Statin drug revolt

16. December 2008 William Davis (28)
I sense a growing revolt against the intrusion of statin drugs into our lives.

No doubt, the statin drug industry is, at least from an economic perspective, a huge success: $27 billion annual revenues at last accounting. The latest big plug for more and more statins was the JUPITER trial that showed reduced cardiovascular events on Crestor in people with "normal" LDL cholesterol levels and increased c-reactive protein.

It seems that not one day passes that doesn't include some news story about the "benefits" of statin drugs: reduction in heart attack, stroke, colon cancer, osteoporosis, heart failure, etc.

Ironically, the overwhelming economic success of the statin drug industry also seems to be encouraging a grassroots revolt.





More and more people are coming to the office, more people commenting on the web over how they want to avoid statin drugs, stop a drug they are already taking, or at least reduce the dose of an ongoing drug.

My day-to-day experience with coronary plaque control and reversal is that, while statin drugs are helpful tools, they are not necessary tools for full benefit of a prevention program. "Need" for statin drugs can differ by the patterns measured, though not the usual patterns suggested by the drug industry. For instance, using C-reactive protein, a la JUPITER, as justification for statin prescription is, in my view, totally absurd and makes no sense whatsoever, since inflammatory responses can be effective reduced with plenty of other strategies besides statin drugs. Conventional LDL, likewise, is a fictitious number that often bear little or no resemblance to the true and genuine measured value (apoprotein B or LDL particle number).

So here are a number of strategies that can help reduce or eliminate the "need" for a statin drug:

--Elimination of wheat and cornstarch--This is no namby-pamby dietary strategy, as low-fat diets were. This is a powerful, enormously effective strategy, particularly if LDL is in the small category. Small LDL drops like a stone when these foods are eliminated. This means no breads, pasta, breakfast cereals, pretzels, crackers, chips, tacos, wraps, etc.
--Non-wheat fibers--Especially raw nuts, ground flaxseed, and oat bran.
--Vitamin D restoration
--Fish oil
--Weight loss
--Niacin

There are additional strategies that focus on specific subsets of LDL cholesterol (e.g., Lp(a) masquerading as LDL). But the above list can reduce LDL cholesterol substantially, reducing the apparent "need" for a statin drug.

You will notice that there are few money makers in the above list, compared to the billions of dollars reaped by the statin drug industry. There is therefore little incentive to allow a pretty sales rep to go to your doctor and pitch the use of over-the-counter vitamin D or make changes in diet.

Statin drugs in my view need to be shoved back into their more limited role as drugs to be used on occasion when necessary (e.g., heterozygous familial hypercholesterolemia with LDL cholesterol values of 250 mg/dl in a person with measurable coronary plaque). These should never have achieved the "celebrity" status they enjoy, complete with gushing endorsements by TV personalities, daily news stories, and back-to-back TV commercials.

Join the revolt!
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Comments (28) -

  • Anne

    12/17/2008 12:46:00 PM |

    Please make mention of the continued prescribing of Zetia and Vytorin. Is there ever a reason to use these?

  • Sean

    12/17/2008 2:40:00 PM |

    It seems like you're ignoring or discrediting some of the more paramount statin trials -- such as 4S, PROVE-IT, HPS, and AFCAPS/TexCAPS, just to name a few.  

    I've only followed your website for about a month, so I'm still getting a feel for your philosophy of practice, but are your fish oil/vitamin D/niacin first-line recommendations (and a statin as a second-line agent) founded on clinical data, or only personal experience?

    The benefit of statins isn't limited to LDL alone -- the pleiotropic effects are actually quite impressive, particularly in type II diabetes.

    Could you possibly elaborate on your reasoning for only using a statin when necessary, despite clinical data that strongly supports their use?

  • Anonymous

    12/17/2008 4:36:00 PM |

    Dr., I am so grateful for your blog. I stumbled across it a few days ago. Although I am really young, I have family history of heart disease at really young age- 20s. So I am reading your blog voraciously and taking notes.
    Your no-wheat recommendation doe seem very hard to follow. what do you suggest we use instead of wheat? How about other grains like millet or Bajra? How about brown rice?

