's the only drawback I'm aware of.) GNC has a great preparation, as does Life Extension. Just be sure it is a gelcap, not a capsule filled with powder.

There's more to CoQ10 than relief of statin muscle aches. More about that in future.
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Comments (10) -

  • DietKing2

    9/17/2007 2:49:00 PM |

    Thanks for this post! I've been waiting for this one!
    So I'm not off base for ingesting my CoQ-10 twice daily! Yay!
    Talk about peace of mind, right?
    The market must be clamoring for this stuff because Life Extension led the way with a newer, more bioavailable version of CoQ10 (ubiquinol vs. ubiquinone) recently and now less expensive versions are popping up all over the internet--affordable protection, man!
    Thanks for the post!
    AdamWink

  • Terri in Texas

    9/17/2007 4:26:00 PM |

    I can appreciate that Co Q-10 probably works for _most_ people, and I wish I was one of them. But... there are those of us who are probably either so sensitive to statins, or perhaps even genetically predisposed to react horribly to statins, that even 200 mgs. daily of the LE quality formulation won't stave off debilitating statin side effects.  So therefore, no statins for me.

    Is there any credible evidence that Co Q-10, say 100 mgs. daily, might still be a good thing?  I currently am taking slo-niacin and a tiny bit of a beta blocker for MVP.

    Thanks!  Keep up the great blogging!

    Terri

  • Nancy M.

    9/17/2007 6:54:00 PM |

    I'm curious if you've seen this article by Gary Taubes.  I really like this guy, he's wonderfully skeptical of "common knowledge".

    http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?_r=1&oref=slogin&ref=magazine&pagewanted=print

  • Dr. Davis

    9/21/2007 12:41:00 PM |

    Terri--

    Outside of the statin issue, I use CoQ10 for 1) blood pressure reduction, 2) enhancement of left ventricular function if it is impaired by heart attack or other conditions, and 3) increasing energy, though an inconsistent effect.

  • Dr. Davis

    9/21/2007 12:42:00 PM |

    I've not read Gary Taubes book, but I think that he makes many excellent points on the mislaid conventional wisdom on diet.

    Over the past few years, we've learned some very important lessons in the Track Your Plaque experience, as well, that has caused us to change out dietary approach rather dramatically.

  • Anonymous

    10/18/2007 1:33:00 AM |

    I have read Gary Taubes' book and there is one very important point he makes that will  get the attention of those of us who are on Statins. That point is that LDL is not relevant to heart disease or metabolic syndrome. He claims that the only credible evidence indicates that triglycerides and HDL are the important factors. What you want is high HDL and low triglycerides and if you have this, forget the LDL reading. That is precisely my situation and I plan to challenge my doctor on this at my next appointment. Can I stop taking the 20 mg of Crestor each day?
    I have been on Zocor for 20 years and recently switched to Crestor to further lower my LDL. I have never had muscle pain of any kind and my liver tests are always good. I did take CoQ10 for awhile, but I could not detect any difference. Perhaps for those of us who can tolerate statins CoQ10 is not necessary?

    Barry S

  • Anonymous

    12/13/2008 5:56:00 PM |

    I think it makes some sense to take the CoQ-10 preemptively, a month before starting any statin therapy. It's easier to prevent rather than reverse muscle pain/weakness.

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    Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells. CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Some prescription drugs may also lower CoQ10 levels.

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    Pictured is the Sam's Club (Members' Mark brand) that has served us well, providing reliable effects at a reasonable price. (CoQ10 is expensive, no matter where you buy it. That's the only drawback I'm aware of.) GNC has a great preparation, as does Life Extension. Just be sure it is a gelcap, not a capsule filled with powder.

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