Are statins and omega-3s incompatible?

French researcher, Dr. Michel de Lorgeril, has been in the forefront of thinking and research into nutritional issues, including the Mediterranean Diet, the French Paradox, and the role of fat intake in cardiovascular health. In a recent review entitled Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3?, he explores the question of whether statin drugs are, in effect, incompatible with omega-3 fatty acids.

Dr. Lorgeril makes several arguments:

1) Earlier studies, such as GISSI-Prevenzione, demonstrated reduction in cardiovascular events with omega-3 fatty acid supplementation, consistent with the biological and physiological benefits observed in animals, experimental preparations, and epidemiologic observations in free-living populations.

2) More recent studies (and meta-analyses) examining the effects of omega-3 fatty acids have failed to demonstrate cardiovascular benefit showing, at most, non-significant trends towards benefit.

He points out that the more recent studies were conducted post-GISSI and after agencies like the American Heart Association's advised people to consume more fish, which prompted broad increases in omega-3 intake. The populations studied therefore had increased intake of omega-3 fatty acids at the start of the studies, verified by higher levels of omega-3 RBC levels in participants.

In addition, he raises the provocative idea that the benefits of omega-3 fatty acids appear to be confined to those not taking statin agents, as suggested, for instance, in the Alpha Omega Trial. He speculates that the potential for statins to ablate the benefits of omega-3s (and vice versa) might be based on several phenomena:

--Statins increase arachidonic acid content of cell membranes, a potentially inflammatory omega-6 fatty acid that competes with omega-3 fatty acids. (Insulin provocation and greater linoleic acid/omega-6 oils do likewise.)
--Statins induce impaired mitochondrial function, while omega-3s improve mitochondrial function. (Impaired mitochondrial function is evidenced, for instance, by reduced coenzyme Q10 levels, with partial relief from muscle weakness and discomfort by supplementing coenzyme Q10.)
--Statins commonly provoke muscle weakness and discomfort which can, in turn, lead to reduced levels of physical activity and increased resistance to insulin. (Thus the recently reported increases in diabetes with statin drug use.)

Are the physiologic effects of omega-3 fatty acids, present and necessary for health, at odds with the non-physiologic effects of statin drugs?

I fear we don't have sufficient data to come to firm conclusions yet, but my perception is that the case against statins is building. Yes, they have benefits in specific subsets of people (none in others), but the notion that everybody needs a statin drug is, I believe, not only dead wrong, but may have effects that are distinctly negative. And I believe that the arguments in favor of omega-3 fatty acid supplementation, EPA and DHA (and perhaps DPA), make better sense.



Comments (4) -

  • Ellen Lewis

    6/18/2013 7:32:42 PM |

    thanks, this seems a sensible take on the issue.

  • Dolph

    6/30/2013 4:59:57 PM |

    This is a (too) far stretched conclusion pretty obviously. O3s still haven’t shown any consistent benefit alone, with a statin drug or without it, and cherry picking the studies that seem to look doesn’t help that fact either! The data is just inconclusive.

    A much more interesting blog article I hope to read in the future would be about niacin!
    Niacin has shown more than once to produce favourable outcomes alone and combined with resins. (CDP, FATS, etc.) On the other hand there can be no more doubt that it doesn’t add any benefit to statin therapy after the results of the two big clinical endpoint studies (AIM-HIGH and HPS2-THRIVE), that flush the cute little landmark studies (ARBITER, HATS, etc.) down the toilet where they belong.
    So what does that imply for the TYP-programm? A rhetorical question it should be, but I’m sure somebody will add some woo…

    - See more at: http://blog.trackyourplaque.com/2013/05/dha-the-crucial-omega-3.html#comments

  • Stephen in Jacksonville

    7/3/2013 10:15:53 PM |

    It is interesting that he should be doing this research into how statins react with Omega-3's. Statins may be one of the most widely prescribed drugs at this point, and I certainly think more research should be conducted on their long-term effects. I recently read about another study which looked at the effects of exercise and statins. Apparently, this drug actually works to counteract some of the benefits that are gained by getting regular exercise for people with cholesterol problems.

  • Brandon Barclow

    7/18/2013 6:07:47 PM |

    Stephen in Jacksonville.   There's no maybe to it.  The number 1 and number 2 selling drug in the world are statin drugs.  32 million Americans are currently taking statin medication.  The one thing that the 32 million have in common is:  THEY HATE TAKING THEIR MEDICATION.

