"The Truth About Statins" - A Book Review

Barbara H. Roberts, M.D., is the Director of The Women's Cardiac Center at the Miriam Hospital in Providence, Rhode Island. Before that, she spent two years at the National Heart. Lung, and Blood Institute at the National Institutes of Health. During her time at N.I.H., she studied the beneficial effect of lowering cholesterol and the occurrence of heart disease. Dr. Roberts earned her undergraduate degree from Barnard College of Columbia University, and obtained her medical degree from the Case Western Reserve University School of Medicine. The author published "The Truth About Statins" in 2012. Regular readers of this blog will note that last summer I read and reviewed a book called "The Statin Damage Crisis", and a lot of the information in this book is similar, but I learned a few things in this book that I did not already know. I think the additional details in this book are useful for the reader, in the event that their doctor wants to put them on a statin drug, plus going over the same concepts again helps with absorption of facts.

Statin drugs were first approved to lower cholesterol in 1987. The way that these drugs work is by inhibiting an enzyme that is integral for the manufacturing of cholesterol by the body, and statins also increase the uptake of LDL (low-density lipoprotein, the so-called "bad" cholesterol) by the liver. Unfortunately, statins also inhibit the production of HDL (high-density lipoprotein, the so-called "good" cholesterol). Many different statins have hit the market over the last three-plus decades, such as Crestor, Zocor, and Lipitor, and all of them have the same properties. However, cholesterol is a naturally occurring substance in our bodies, and it serves many important functions. As the author says, "It's an integral part of the cell membrane that surrounds every cell in our bodies, keeping all the structures inside the cell from leaking out. It is a building block of other molecules that our bodies need to function, such as vitamin D, and many hormones. Cholesterol is used to make bile acids, which assist in digestion." Dr. Roberts goes further, saying, "But cholesterol, far from being the villain it's said to be, is a vital part of every cell in our bodies. This waxy fat, primarily produced by the liver, is absolutely crucial for the normal functioning of muscles, nerve cells, and the brain-and it's also the building block that our bodies use to manufacture many hormones, including the reproductive hormones estrogen and testosterone." These are facts that are rarely discussed by the pharmaceutical companies.

Statin drugs also carry some pretty significant side effects. Reported side effects from statins include muscle pain and muscle damage, nerve damage, cognitive dysfunction, tendonitis and tendon rupture, joint pain and stiffness, liver damage, mitochondrial dysfunction, ALS, diabetes, and congenital defects in children of women who took statins during pregnancy. Sounds pretty nasty, right? Myopathy is the most common side effect, which can result in mild muscle pain and progress to cramps, tenderness, weakness, and even a life-threatening condition called rhabdomyolysis. Unfortunately, all of these risks do not even translate into much benefit if you take a statin. According to Dr. Roberts, "So even though statins do not decrease the risk of dying when given to people without vascular disease, they do lower the risk of dying in people with vascular disease, albeit by only a few percentage points." It doesn't sound like the juice is worth the squeeze.

If your doctor notes that your cholesterol is elevated and wants to prescribe a statin, Dr. Roberts lists a series of questions that you should ask your physician. The first thing she suggests is to advocate for dietary changes to see if it improves the cholesterol numbers. Another recommendation is to ask for an explanation from your doctor about what the numbers mean and, based on the current guidelines, why they think it is the right course of action to take. The author describes in detail during chapter four the differences between women and men with statin use. Statins are far less effective in women than they are for men, in large part because elevated LDL cholesterol is much less harmful for women than it is for men. The good doctor concludes the chapter by stating, "In women under the age of sixty-five who don't have established vascular disease, we have zero evidence (her emphasis) that statin treatment lowers their risk of having a cardiac event...And women experience more side effects from statins than men do."

Dr. Roberts shares some patient experiences of being on statins, and she offers several alternatives to taking these drugs. There is a drug that she has prescribed called Questran, which is part of a family of drugs that are bile acid sequestrants, and she has also recommended Niaspan, which is a B vitamin that in high doses lowers LDL cholesterol and triglycerides and raises HDL cholesterol. Neither of these options have the awful side effects of statins. There is also an entire section of the book that deals with dietary recommendations, rare counsel for most doctors. The author espouses a variation of the Mediterranean Diet, and suggests hearty consumption of olive oil, vegetables, fruit, seafood, beans, nuts, and whole grains. She even includes several recipes in the last section of the book. Dr. Roberts warns us of the dangers of the traditional Western diet and cautions us to avoid processed foods and sugar.

Overall, I enjoyed this book. Some of the information was a little repetitive for me, but that is only because I have read about the subject before. The doctor's writing style is engaging, and I liked the alternative treatment suggestions that I mentioned in the previous paragraph. She does an excellent job of exposing the limitations of clinical trials and shining a light on how the pharmaceutical companies not only pay for the studies, but also manipulate how the results of the trials are released to the public. This has been going on for years, and not just with statin medications. Particularly useful is the discussion of metabolic syndrome risk factors, which are rarely mentioned by most mainstream outlets and are far more problematic than high levels of LDL cholesterol for people with atherosclerosis. My only disappointment with the book is that there was no mention of intermittent fasting as an alternative strategy/treatment. It could be that the doctor is (or was) not familiar with the concept, or that because this book was published in 2012 it did not garner as much attention then as it does today.

Books like "The Truth About Statins" give you more information to act as your own health advocate. You cannot rely solely upon your doctor to help you, and you do not want to be under the thumb of Big Pharma. Use this opportunity to take control of your own destiny. Knowledge is power.