    Thanks.
    P

  • Scott Miller

    12/17/2008 4:47:00 PM |

    Dr. Davis, I still think you're missing vit. K2 from your program, which is a key regulator of calcium, and showing to reverse coronary calcium.  The current issue of Life Extension magazine has a cover story on K2, claiming it reduces all-cause mortality by 26% based on a large study (Rottingham, I think).

    I've been taking and recommend K2 for years. I recently had several arteries imaged, including the carotid artery, and there was no detectable plaque. Note that the first 40 years of my life I lived on wheat-filled processed/junk foods, so I'm sure I had detectable, worrisome plaque -- but 7 years later my blood pressure is at an athletic level, and the plaque is gone.  K2, I'm sure, played a big role in this, along with the other tactics you've listed.

    More on K2 and arterial calcification reversal:
    http://tinyurl.com/5rzoh4

  • Anonymous

    12/17/2008 6:05:00 PM |

    Dr. D.,

    I know you don't often reply to posts to your blog anymore, but if you find the time I was wondering what your opinion was for statin use for someone WITH heterozygous familial hypercholesterolemia but WITHOUT any measurable coronary plaque?? I have FHC but a heart scan on my 37th birthday revealed a heart scan score of 0,0,0. I did have a small pixel of calcium show up around the aorta. Not one to rest on my good fortunes, I have since found an Internist that specializes in lipid disorders and we have since done NMR testing, added fish oil (2.4g EPA/DHA), vitamin D3 (3,0000IU) and niacin (1g) and went from Vytorin 80/10 from my previous physician to Crestor 10mg & Zetia 10mg. I plan on adding 100mcg of K2 (MK-7) in the hopes of arresting/reversing the calcium dot around the aorta.

    For the record, I have been on statins for the most part since they were first introduced in 1987/88.

    Thanking you in advance.

    Keep up the good work.

  • Jenny

    12/17/2008 6:56:00 PM |

    Dr. Davis,

    Since you cite weight loss as an effective strategy, I'm curious if you have any unique ideas for promoting weight loss among those of us who stall out on low carb diets.

    It is an unfortunate, but very common finding that many of us can eat very clean low carb diets without losing any weight, even with calorie restriction.  I have run into this myself and know others who have too.

    Do you have any tricks and tips you've found helpful for your compliant patients who stall?

    If so, could you discuss them in a future blog post. The online low carb forums are filled with people who stall out.  This may be partly due to changes in thyroid hormone levels that many of us cannot get our doctors to treat as they are considered within the normal ranges.

    Whatever it is, it is one of the big frustrations real people, as opposed to those who star in diet books, run into with the low carb diet after an initial burst of encouraging weight loss.

  • steve

    12/17/2008 7:49:00 PM |

    excellent points.  are peanuts in the nut category you recommend?
    is zero sat fat recommended as in your book( i know new revision out in 2009)

  • e4e

    12/17/2008 8:02:00 PM |

    Thanks for this advice. JUPITER (and the reporting on it) was really flawed.

    I wrote about it and there are links to some other good analyses too.

    http://www.emotionsforengineers.com/2008/11/more-statin-misreporting.html

    Regards,
    Tony

  • renegadediabetic

    12/17/2008 9:32:00 PM |

    I revolted when my doctor prescribed Lipitor after I was first diagnosed with type 2 diabetes.  After researching side effects, I knew I didn't want to take it.  Then I discovered what a scam this whole cholesterol business is.  By cutting carbs and increasng fat, I lowered my cholesterol to the point that it was no longer an issue.  Now I'm armed for battle if the issue ever comes up again.  Thanks for all you do in keeping us informed of the facts.

  • JPB

    12/18/2008 4:13:00 PM |

    I hope that you are right!  Unfortunately a lot more people are going to be dismissed from their doctors' practices for refusing these drugs unless the truth about lipids and statins becomes more widely known.  The dogma is almost impenetrable!

