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How To Get Off Statins

Getting off statins is easy. Stop swallowing the pill. If you’re not in a potentially high-risk group (as described below) and your doc prescribed a statin to get your cholesterol down a bit, you won’t have a heart attack or a stroke that day or week or probably that decade.

There’s no “statin withdrawal” and you weren’t born with a statin deficiency.

In fact, many of you quitting statins will probably start feeling better in just a couple weeks. I admit “better” is rather vague, but perhaps you’re so used to having achy muscles, fatigue, and brain fog that you think these symptoms are normal.

Does my recommendation to stop taking your statin sound glib, a bit cavalier? After all, when you were handed the prescription you were told something like “You must take this every day or you’ll get a stroke or heart attack.” And now I come along suggesting that for most of you statins are simply not necessary…provided you’re willing to take charge of your health.

A new verb: deprescribing
The statin controversy is quite lively among physicians themselves. John Mandrola, MD, a cardiac electrophysiologist from Louisville, wrote a short blog post on the physician-only portion of Medscape expressing his doubts about statins. You can’t link to his piece without a password, but do have a look at Dr. Mandrola’s very good website and especially at this piece, “To Deprescribe…Adding a New Verb to the Language of Doctoring.”

Dr. Mandrola’s Medscape post received an astonishing 631 physician comments, most of which supported his position, namely that the latest guidelines from the American College of Cardiology (ACC) on statin prescribing were not only unrealistic, but potentially dangerous.

There are four guidelines regarding who should take statins. Many physicians in the US and most in Europe agree with the first two, partially with the third, and not at all with the fourth (my comments in italics):

  1. People 40 to 70 with Type 1 or 2 diabetes. This group has an increased risk for heart disease, including heart attack, and taking statins has been shown to reduce this risk. (However, diabetes is a potentially reversible condition with weight loss and exercise, and once the diabetes has been reversed it is possible to go off statins.) 
  2. People with a history of a cardiovascular “event” such as heart attack, stroke, transient ischemic attack (TIA), angina, or peripheral artery disease (statins definitely reduce the chances for a second such event).
  3. People 21 or older with a very high level of bad cholesterol–LDL 190 mg/dl or higher. (Even though the high cholesterol may be genetic rather than lifestyle-induced, you needn’t capitulate entirely to your genes. Healthful eating, weight reduction, and exercise can bring down high cholesterol of any kind, including genetic. If, after several months of lifestyle changes, your cholesterol remains stuck in a danger zone, then taking a statin is reasonable, especially if along with genetic high cholesterol you also have a genetic premature early death risk.)
  4. People 40 to 75 with no cardiovascular disease, a (bad cholesterol) LDL of 70 mg/dl or higher, and who have a 7.5% or greater risk of having a heart attack or stroke within 10 years (the 7.5% or higher is predicated primarily on reversible  lifestyle factors—see more below).

Note: the ACC does acknowledge that beyond age 75, there is no significant data showing any heart disease prevention benefit from statins.

Lifestyle…again
It’s Number 4 that caused a great deal of eyebrow raising among doctors. The risk factors that would put a person in the 7.5% category include genetic susceptibility, yes, but also smoking, obesity (especially belly fat), inactivity, high blood pressure, and a significant family history of early heart disease. When these factors are combined with the newly established LDL of 70 mg/dL, it’s estimated that in the US alone the number of current statin users would increase from 12.8 million to 48 million.

If you’ve been following the news on bad cholesterol over the years, it used to be worrisome when LDL was higher than 100 mg/dL. According to the ACC guidelines, 36 million more people now need statins to hit that glorious 70 mg/dL. That means one adult in three would be taking statins, as many as one billion statin users worldwide, and total statin sales at $1 trillion a year.

