For decades, statins - the most common cholesterol-lowering medications - have been recognized as a lifesaver for those with heart disease. Although statins have positively revolutionized heart health, some studies highlight the lesser-known concerns of the medication: energy-sapping, increased diabetes risk, and, for many people, muscle pain.
A recent systematic review of 11 epidemiological studies with nearly 47 million participants found associations between statin use and decreased insulin sensitivity, and increased insulin resistance - both significant factors for developing Type 2 diabetes. Additionally, statins were found to reduce glycemic control and elevate fasting glucose levels.
Experts are uncertain about the precise mechanism through which statins might affect insulin resistance, considering their advantages, such as lowering inflammation, decreasing oxidative stress, and enhancing endothelial function - all of which improve insulin sensitivity rather than diminish it.
A 2021 study published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology also found that statins can increase the risk of Type 2 diabetes, but how was unclear. Despite the risks, most researchers and health care professionals still believe statins are more beneficial than harmful.
“It is generally viewed that the strengths of lower cholesterol by a lot outweigh a modest increase in insulin resistance,” Michael Snyder, a genetics professor and chair of the Genetics Department at Stanford University School of Medicine, told The Epoch Times.
But the double-sided nature of statins remains unclear to researchers, according to Dr. Snyder, who has coauthored multiple studies investigating the correlation between statin usage and insulin intolerance.
Lifestyle factors such as obesity also play a major role in insulin resistance, and people can reduce body weight to potentially offset statins’ effects, Dr. Snyder said.
Fatigue and muscle pain seem to be common with statin use. A study of more than 350 statin users found that 93 percent reported muscle pain and fatigue, while 85 percent reported weakness.
“This is of no surprise because of the well-documented effects that statins have on coenzyme Q-10 (CoQ10), which is a primary cofactor for mitochondrial function,” Dr. Node Smith, a board-certified naturopathic physician, told The Epoch Times. Mitochondria create energy for the entire body at the cellular level. Therefore, statins can deplete the body’s cellular energy by depleting CoQ10, he added.
A letter to the editor published in the British Journal of Clinical Pharmacology noted that people taking statins who also supplemented with CoQ10 were less likely to experience chronic fatigue.
Dr. Smith said many of his patients who have taken statins long-term have reported experiencing persistent muscle pain, weakness, fatigue, and brain fog.
“Some of these patients are avid athletes and simply are confused why they can no longer work out,” he added.
“If I see this presentation in someone on a statin medication, I will almost always assume the statin is at least a contributing factor and discuss with the patient its removal and replacement with another therapy.”
Statins are commonly used alongside niacin (vitamin B3), which has been recommended for more than 40 years to prevent heart disease because of its positive effect on lipid levels.
Niacin is the most common and effective treatment that replaces statins, according to Dr. Smith.
“Of all the pharmaceutical medications I’ve helped people get off of, statins are the easiest, least concerning, and patients typically have the best results with - because it is not uncommon for them to feel almost instantly better.”
Niacin decreases LDL cholesterol, which can build up plaque in arteries when levels are too high. It also increases HDL cholesterol, which absorbs other forms of cholesterol in the bloodstream and carries it back to the liver for removal, according to a clinical trial of more than 300 people. Additionally, niacin lowers triglycerides, a type of fat in the blood.
Optimized niacin therapy costs patients $15 to $30 per month and is worth trying before statins, Dr. Smith said.
Studies have found that combining niacin and statins may outperform statins alone. Dr. Smith has observed similar results in his practice, although some studies suggest otherwise.
Niacin fell out of favor because of the side effect of niacin flushing, which produces a slight prickly heat sensation for about 30 minutes and can be uncomfortable and concerning for some people, he said.
About 15 years ago, wax-coated niacin tablets were developed. They allow high doses of niacin to be delivered while reducing flushing for most people, according to Dr. Smith. Side-effect management methods such as taking niacin with food or baking soda can also help.
However, Dr. Smith cautioned that people with familial hypercholesterolemia, a genetic disorder, may need more aggressive therapies, potentially including statins.
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