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Appetite stimulants

Appetite stimulants

Ever have days when you just can't seem to get enough to eat, your stomach gnawing just a hour after a meal? We all get them, some more than others. Other days, you can be content with a few simple foods and hunger is subdued, temptation easy to control.

Why such contrasts on different days?

A major part of the reason can be the presence of appetite stimulants, factors that trigger appetite beyond rational control. The list of common appetite stimulants includes:

--Sleep deprivation--A very important factor. Lack of sleep drives tremendous appetite, and often for the wrong foods (processed carbohydrates). I personally have experienced my most shamefully indulgent days when sleep-deprived. The solution is obvious: Sleep. Another factor that is based purely on personal observation is that of waking mid-phase. In other words, waking up while you're still enjoying the deeper phases of sleep (e.g., phase 3,4, or REM). This can oddly disrupt your day and your impulse control. I usually try and time sleep to increments of 90 minutes to coincide with the average duration of the full cycle of sleep. For example, 7 1/2 hours is better than 8 hours, since the extra half hour puts your square into a deeper sleep cycle.

--Excessive caffeine--Caffeine stimulates stomach acid. This triggers the impulse to eat . . . and eat and eat.













Image courtesy Wikipedia

--Aspirin and other anti-inflammatory agents--If you take aspirin (as many of our Track Your Plaquers do), then beware of the gastritis that can develop. Like excessive caffeine, it also triggers the impulse to eat, likely a protective mechanism, since food sops up excess acid. I ask patients to take periodic breaks from aspirin, e.g., a week off every two or three months, to allow the stomach to heal. Alternatively, an occasional dose of acid-suppressing medication is a safe practice, e.g., Pepcid AC 10-20 mg; Prilosec 10-20 mg.

--Wheat-containing foods--Followers of The Heart Scan Blog know my feelings on this. Wheat is a potent appetite stimulant: Eat something containing wheat like a pretzel or whole wheat bagel, and you want more. You may want more immediately, or a little later when your blood sugar plunges after the wheat-driven insulin surge. Solution: Dump the wheat, one of the most unhealthy food groups around.

--Alcohol--Though perhaps not a direct appetite-stimulating effect, the loss of impulse-control with alcoholic drinks can lead to overindulgence, often in the worst foods. Just beware.

--Hanging around with heavy people. Remember peer pressure? It can be subliminal. People with poor eating habits provide the silent message that it's okay to yield to impulse, overeat, overindulge, and choose the wrong foods.

--Stress--Whether through cortisol stimulation or other means, stress triggers appetite in some people. If you experience this and must give in, reach for raw nuts or nuts, rather than wheat snacks or chips. The effect will be minimal, perhaps even beneficial, rather than the bloating, appetite-stimulating, fattening effect of crackers, chips, or pretzels. This may be the same phenomenon as taking prescription steroids like prednisone.

--Short dark days, long nights--In other words, winter. Though just an anecdotal observation, I am convinced that vitamin D supplementation is an effective antidote to this effect. The short, dark days just don't bother you as much, perhaps not at all, and there's no impulse for comfort foods.


How about appetite suppressants? In this list I would include 1) raw nuts--especially almonds, walnuts, pecans, and pistachios, the sort with a fibrous covering and rich in monounsaturates, 2) other sources of plentiful healthy oils, e.g, use more olive oil in your salad or add it to hummus for your veggie dip, 3) space-occupying fibers such as glucomannan, inulin (such as in Fiber Choice), and psyllium seed products. Counteracting the above appetite stimulants like sleep deprivation is, of course, important.

The coming wheat frenzy, otherwise known as the holidays, is an especially important time to be aware of these effects. Eat, drink, and be merry--but with rational impulse control not driven by subconscious appetite stimulants.

Comments (17) -

  • Nancy M.

    12/20/2007 4:16:00 PM |

    You didn't mention one of the biggest appetite stimulants ever.... insulin. They used to inject it directly into anorexics to get them to eat.  That pre-meal release of insulin where you get very, very hungry as you're about to sit down to your dinner.

    Actually, it probably isn't the insulin per se, but what the insulin does, drops your blood sugar.  This is why a low carb diet works so well on moderating appetite, insulin and blood sugar drops are much quieter.

  • Stan

    12/20/2007 6:28:00 PM |

    It is not surprising that you have listed nuts and seeds as appetite supressants.  In my experience the most powerful apetite controller (suppressants if you have eaten enough) are fats!   All fats work like that, especially butter, lard, egg yolks etc.  Typically, our digestive system produces a satiety feedback within 10-20 minutes from eating a meal containing a reasonable amount of fat (for me personally, "reasonable" means 60-80%).  It does not work for low fat high carb meals - then the only restraint is the bulk volume.