But wait a minute. Except for the genetic susceptibility to early heart disease, every one of those factors that would place someone in the 7.5% risk group is reversible with lifestyle modification. And, most importantly, lifestyle changes will help even if you’re genetically predisposed to heart disease. Also, the newly available Corus-CAD test (which I discussed in a previous Health Tip) can confirm or refute your personal genetic susceptibility. If you’re concerned about your susceptibility to heart disease, I do suggest the Corus-CAD.  It might be a good idea to get this test if you’re in that LDL group with 190 mg/dL or higher.

With all this in mind, read these aloud.

  • Lifestyle beats statins every time. A healthy lifestyle is the foundation of cardiovascular health, period. There has never been a study undertaken to prove that statins are superior to lifestyle changes, and you can probably guess why: lifestyle would win hands down.
  • Preventable heart attacks. A recent Swedish study proved that four out of five heart attacks in men were completely preventable. When 20,721 men agreed to stop smoking, eat healthfully, lose weight (belly fat, people), and reduce alcohol, after ten years there was an 86% reduction in the number of expected heart attacks for that number of men.
  • False reassurance. Recent studies also show people who take statins eat more, move less, and gain weight, thus increasing their heart disease risks and cancelling any already dubious benefit they think they’re receiving. People who take statins are falsely reassured (in the well-chosen words of JAMA: Internal Medicine editor Rita Redberg, MD) that they’re getting some protection.

Statin side effects
Statins work by blocking an enzyme called HMG-CoA reductase, which controls cholesterol production in the liver. However, this enzyme is also responsible for your body’s production of coenzyme Q-10, a powerful antioxidant that prevents age-related macular degeneration, heart disease, and fatigue. The muscle pain caused by statins (the pharmaceutical industry reports this at 2%, primary care physicians at 30%) occurs as the statin lowers your CoQ10 levels.

As a side note, everyone (and I do mean everyone) taking statins should also be taking CoQ10 (100 mg UBQH daily).

Statin use has also been associated with memory impairment (25% of your body’s cholesterol is in your brain) and with the early onset of cataracts (27% increased risk among statin users).

One reason statins are a no-no in older adults is that a recent NIH study showed that after age 70, best memory function was observed in those with highest cholesterol levels.

Back to Dr Mandrola
Among the 631 physician comments that Dr. Mandrola received on his blog, several pointed out that doctors virtually had to prescribe statins because they couldn’t offer their patients nutritionists and exercise equipment (or, I would add, prescribe it with the expectation the patient would be reimbursed) and that many patients simply were so chronically noncompliant with health care advice that the doctor was lucky if she could get them to take the statin itself.

Dr Mandrola was sympathetic, but felt an attitude change among physicians was in order.

Sidebar: WholeHealth Chicago has three nutritionists and although most WHC patients work out regularly, I do maintain for my patients a rolodex of personal fitness trainers.

Physicians at the blog also asked about other cholesterol-lowering agents (such as prescription niacin, called Niaspan, and Zetia, which works by blocking cholesterol being absorbed from the digestive tract) and supplements (red yeast rice, plant sterols). Again, however, taking pills misses the point. All of these do lower cholesterol, though not as dramatically as statins, but none is superior to lifestyle modifications for overall heart disease prevention.

In the 15 years since WholeHealth Chicago opened, I’m aware of exactly two patients who died of a heart attack, and both were at high risk when they arrived. I attribute this really low number to the majority of our patients being highly motivated to live lives of wellness. They accomplish this via healthful eating (guided by our nutritionists if needed), weight reduction, and regular exercise. I can’t think of a single patient who’s still smoking.

Patients who resist the sort of DIY efforts we endorse seem to just drift away to pill-pushing medical practices where physicians are agreeable golden retrievers in comparison to our own WHC wellness wolverines.

Statin summary
Return to the four reasons for statins listed above.

