Can Statins Be Avoided With Lifestyle Interventions? Part 1

It likely comes as no surprise that whenever possible, I advise avoiding pharmaceutical drugs in favor of healthy lifestyle changes. Prescription drugs invariably come with a host of side effects—some of which can be life threatening.

Statins, used for lowering cholesterol, are among the most commonly prescribed drugs. Although we’ve long been reassured that statins are safe, the truth is that statin-related side effects—including statin cardiomyopathy—are far more common than previously recognized. Fortunately, this serious condition is reversible with the combination of statin discontinuation and supplemental CoQ-10 (both ubiquinol—the reduced form and/or ubiquinone) and other mitochondrial-enhancing nutrients, such as R-lipoic acid, magnesium-creatine, magnesium glutamine, and botanicals, such as anabolic adaptogens and cardiovascular nourishing tonics.¹

 

In my opinion, the use of statin drugs should be re-stated as the abuse of statin drugs. Other than very few exceptions, people don’t need them and the risk-to-benefit ratio is very hard to equate. In reality, statins often do more harm than good. Recently, a literature-based meta-analysis of eleven studies on statin drug use involving a total of 65,229 people (Jan 1970 – May 2009) did not find evidence for the benefit of statin therapy on all-cause mortality in people at high-risk of CVD.²

If we had no other way to improve lipids and reduce the risk of cardiovascular disease, then for some people, the use of statin drugs can and should be considered. But my approach—the ETMS approach—which combines botanical, nutritional, dietary and life-style toolboxes, is very effective. Within the ETMS approach, even if someone might still consider taking a statin, they would need only a tiny amount—for example, 5 or 10 mgs rather than 20 or 40 mgs. In addition, the statin would be combined with compounds that both potentiate the effects of the drug and protect against adverse effects, both short and long-term.

In the ETMS approach, I advise lifestyle modifications that will not only normalize cholesterol profiles, but also improve overall health. I universally recommend that my patients adopt a Mediterranean diet, the same diet that my family and I eat. Many studies have demonstrated that the Mediterranean diet offers significant protection from heart disease and cancer, and substantially increases lifespan.In fact, studies show that eating a Mediterranean diet decreases the risk of coronary artery disease more effectively than using statin drugs. ^3-9 And a recent meta-analysis of cohort studies shows that fruit and vegetable consumption—the basis of the Mediterranean diet—is inversely associated with the risk of cardiovascular disease.¹⁰

The Mediterranean diet includes locally grown wild vegetables; other common vegetables such as cabbage, leafy and root vegetables; bitter greens including arugula, radicchio, and endive; mushrooms; tomatoes and other fruiting vegetables; grapes and berries; fish; a moderate intake of hard cheeses; grains; and plenty of olive oil. The diet is varied, delicious, and contains a wealth of phytonutrients that are essential for health and longevity.

 

Mediterranean Diet Reduces Cardiovascular Disease Risk

In a study of almost 400,000 people ranging from 50 to 71 years of age, researchers found that adherence to a Mediterranean type of diet was associated with significant reductions in the risk of mortality from cardiovascular disease and cancer. “The beneficial effect of the Mediterranean diet on mortality may be mediated by a number of mechanisms, including oxidative stress and chronic inflammation,” wrote the researchers. “Conformity with the Mediterranean dietary pattern is associated with high antioxidant capacity and low concentrations of oxidized low-density lipoprotein cholesterol, suggesting that this dietary pattern could be capturing the combined effect of dietary antioxidants, which could, partially, explain a lower risk of mortality.¹¹

Study after study proves the health benefits of adopting a Mediterranean diet. In randomized intervention trials, the Mediterranean diet improved endothelial function and significantly reduced factors associated with metabolic syndrome. Studies also show the favorable effects of the Mediterranean diet on plasma lipid profile, including reduction of total and plasma LDL cholesterol levels, plasma triglyceride levels, and apo-B and VLDL concentrations, and an increase in plasma HDL cholesterol levels. In another study, researchers determined that a modified Mediterranean-style, low glycemic diet with additional phytonutrients in the form of soy protein and phytosterols proved more effective than the American Heart Association Step 1 diet on cardiovascular disease risk factors.¹²

For those who have already suffered a cardiovascular event, it’s essential to understand that you can’t rely on statins to protect you from another heart attack or stroke. In fact, researchers have found that shifting to a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin. The recently published PREDIMED randomized controlled trial was stopped early after it showed that in high risk people the Mediterranean diet achieved a 30% improvement over a “low fat” diet in terms of cardiovascular events.¹³ Statins are also frequently associated with an increase risk for dementia and possible Alzheimer’s disease, or simply mental decline. Two new studies found cognitive dysfunction as a possible adverse effect of statins.¹⁴

The Mediterranean diet and concurrent lifestyle interventions are not only effective for reducing heart disease risk, but also for reducing dementia, AD¹⁵ and other neurological diseases, as well as cancer.¹⁶ Research indicates that older individuals who regularly consume a Mediterranean-style diet (high intake of fruits and vegetables and low intake of meat) score significantly better in tests of cognitive skills than those with less healthful dietary habits.¹⁷

Despite the popularity of statins, recognition of the role of diet in lowering cholesterol is gaining ground.A study published in the March 2006 issue of the American Journal of Clinical Nutrition reported that consuming a combination of cholesterol-lowering foods reduced low-density lipoprotein (LDL) cholesterol similarly to a statin drug.¹⁸

In sum, adopting a Mediterranean diet is associated with significant reduction in overall mortality, mortality from cardiovascular diseases and stroke, incidence of or mortality from cancer, and incidence of Parkinson’s disease and Alzheimer’s disease and mild cognitive impairment. The more closely you adhere to a Mediterranean diet, the greater the benefits.^19,20 While diet is foundational, there are times when additional support is necessary. In part 2 of this series, I’ll address supplemental nutrients that can help to normalize cholesterol.

