Dilochols direct proteins to the areas of the cells that need repair. Without them, the cells can’t carry out their genetic programming for cellular functioning and restoration. Statins therefore potentially wreak havoc with cellular repair. Coenzyme Q10 (ubiquinone or CoQ10), which is far better known than the dilochols, is a critical cellular nutrient that is necessary for producing energy in the form of ATP in the part of the cell known as the mitochondria. ATP is a molecule that carries energy for cellular function much like gasoline powers the engine of a car. Without it, nothing can run. The heart, in particular, requires an enormous amount of energy and CoQ10 to function efficiently. CoQ10 is also necessary for the vital role played by cell membranes (the actual “brain” of the cell) and also for the formation of collagen and elastin that make up the connective tissue in skin, muscles, and blood vessel walls. Because every cell in the body requires coenzyme Q10 to function properly, depletion of this enzyme from statin drugs causes problems throughout the entire body.
Statins reduce the production of vitamins A and D as well—two other anti-inflammatory nutrients. Statin drugs also negatively affect the omega-3-to-omega-6 ratio, raising the risk of inflammation.38 (It should come as no surprise, then, that seven clinical trials in recent years show that patients taking statins had better results when they also took omega-3 fats.)39
SIDE EFFECTS OF STATIN DRUGS
~ Muscle weakness, pain, and fatigue. This is the most common side effect of statins and it is the direct result of depletion of CoQ10 in the muscles and heart.40 Beatrice Golomb, M.D., Ph.D., has studied statin side effects and has reported that nearly all patients taking Lipitor and about one-third of patients taking Mevachor have experienced muscle problems.41
~ Brain and nerve damage. Cognitive problems are the second most common side effect reported with statin use.42 CoQ10 is essential for normal brain and nerve function. When it is depleted, dementia can result. This is why many people on statins have difficulty with memory, mood, and clear thinking. In a study in Denmark of 500,000 people, researchers found a significantly higher incidence of neuropathies, including peripheral neuropathy, in those taking statins.43 Another study showed a fourteenfold increased risk of neuropathy after two or more years on statins compared to controls.44 A study published in 2003 suggested that cognitive impairment and dementia should be considered potential adverse effects associated with statin therapy.45 Even more telling was a 2009 study reporting that 75 percent of people who took the statins experienced cognitive problems that were determined to be probably or definitely related to statin therapy. Of the people who then stopped taking statins, 90 percent reported improvement in their cognitive problems—sometimes within a matter of days. (In some patients, even the diagnosis of dementia or Alzheimer’s disease was reversed.) The study also reported significant negative impact on quality of life in people taking statin drugs.46
~ Heart disease and heart failure. CoQ10 levels fall naturally as we age, decreasing by about 50 percent between the ages of twenty and eighty. This is one of the reasons why heart attack, stroke, and cancer increase with age. Statin drugs deplete this nutrient even further, thus increasing the risk of cardiomyopathy and heart failure. The heart is the worst place in the body to deplete CoQ10 because it requires so much energy that must be constantly replenished. Cardiologist Peter Langsjoen, M.D., has reported on the adverse effects of Lipitor among twenty patients who started on the drug with completely normal hearts. After six months and a low dose of Lipitor (20 mg per day), two-thirds of the patients started to show signs of heart failure.47 Dr. Langsjoen credits this effect to CoQ10 depletion. While the heart attack rate has decreased somewhat over the last twenty years, cardiomyopathy and heart failure incidence have increased. I’m concerned that this problem will increase even more in those taking statins.
~ Liver damage. The liver constantly detoxifies the blood and carries out a huge number of enzymatic reactions. So it, too, requires a good supply of CoQ10. Even a modest deficiency can cause liver problems, reflected in increased liver enzymes on a blood test. People on statins need to get liver enzymes checked regularly. Liver damage can begin the moment one begins taking statin drugs.