  • If you’re in groups 1 or 2 (you have Type 1 or 2 diabetes or you’ve had a previous cardiovascular event), stay on your statin. If you’re mildly diabetic, know it’s reversible and being statin-free is a possibility.
  • If you’re in the third group (LDL over 190 mg/dL), meet with a nutritionist, start eating well and working out, and get further testing, especially the Corus CAD. You’ll probably be able to stop your statin in a few months.
  • Members of the fourth group are likely taking statins unnecessarily. You may be thinking it’s helping when it’s really not. Stop your statin, review the discussion of lifestyle factors above, and get to work on yourself. If you simply cannot commit to significant lifestyle changes, then you might as well CYA and go back on the statin. Just don’t expect it to perform miracles.

Be well,
David Edelberg, MD

 

Leave a Comment


  1. Linda Hudson says:

    Can you just stop taking statin all at once or does it take a little each day. How do you just stop.

  2. Dr. R says:

    Linda. Before changing the dosing of any medication, it is always best to consult with the physician that prescribed the medication or another physician that is familiar with your health history.

  3. ERIC says:

    I got proscribed cholesterol and BLOOD pressure meds. I am 40 years old I was in great shape before hand. Doctor prescribed them I took them and they really messed me up..doctor told me to stop taking them I’ve had several problems now including off balance unsteady that permits me from walking..can anyone explain? I only took medicine for 5 days

  4. Steve Vorchheimer says:

    Getting off Lipitor today. I’ve only been on it a little over a year. After reading more than I wanted to know no more. I eat very little sat fat. Now I will eat even less. The strange thing my wife eats what I eat she has no problem. I’m going try B12, B6 and few other things. I have never smoked, drink a glass of wine a day. 5’10 155lbs. 72 years young. Walk everyday 4-6 miles, run/walk intervals.

  5. Ed says:

    I’m 61, high blood pressure (treated and controlled), family history of heart disease,.
    I was put on statin (20 mg) after 96 LDL, 49 HDL, 120 trig. lipid test.
    After 6 weeks 42 LDL, 54 HDL, 99 trig.
    I’d like to get off the statins or reduced dose. Any advice?

  6. cliffmaurer says:

    Hi Ed –

    Your HDL number appears to be great! Make certain that your doctor is reminded of the statin dose that you’re on and your current cholesterol numbers. Believe it or not, we don’t like to see patients’ cholesterol numbers fall too low, since we all need cholesterol to make hormones and complete other bodily functions. If you’re going to discontinue the statin, you should definitely do so under a prescriber’s advice. Never be afraid to ask for a second opinion if you have misgivings about continuing a medication with which you’re not comfortable. Any of our MDs, DO or Nurse Practitioners can help if you’re in the Chicago area.

    Best,
    Dr M

  7. kathy Vaughan says:

    Very informative. As a writer, I have suffered cognitive impairment since on Lipitor 5 months. I am stunned at the effects on my mind. I totally agree with doctors prescribing statins for the unhealthy patient who is overweight, sedentary etc. my own doctor is on them and is a blimp.

    I’m off this poison weaning slowly,Mobutu after reading this, I’m done. My cholesteral was at 296, now at 183. But I suffer. Hired a nutritionist, tweaked my already good diet, exercise a lot but was told I am genetically inclined, blah blah. So, thx for the right on info. Kudos to u.

  8. Rodney Collier says:

    Hi. 50 yr old male. Two stents placed in my circumflex and circumflex branch in November 2015. I have tried Lipitor , Crestor , and just tried Livalo. Side effects were just crushing. Fatigue, muscle pain and weakness, memory loss, vision problems, etc. tried Livalo for one week and it was the worst. I experienced headache, indigestion, heartburn, stomach distress, and heart palpitations. I stopped after 7 days now been off for three days. I was doing great during the 2 months once I stopped Crestor but doctor wants me on a statn so tried Livalo. Can that drug cause all of these problems and how long will it take to get completely out of my system? Help in statin distress.

