by Henri Roca, MD, Clinical Functional Medicine Specialist
November 12, 2013 the American Heart Association and the American College of Cardiology issued a new guideline that is a boon to those who make and sell the statin class of cholesterol lowering medications. In my mind, they triggered the eternal question: “Just because there is sufficient evidence to suggest using a therapy, does that mean it is necessary to use that therapy?”
Here are a few things to help understand the issue:
- They assumed the only intervention was to use statin medications.
- They measured risk of cardiovascular disease using older, more traditional means including age, cholesterol levels, blood pressure, smoking and diabetes. They excluded measures such as inflammation and fibrinogen.
- They talk about tailoring treatment to the patient and utilizing lifestyle changes, but it seems as if they presumed the lifestyle change was not successful or sufficient.
Keep in mind that the effects of statins are greater than just their ability to reduce bad cholesterol and total cholesterol while increasing good cholesterol. The statin medications also seem to have an anti-inflammatory effect. So there’s more to this medicine than meets the eye, and we don’t totally understand it all.
Another fact to keep in mind is our absolute need to have sufficient levels of total cholesterol in our body in order to have healthy cell membranes, healthy memory, resiliency, and healthy adrenal and reproductive hormones. All these things and more come from appropriate cholesterol levels. Cardiologists focus on the effect cholesterol has on arteries and plaque. Functional Medicine physicians focus on the entire person rather than on their hearts and arteries exclusively.
When I evaluate all of the data, my take-away points are:
- Be sure to keep your cholesterol at a healthy level, a total cholesterol no lower than 100 with a bad cholesterol level no lower than 50 to 70.
- Be sure to keep all measures of inflammation as close to non-detectable as possible and no higher than 1.
- Be sure to keep your blood on the slippery side.
- Be sure to keep calmness and the relaxation response as the predominant way you respond to your world.
- Shift your diet, eating meat only on rare occasions. Eat high vegetable proteins with at least 9 servings of vegetables a day and no trans fats.
- Include cardiovascular exercise at least 20 minutes a day or 40 minutes three to four times a week.
- Maintain a healthy body weight with a BMI between 19 and 27. For most people being just slightly overweight gives a survival benefit.
If you are accomplishing the above with nutrition, exercise, sleep, and stress reduction, then you will not likely need statins. Remember this was demonstrated by Dean Ornish in his Healthy Heart Program.
So when would I offer statins:
- If a person has had a heart attack previously or has out-of-control diabetes. The data in this case is very strong. It is often better to use the tools on hand, and work to wean off them once lifestyle change has taken hold rather than risk a heart attack or a stroke.
- If a person’s cholesterol remains out-of-control even after significant nutritional change including vegetarianism and juicing. Under these circumstances, we’d have to conclude that the person’s genetics irreversibly creates within them high cholesterol.
- If a person’s level of inflammation is out-of-control despite anti-inflammatory botanicals and food such as turmeric, essential fatty acids, and an anti-inflammatory diet to name a few. Here the effort would be to identify the underlying drivers of inflammation and reverse them.
As you can see, each of these circumstances would occur after serious and significant work on lifestyle change. At the very least, every person who takes a statin would need to take Co enzyme Q 10 200 mg once a day in order to reduce the potential side effects of fatigue and muscle pain. Although I only very occasionally prescribe statins, I recognize their usefulness. That said, I’ve seen people change their lifestyles and use their living as their medicine in ways that are more effective than statins. It’s this latter approach that I generally favor.
Even though the data is sufficient to indicate the use of statins, I would say in no way is it necessary to use these medications in most people who would steadfastly choose a lifestyle approach to heart health.