  • Anonymous

    12/18/2008 7:33:00 PM |

    hmm, I posted a comment yesterday and it seems to have disappeared. Dr. Davis, what is your take on consuming grains other than wheat like millet or quinoa?

  • Ed

    12/18/2008 11:07:00 PM |

    Dr. Davis: I've been on 5 to 10mg of Crestor for several years and your article has encouraged me to discuss a reduction with my doctor. (I purchased almost a 1 year supply of Made in the U.S. Crestor for about $1/pill in Argentinian pharmacies. It paid for my airfare. Here I pay $3/pill. I consulted you via mail after I had a scary 346 (97 percentile) on a heart scan in July of '07. I'm fit and had always followed a "good" diet so the scan results were surprising. After looking at my numbers you accurately predicted that I probably had high Lp(a). I've been following your recommendations (nuts,oat bran, flaxseed, fish oil, niacin, very low wheat, etc.) to get it lower.

  • Dr. William Davis

    12/18/2008 11:15:00 PM |

    Scott Miller--

    My March 2008 Life Extension Magazine article on vitamin K2 can be found at:
    http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=776&query=k2%20davis&hiword=DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20davis%20k2%20.

    There are also extensive discussions on K2 on the www.trackyourplaque.com website.

  • Scott Miller

    12/19/2008 4:20:00 AM |

    Very nice LEF article, Dr. D.

    So why not list it among your other essentials in your program?  You're clearly very knowledgeable on K2's benefits, and used properly, there appears to be no downside/toxicity to using it.

    BTW, I know you frequent TheHeart.org forum.  Perhaps you've seen some of the posts I've made recently in the most busy threads, in defence of natural supplements.  Dr. Hackam, in particular, is truly a lacky of Big Pharma propoganda, and gives zero credit to vitamins, writing: "I will stick with what works and try to get my patients off their addictions to these drugs (yes vitamins are drugs; because they are taken in pharmacological rather than physiologic doses by most people)."

  • Anonymous

    12/19/2008 7:21:00 AM |

    As a nutritionist myself it is difficult to understand this demonization of even whole grain wheat. What is wrong with that?

  • Anonymous

    12/19/2008 4:49:00 PM |

    Responding to the nutritionist who wrote on December 19, 2008 questioning the "demonization" of whole grain wheat take a look at today's article in the NY Times about diabetics and diet.

    http://www.nytimes.com/2008/12/19/health/19diet.html

    This study found that a diet high in whole grains (and thus high in glycemic load) caused a decrease in HDL-C.  In contrast, a purportedly lower glycemic load diet, which excluded whole grains but included beans, peas and lentils, was found to reduce blood glucose levels in diabetics and increase HDL-C.  Perhaps this is reason to reconsider the traditional advice regarding eating whole grains???

    -Russ

  • Anonymous

    12/19/2008 7:52:00 PM |

    Nutritionist, his entire blog is about what's wrong with wheat.

  • moblogs

    12/19/2008 7:57:00 PM |

    I think it was only a matter of time before people started going 'hey wait a minute - statin companies are raking in billions but heart morality is still the same or worse?'.

    If statins were the wonder drug(tm), in about 30yrs of use you'd have thought heart disease was something relegated to history books.

  • Anonymous

    12/19/2008 8:23:00 PM |

    Anonymous Nutritionist:

    As previously stated, Doctor Davis no longer replies to questions on his blog (very rarely at least..). Do a search of his blog and read up if you are wondering why he is in favor of wheat elimination. Many patients that have been referred to him by other Physicians have been practicing the consumption of whole wheat products because they were told this is "heart healthy". Many of these same patients turn out to have terrible lipid profiles when tested by advanced lipoprotein testing (like the NMR test)....specifically small particle LDL. Once wheat consumption is reduced or eliminated, these abnormalities usually vanish. Dr. Davis believes that small  particle LDL is one of the biggest causes of CAD. Let's face it, many of the products that are sold to the average consumer that claim to be whole wheat and/or whole grain are high glycemic because they still are HIGHLY refined. The Paleo Diet Dr. says that a natural wheat berry is hard enough to break a tooth. Obviously the stuff that the food manufactures sell us is HIGHLY refined to be palatable to us. I've checked glycemic food databases and whole wheat bread is usually just as highly gylcemic (index & load) as a piece of white bread. Cornstarch is another culprit that Dr. Davis feels people should avoid if they want to improve their lipid profiles. I've often thought to myself that eating a sandwich...even with (mass produced) whole wheat bread, is probably no different to the pancreas then eating a sandwich made between layers of equivalent weight sugar cubes bonded together (actually most breads have a worse GI then sucrose!!). Nobody would eat a sandwich made of sugar cubes, but likewise..few people would think there is anything unhealthy about eating a sandwich on whole wheat bread..   Frown

    Just my 2 cents worth..

  • Michael

    12/19/2008 10:04:00 PM |

    Dr Davis,
    Just a quick comment to say that in a way I'm heartened by the comments on this thread and on recent posts by people who "don't get it". It means that neophytes are now reading the blog and are a demonstration of the influence you appear to be gathering.
    More power to you and, though I know it's testing on your patience as you're a busy man, please look on such posts as "what's wrong with grains anyway?" and its like, as a sign that the message is at last getting out as it so thoroughly deserves (even those that are trying to counter your ideas -- another sign that you are having an effect).

  • Anonymous

    12/19/2008 10:57:00 PM |

    Wheat increases inflammation.

    Jeanne

  • Dr. William Davis

    12/20/2008 12:49:00 AM |

    Thanks for the assistance, everyone!

  • Shreela

    12/20/2008 4:08:00 AM |

    My hubby and I hadn't been to a GP in a long time, and he noticed a change in one of his back moles. So I took advantage of his concern about that to finally get him to go in. We both knew his BP was too high, but since it was only a little too high, he ignored it.

    The GP chemically burned off the back mole, started him on BP meds, and prescribed him some kind of statin.

    On our follow up, I asked him why he prescribed a statin when our lipid labs hadn't even come in yet. GP answered it was his age, combined with his BP problems. I replied that they were medicating him for his BP, and we'd wait until the lipid tests came back before going on statins.

    The GP didn't even argue, which made me think there wasn't a very good reason to start statins, except for the big pharma push on them.

    Both our lipids came back within normal limits.

  • Anne

    12/20/2008 9:04:00 AM |

    Nutritionist,

    Wheat, whether whole grain or not, contains substances such as lectins and phytates which are essentially poisons used by the plant to protect itself from 'predators'...ie from being destroyed by being eaten or by the digestive process if they are eaten. This is the same for all grains, not just wheat, which is why they are not good for people.

    Anne

  • Kuntsa

    12/22/2008 2:11:00 AM |

    I'm curious how the American cholesterol measurements (taken as mg/dL) are converted to more conventional mmol/l measurements?  Does the analysis assume certain lipoprofile which is used to convert the result to mg/dL?

    http://www.globalrph.com/conv_si.htm gives factor 0.0259, but 10 mmol/l sounds awful high (they are recommending statins if your cholesterol is above 4 mmol/l here in Finland).

  • Anne

    12/22/2008 9:13:00 AM |

    To convert total cholesterol, LDL or HDL from nmol/L to mg/dl multiply by 38.67 - or divide by 38.67 to convert the other way round. And to convert triglycerides, multiply by 88.57 to convert nmol/L to mg/dl or divide by 88.57 to go the other way.

    Anne

  • Sanael

    2/9/2009 9:13:00 AM |

    Dr., I liked the article, from your permission I will publish it at myself in a blog.

  • simvastatin side effects

    5/9/2011 2:29:00 AM |

    The used of statin worldwide is a very overwhelming success in drug industry. We can read this on different blogs where in more people are commenting on this drug.

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