If you’re diagnosed with high cholesterol, your doctor will probably prescribe a statin.
You might get a general overview of the drug. Maybe a pamphlet if you’re lucky.
And with that, you’re expected to take them every day — possibly for the rest of your life.
I take issue with this approach. Statins are one of the most prescribed medications in America, so the fact that patients are so poorly educated doesn’t sit well with me.
I want you to know the truth about statins so you can make informed decisions about your personal care. To do this, we’ll need to cover info your doctor probably didn’t, including how statins affect your metabolic health.
But first: an introduction to statins
Statins, also known as HMG-CoA reductase inhibitors, are a type of medication that reduce your ability to produce cholesterol. Most of your cholesterol comes from your body (not your food), so the drug blocks specific enzymes in your liver to slow production.
Statins are a relatively new drug to humans — their initial discovery was made in 1986. Since then, the prescription rate among Americans has been steadily on the rise. A whopping 47 million Americans take statins every day (an increase of 197% between 2008 and 2019).
There’s no doubt statins do what they advertise. The average American’s blood cholesterol level has dropped significantly in recent decades.
However, our metabolic health isn’t getting any better.
Just take a look at the facts:
- The death rate for cardiovascular disease has risen ~4% per year since 2020.
- The number of adults with chronic diseases (including obesity and heart disease) has increased by 25% in the last decade.
- More than 93% of US adults aren’t considered metabolically healthy, even though 90% of them have ‘normal’ cholesterol levels.
Statins aren’t solving America’s heart health problem, even if they’re lowering our cholesterol levels.
What’s worse, they’re encouraging metabolic dysfunction.
So here’s what you should know before heading to the pharmacy.
How statins affect your metabolic health
If you ask your doctor about the side effects of statins, you’ll probably get answers like ‘muscle pain’ or ‘headaches.’
The real risks, however, run much deeper than this.
Let’s take a look at the evidence:
Statin-induced diabetes
Statins don’t just interfere with cholesterol-producing enzymes. They also inhibit your body’s ability to use insulin, which can lead to type 2 diabetes.
Research shows that statin therapy raises the risk for new-onset diabetes by 71%. Another study demonstrates that one in every 255 patients will get statin-induced diabetes, even if they don’t have a history of blood sugar issues.
And yet, you’ll see some publications say the benefits outweigh the risks.
I would rather you make that decision for yourself.
Muscle wasting
Muscle is the most metabolically active tissue you can have. A pound of muscle requires a lot more energy than a pound of fat, for example.
But taking statins regularly may lead to myopathy, which is dysfunction of the muscle tissue causing tears or muscle weakness. It also blunts the benefits of aerobic exercise, particularly your ability to utilize oxygen effectively.
More severe cases include rhabdomyolysis, which refers to muscle wasting. This disproportionately makes older persons weaker according to recent evidence.
The most concerning element of muscle wasting and statins is how little historical research we have.
Some doctors even want to prescribe them to children, despite their possible side effects on cell growth and division.
Nutritional deficiency
Most of our metabolic health depends on the food we eat. Eat the Standard American Diet, and you’re likely to experience issues. Eat whole, real foods, and you’ll significantly improve your metabolic health.
But even if you are eating whole, real food, statins make it difficult to reap the benefits. This medication binds to fats, which means it inhibits the production of several fat-soluble vitamins.
The most important of these include:
- Vitamin E (anti-inflammatory)
- Vitamin K (blood clotting)
- Vitamin K2 (improves bone density)
Statins also increase the amount of nutrients excreted through urine. This means critical trace minerals get passed more quickly out of the body, including:
- Zinc (stabilizes insulin)
- Selenium (regulates thyroid hormones)
- Antioxidant CoQ10 (ubiquinone) (reduces oxidative stress)
With all these nutritional imbalances, it’s no wonder statins are linked with gut dysbiosis in mice.
Our healthcare system is hyperfocused on quick fixes, which statins certainly do provide. Most people see lower cholesterol in four weeks or fewer, even if it leads to nutrient deficiencies.
If all you want is to lower your cholesterol, then statins will do the trick.
But there’s no magic pill for fixing your metabolic health. Relying on medications to avoid a heart attack could leave you vulnerable to worse issues down the line.
Are physicians incentivized to prescribe statins to patients?
We need to address the elephant in the room — because bias in healthcare is a very real thing.
Approximately 37% of Medicare doctors accept industry payments from statin providers (think food, gifts, and medication fact sheets). Those who take the money prescribe brand-name statins up to 5% more than those who don’t.
This issue runs rampant even outside of Medicare. Up to 90% of doctors in cardiology and internal medicine are three times more likely to prescribe brand-name statins.
Your doctor probably won’t tell you about this when you get your statin prescription.
But there’s a very real chance they have ulterior motives, even if they’re not intending to be malicious.
So should you take statins or not?
It’s clear medication isn’t always the best way to treat chronic disease.
And anybody who tells you statins are ‘perfectly safe’ is oversimplifying things.
Statins can lead to many different side effects. And with less than 40 years of clinical history, we have lots to learn about how they truly affect the body.
All that said, I’m not going to tell you whether or not to take statins. My role as a doctor is to inform you about your options — not tell you what to do.
I would encourage you to do more research about statins and chat with your primary care physician about potential alternatives.
You should also understand how misunderstood cholesterol is.
Learn all about it in my Introduction to Cholesterol course.