~ Psychiatric problems, including depression. A 2007 study from New Zealand reported an increase in reports of suspected psychiatric adverse reactions (including depression, memory loss, confusion, and aggressive reactions) associated with statins, as well as with other lipid-lowering agents.48 A Norwegian study noted that psychiatric disorders (including aggression, nervousness, depression, anxiety, sleeping disorders, and impotence) represent 15 percent of the adverse reactions to statins in that country.49 It is well documented that low cholesterol is associated with depression and may even increase the risk of suicide. This all makes sense because cholesterol is an essential building block of brain and nerve tissue. It is like the coating on the wires that govern nerve conduction and function—including maintaining a stable mood. It is fairly common for women to begin experiencing anxiety and mood problems after beginning statin drugs. A study at the University of California, San Diego, reported that statin use was associated with severe irritability.50 A study of 121 women aged eighteen to twenty-seven found that women with low cholesterol are twice as likely to have depression and anxiety.51 Supplementing one’s diet with the right type of omega-3-rich fats often helps this problem dramatically. So does getting off statins.
~ Cancer. Statin drugs have been found to suppress the immune system (which is why they are sometimes prescribed for those with inflammatory conditions such as arthritis). And that also explains why they’ve had some effect on decreasing cardiovascular events such as stroke, which results from inflammation in blood vessel walls. In fact, any benefit from statins may be from this anti-inflammatory effect. Unfortunately, it is well documented that drugs that suppress the immune system increase the risk of cancer. That is why statin drugs have been found to cause cancer in rodent studies.52 The most likely reason that we haven’t yet seen this effect in studies on humans is that clinical trials haven’t lasted more than two to five years. It would take longer to see this effect. Not surprisingly, CoQ10 is effective at lowering the risk of many cancers, including colon, rectum, breast, lung, prostate, and pancreas.53
I’m also very concerned about the increased risk of breast cancer in women on statins.54 In fact, the CARE (Cholesterol and Recurrent Events) trial at Brigham and Women’s Hospital in Boston found twelve new cases of breast cancer in the 250 women taking Lipitor, while there was only one new case in the placebo group.55 While not proving a cause and effect relationship, it’s certainly worrisome. Though other studies have failed to show this effect, they have not been double-blind, placebo-controlled.56
A Word About the Pharmaceutical Industry
It’s important to your health that you realize the degree to which the pharmaceutical industry influences medical research, medical reporting (in both medical and mainstream media), and medical prescribing. The overuse of statins is a stellar example of this influence. Marcia Angell, M.D., the former editor-in-chief of the prestigious New England Journal of Medicine, has documented the way in which drug companies influence medical research, prescribing, and reporting very strongly and effectively in her book The Truth About the Drug Companies: How They Deceive Us and What to Do About It (Random House, 2004). (For more information on the statin debate, read Lipitor: Thief of Memory, Statin Drugs and the Misguided War on Cholesterol [Infinity Publishing, 2004] by Duane Graveline, M.D., a former astronaut and aerospace medical research scientist who twice developed global amnesia after taking Lipitor on his doctor’s recommendation.)
The current situation with the pharmaceutical industry can be likened to the influence of the tobacco industry on the medical profession back in the 1940s and ’50s when doctors and the AMA espoused the “benefits” of smoking to their patients and were paid handsomely by big tobacco. Eventually the truth won. And it will again.
High Blood Pressure
Blood pressure fluctuates all the time, hour by hour, day by day, and there has been extensive overdiagnosis and unnecessary treatment of millions of people because of this. It’s not uncommon for blood pressure to rise simply in response to a doctor’s visit! This is called “white coat syndrome,” and I’ve seen it repeatedly. On the other hand, bona fide hypertension is a well-known risk factor for heart attack, kidney disease, and stroke. Blood pressure should be 130/85 or less. One in three adults in the United States has high blood pressure, and in those who are age sixty-five and up, a higher percentage of them are women. According to the famous Nurses’ Health Study, this condition has been found to increase the risk of coronary artery disease by 3.5 times.57
Blood pressure can be significantly lowered by any one of the following lifestyle changes: regular exercise (such as brisk walking), biofeedback, dietary improvement, or weight loss. Even in very overweight women, losing only ten to twenty pounds will often lower blood pressure significantly. If these measures fail, then it’s advisable to use blood-pressure-lowering medication, even though these medications can have side effects such as dizziness, headaches, and fatigue.