    Stan (Heretic)

  • HeartCipher

    12/20/2007 8:15:00 PM |

    Maybe I'm just imagining it but I could swear that I'm less hungry if I drink two large glasses of water as soon as I get up in the morning and then eat 2 or 3 hard boiled eggs for breakfast.

    That keeps me going through lunch as I also snack on almonds during the morning (while doing my 2 month "almond eating personal trial".

    If I manage to have a couple of more eggs for lunch then I'm good until dinner.

    Anyone else had this experience with eggs?

  • Anonymous

    12/20/2007 9:29:00 PM |

    Here's an odd one, but true: diet sodas cause tremendous hunger.  And they especially cause ravenous carb cravings before bedtime on any day a diet soda has been consumed.

  • Dr. Davis

    12/21/2007 2:41:00 AM |

    I have. The combined protein in the white and fat in the yolk are very filling.

  • Dr. Davis

    12/21/2007 2:42:00 AM |

    What an interesting observation!

    This would also be consistent with the recent study suggesting that diet sodas are no different than sugared sodas on long-term impact on weight.

  • chickadeenorth

    12/21/2007 7:09:00 AM |

    Yes I notice eggs can hold me till late aft and ground flaxseed only holds me for 2 or 3 hrs.

  • Anonymous

    12/21/2007 11:02:00 AM |

    It really is remarkable how a heart healthy diet has cut down on my appetite.  Going into it, I never thought this would happen.  I figured I'd have a feeling of starving all the time.  

    A little different question, but a topic that came up over dinner last night, some friends and I have been on a low carb diet for a few months, and have noticed that our hair that was formerly thinning has become thicker.  Have you noticed this yourself, or patients mention this before?

  • Dr. Davis

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

    Curious. No, I've never seen this effect before. I'll have to watch for it.

  • g

    12/22/2007 3:37:00 PM |

    Yes, I had a pt in his 60s (his 25(OH)D was already 60ng/ml in Nov naturally because he lives in Arizona) and after ONE-WEEK on the TYP meal plan, he reported more hair. a-m-a-z-i-n-g!
    he even smokes still 1/2-ppd.
    I think that TYP somehow magically synergizes things in the body. I wonder why? DR. Davis, you are truly like other talented artists like Emeril... you put things all in a pot *POW*  *BAM* and make them A-L-L.... HAPPY!

    BTW an interesting observation, I've been on Vit D and TYP now for 2mos and I'm getting hit on more than ever... and it aint the Victoria S Superbra *ha ha* ;)
    Keep trackin' and REVERSE-PLAQUIN,
    g

  • MAC

    12/22/2007 10:45:00 PM |

    Re: hair growth and low carb.

    There is a statement in the "Life w/o Bread" book by Christian Allan that too much insulin interferes with human growth hormone levels. Fingernails grow faster and hair growth increases on a low carb diet. This book is about Dr. Lutz who prescribed a low carb diet to his patients for 40+ years in Austria and Germany. The low carb diet puts the body back in balance between anabolic and catabolic processes.

  • Dr. Davis

    12/23/2007 12:39:00 AM |

    Hi, MAC--
    I wasn't aware of that. Thanks.

  • chickadeenorth

    12/23/2007 9:04:00 AM |

    Yes my nails grow like crazy as does my hair and lots on Atkins board said their hair grew and thickened.

  • Anonymous

    12/25/2007 9:57:00 AM |

    Hey g,

    Vitamin D must be an elixer huh?

    Very funny!

  • Anonymous

    1/18/2010 4:33:41 PM |

    Hanging around with heavy people can be bad for your health...?

    Comments like that are very hurtful and feed into the pressures in this country to be the perfect size 2.  Also, it assumes that only fat people eat a lot.  Thanks for that.  Appreciate it.

  • buy jeans

    11/2/2010 7:41:47 PM |

    --Hanging around with heavy people. Remember peer pressure? It can be subliminal. People with poor eating habits provide the silent message that it's okay to yield to impulse, overeat, overindulge, and choose the wrong foods.

  • pammi

    11/9/2010 11:32:04 AM |

    Heart  disease is one of the most  dangerous disease which takes thousands of life every years all over the world. If we know its symptoms and Treatment for heart disease. We can prevent is to large extent.

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