  9. Tara Messner says:

    Hi, i am 56 yrs old & my dr. Keeps wanting me to take choloesterol meds. She says its too high at 140 but thats what it always seems to b around. I take the med once in awhile & when i get my blood work done the number never seems to change, then my dr. changes my med to something different & i dont take them regularly either! So, do i really nerd the med & why is she always pushinf some kinda statin on me??

  10. cliffmaurer says:

    Hi Tara – We try to see cholesterol as a piece of the puzzle. When our docs and nurse practitioners decide whether or not a cholesterol number is worth treating with medication, we take into consideration other factors as well. It’s true that use of statin medications have been shown to provide heart-protective benefits to some patients, and perhaps that’s what your doctor is focusing on. However, a second opinion on a medication you’re reluctant to take is a good idea. If you’re in the Chicago area, I’d recommend seeing one of our doctors or nurse practitioners for a consultation. If you’re elsewhere, we like this website from the Institute for Functional Medicine t help folks find providers near them: https://www.functionalmedicine.org/practitioner_search.aspx?id=117

  11. Debbie says:

    Thanks for the extremely valuable information! I think most conventional doctors treat symptoms, not causes, strictly according to protocol with no regard for the individual. I of sick of not being listened to hearing the benefits of the meds out way the negatives I disagree! I live in NJ and I’m searching for an alternative physician, but not having much luck. Any suggestions?

  12. Dr. R says:

    Hi Debbie. You might try the Institute for Functional Medicine. https://www.functionalmedicine.org/practitioner_search.aspx?id=117

  13. Bonham says:

    Glad I found you.

  14. Tom Caron says:

    Lipid panel –
    Colesteral – 119
    HDL – 39
    Triglycerides – 69
    LDL – 66
    Age 64 male, 2000 Metformin a day.
    10mg Crestor daily.
    Blood pressure 116/70, 6, 1″ tall, 195lbs
    Do I need to keep taken the Crestor?
    Should I be concerned about the low Lipid numbers?
    Thanks!

  15. Dr E says:

    Hi Tom
    Your doctor likely started you on statins not because you had high cholesterol but because he had been taught that all diabetics should take statins no matter what their cholesterol happened to be (you being on metformin told me you are diabetic)
    There is now considerably controversy about this recommendation especially since it has been shown that statins can actually cause diabetes.
    For you, I would take a look at your cholesterol before statins. If it was not particularly high, I would suggest that you ask your doctor to give you a compelling reason to remain on them

  16. Jay says:

    Hello –

    I’ve been put on a atrovastatin dose of 20mg which I’ve been taking since past 2 months.

    I am also on 500mg metformin
    Here are a few stats on my latest blood work:

    A1C – 6.1 (was at 6.7 before this check)
    LDL- 110
    HDL – 53

    I am 39 yrs old, vegetarian and maintain active lifestyle.
    After reading several posts/blogs on statins and its side effects, just wanted to check if I can stop taking it after consulting the doctor.

    Not sure if my case is mildly diabetic or highly diabetic.

    Somehow the numbers that the doctors ask us to achieve seem quite aggressive (for e.g. have an a1c of < 5.8 and LDL of < 100). Not sure if there is universal acceptance of these figures and its implications.

    As layman, I am confused !
    Just wanted to know your opinion. Appreciate your response in this regard

    Regards,
    Jay

  17. Dr E says:

    Hi Jay
    You’re not really diabetic but rather pre-diabetic. Given that you are physically active and a vegetarian I would place your overall risks as “low,” but to remain there, you’ll need to continue to work on it. If there’s early heart disease or diabetes in your family your doctor may want to be more aggressive in your treatment. Overall, I think you are doing well

  18. Constance says:

    You state if you have had a heart attack then stay on your statin but what if it was misdiagnosed and it was a lack of magnesium or other nutrient? And what if the statin is doing more harm than good wouldn’t it be better to employ a lifestyle change and take supplements like Ubiquenol, Serrapeptase, vitamin D,c,e, as well as fish oil?

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