Be sure to get your lipid profile and blood pressure checked again within three to six months. Note: If you follow the insulin-normalizing diet I recommend at perimenopause, you can expect substantial improvements in your lipid profile, your blood sugar, and your blood pressure within two to four weeks.
Homocysteine
Elevated blood levels of the amino acid homocysteine, which is found in high amounts in animal protein, constitutes a strong risk factor for cardiovascular disease. At least 10 percent or more of the population has a genetic tendency for elevated levels of homocysteine, but there are other factors besides genetics that elevate it. When high homocysteine levels are reduced, the incidence of heart attack is cut by 20 percent, the risk of blood-clot-related strokes decreases by 40 percent, and the risk of venous blood clots elsewhere in the body plunges by an impressive 60 percent. Studies have shown that dietary intake of vitamins B12, B6, and folate can help combat an elevated homocysteine level, as can cutting back on the amount of animal-based protein in your diet. Ask your health care provider to determine your homocysteine level. (It should be below 7.) If it’s too high, you need to add folic acid, vitamin B12, and vitamin B6 to your diet. You may also need folate supplements of 1,000–2,000 mcg for three months or so, after which point you can decrease the supplements to a maintenance amount. (As one of those with a genetic tendency toward high homocysteine, I was able to lower my levels to normal by taking extra folic acid.)
Periodontal Disease and Cardiac Risk
Periodontal disease (inflammation and infection of the gums) is present in a significant percentage of adults in the United States. In recent years, a number of compelling studies have shown that gum disease is a risk factor for coronary artery disease and stroke. Although no one can say that periodontal disease directly causes cardiovascular disease, research has clearly shown that periodontal disease is more prevalent in patients with acute and chronic heart disease. This association may be due, in part, to the fact that inflammation plays a central role both in gum disease and in hardening of the arteries. It has also been shown that the inflammation seen in periodontal disease is associated with narrowing of the carotid arteries, a risk factor for stroke.58
Periodontal disease is easily preventable (and often treatable) from the outside through proper brushing, flossing, and regular visits to the dentist for professional evaluation and cleaning. Dietary improvement and supplementation help treat it from the inside. Caring for your teeth and gums is a practical and easy way to decrease at least one risk factor for cardiovascular disease or stroke.
Smoking
Smoking is responsible for 55 percent of the cardiovascular deaths in women less than sixty-five years old because smoking increases oxidative stress enormously in every cell of the body. The Nurses’ Health Study followed more than 117,000 female nurses ages thirty to fifty-five. In that study the relative risk of total coronary artery disease among smokers was four times higher than that of women who never smoked. But in women who stopped smoking, the relative risk of coronary artery disease immediately decreased to 1.5. Two years after stopping smoking, the risk dropped to that of a woman who has never smoked. Smoking is also responsible for approximately 29 percent of all cancers. Since 1987 lung cancer has been the leading cause of cancer deaths among women.59
At least thirteen studies have shown that smokers cease menstruation one to two years earlier than nonsmokers. The effect is dose-dependent, and the difference persists after controlling for weight. Female smokers sixty years and older also have significantly reduced bone mineral density of the hip compared with nonsmokers.60
HOW TO QUIT
You have to want to quit to be successful. With each subsequent attempt, however, the chances for successfully staying off tobacco increase. The biggest problem women have with successfully quitting smoking is that they often have to change their friendships and behavior patterns and begin to think of themselves as nonsmokers.
Acupuncture can help people quit, because it’s helpful for detoxing addictions. Some women also do well with Smokers Anonymous programs or with one of the nicotine patches.