I recommend the following guidelines for a Mediterranean style diet:

• Use olive oil as the principal fat, replacing other fats and oils; and eat olives daily. Use olive oil for salad dressing and for cooking at low to medium temperatures; for high heat use coconut oil.
• Drink a moderate amount of wine, normally with meals, about one to two glasses per day for men and one glass per day for women.
• Eat fresh fruit as a typical daily dessert; limit sweets with a significant amount of sugar and saturated fat.
• Incorporate an abundance of food from plant sources, including fruits and vegetables, whole grains, whole-grain breads, beans, nuts, and seeds.
• Eat minimally processed and seasonally fresh and locally grown foods (even some wild foods when available).
• A very general guideline to follow (although I’m not much for these kind of percentage rules) is the following: Total dietary fat should range from 30 to 35 percent, with saturated fat between 7 to 8 percent of total calories. Protein between 15 to 20 percent. Complex whole-food carbohydrates (vegetables, fruits and whole grains) around 50 percent.
• Eat moderate amounts of high quality cheese (choose goat, sheep, and cow, of which the hard cheeses are best) and yogurt daily.
• Consume moderate amounts of fish and eggs. If desired, include poultry, up to three servings per week.
• Limit red meat consumption to a few times per month. In the case of iron deficiency, red meat can be consumed a few times per week until iron levels reach normal.

 

References:

1. Langsjoen PH, Langsjoen JO, Langsjoen AM, Lucas LA. Treatment of statin adverse effects with supplemental Coenzyme Q10 and statin drug discontinuation. Biofactors. 2005;25(1-4):147-52.
2. Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, Sattar N. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants, Arch Intern Med. 2010 Jun 28;170(12):1024-31.
3. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, van Staveren WA.Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004 Sep 22;292(12):1433-9.
4. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994 Jun 11;343(8911):1454-9. Erratum in: Lancet 1995 Mar 18;345(8951):738.
5. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85.
6.  Trichopoulou A, Bamia C, Trichopoulos D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med. 2005 Apr 25;165(8):929-35.
7. Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, Manor O, Pella D, Berry EM. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high-risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet. 2002 Nov 9;360(9344):1455-61.
8. de Lorgeril M, Salen P, Martin JL, Monjaud I, Boucher P, Mamelle N. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med. 1998 Jun 8;158(11):1181-7.
9. Renaud S, de Lorgeril M, Delaye J, Guidollet J, Jacquard F, Mamelle N, Martin JL, Monjaud I, Salen P, Toubol P. Cretan Mediterranean diet for prevention of coronary heart disease. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1360S-1367S.
10. Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006 Oct;136(10):2588-93
11. Mitrou PN, Kipnis V, Thiébaut AC, Reedy J, Subar AF, Wirfält E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A. Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study. Arch Intern Med. 2007 Dec 10;167(22):2461-8.
12. Lerman RH, Minich DM, Darland G, Lamb JJ, Schiltz B, Babish JG, Bland JS, Tripp ML Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial. Nutr Metab (Lond). 2008 Nov 4;5(1):29.
13. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25.
14. Hughes, Sue, Statins Linked to Reduced Dementia, European Society of Cardiology (ESC) Congress 2013. Abstracts #1609, P4077, Sept. 05, 2013
15. Brauser, D., Meditation May Slow Progression to Alzheimer’s, Neurosci Lett. 2013:556;15-19; http://www.medscape.com/viewarticle/815009_print
16. Giuseppe Grosso, Silvio Buscemi, […], and Antonio Biondi, Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects, BMC Surg. 2013; 13(Suppl 2): S14.
17. Titova OE, Ax E, Brooks SJ, Sjögren P, Cederholm T, Kilander L, Kullberg J, Larsson EM, Johansson L, Ahlström H, Lind L, Schiöth HB, Benedict C. Mediterranean diet habits in older individuals: Associations with cognitive functioning and brain volumes. Exp Gerontol. 2013 Oct 11. doi:pii: S0531-5565(13)00303-3. 10.1016/j.exger.2013.10.002.
18. Jenkins DJ, Kendall CW, Faulkner DA, Nguyen T, Kemp T, Marchie A, Wong JM, de Souza R, Emam A, Vidgen E, Trautwein EA, Lapsley KG, Holmes C, Josse RG, Leiter LA, Connelly PW, Singer W. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 2006 Mar;83(3):582-91.
19. Demarin V, Lisak M, Morović S. Mediterranean diet in healthy lifestyle and prevention of stroke. Acta Clin Croat. 2011 Mar;50(1):67-77.
20. Panico S, Mattiello A, Panico C, Chiodini P. Mediterranean dietary pattern and chronic diseases. Cancer Treat Res. 2014;159:69-81. doi: 10.1007/978-3-642-38007-5_5.