I recommend calling your local hospital to see what is available. Or discuss stopping smoking with your doctor.
Age
The only reason that age is a risk factor for heart disease is that by the time you reach fifty or so, the processes that clog arteries are often well established. Coronary artery disease starts in many by the teenage years. It’s the result of your day-to-day decisions on all levels: emotional, physical, and psychological. To treat it, reverse it, or prevent it, you need to change those day-to-day actions that led to it in the first place.
A large study of coronary risk factors in fifteen-year-olds and young adults, for example, showed that of 197 males and 197 females, 31 percent of the males and 10 percent of the females had calcification of their coronary arteries by age fifteen. We know that these calcifications are closely associated with heart attack, stroke, and aneurysm in later life. To further figure out which individuals were more likely to have these lesions, the investigators found that the following factors were most predictive of coronary artery pathology: high body mass index and low HDL (“good”) cholesterol.61 All roads lead back to glycemic stress!
Powerful Versus Powerless
If you perceive that you are valuable and powerful in the world and have choices, then your heart will be more apt to work optimally. The opposite is also true. At least two studies have shown a relationship between a woman’s job and her health. One study found that women who are employed and married have the best health, with or without children. If their husbands are supportive, so much the better. Good health is also associated with more complex and challenging jobs characterized by autonomy.
But if you feel that you have no autonomy, the risk for heart disease goes up. Clerical workers whose supervisors are demanding and whose job situations do not allow them to express anger are at increased risk for developing heart disease. Time pressure is also a risk factor that has been associated with poor health.62
If a woman’s heart isn’t in her work, she cannot express her anger about this, and she perceives that she can’t leave, this conflict hits her right in the heart, an organ that is exquisitely sensitive to the effects of excessive catecholamines over time. A woman in a stressful job in which she feels she doesn’t have a say is also more likely to smoke, which results in higher blood pressure and cholesterol—both additional risk factors for heart disease.
Studies suggest that low educational standing is consistently associated with higher risk of coronary artery disease in women. This isn’t necessarily related to formal education, however; rather, it is tied more to the fact that those who are better educated tend to take better care of themselves and to know that they have choices. Also, body mass index and cigarette smoking are inversel
y related to educational attainment. Vigorous leisure-time activity is also related to educational attainment. Fitness levels assessed by treadmill have been directly related to educational attainment in women but not in men.63 The good news is that you don’t need to go back to school for an advanced degree to change your perception and take charge of your lifestyle.
The number and diversity of your friends and associates also contributes to heart health or lack of it. Women with greater numbers of children and too many demands on their time combined with a lack of emotional support have been shown to be at greater risk for heart disease. But women who perceive that their families are supportive are at lower risk.
SHARON: Dying for Her Benefits
Sharon had been a patient of mine for years. Though she was about twenty pounds overweight, she walked regularly and was in a very happy, supportive relationship. Her blood pressure and cholesterol were normal, and she was in good health. She was also on Premarin and Provera—two hormones that had been prescribed for her at the beginning of her menopause for hot flashes. She had done well with this approach and there was no reason to change the prescription. (At the time, we didn’t have the data on alternatives that are now available.) At the age of fifty-four Sharon developed chest pain, and a cardiac workup showed that she had narrowing of her coronary arteries. She underwent bypass surgery. When I asked Sharon if she was going through any unusual stresses around the time of her chest pain, she told me that she had been hoping she could take early retirement from her job as a university professor. She and her husband had bought a house in Florida, where they spent as much time as possible. But she discovered that if she took early retirement, she wouldn’t be eligible for her full pension benefits. So she halfheartedly decided that she had no choice but to stay another ten years. It was shortly after she made this decision that she developed her chest pain. As I did her annual pelvic and breast exam, I asked her if she really felt it was worth it to stay another ten years in a job that was literally shutting off the joy to her heart. And I was reminded that people who stay in jobs they hate strictly for their benefits rarely get to use them.
The Wisdom of Menopause Page 72
