Scott: Let's talk a little bit about some things that maybe drain some of our energy. Statin drugs, in fact just a couple weeks ago, there was a new regulation set out where it seems like they hope to double the amount of statin drugs that are prescribed, and trying to get that cholesterol lower. What do those do to us?
Dr. Jennifer Landa: Statin drugs, of course, lower cholesterol, but on the flip side, there can be a big price to pay for taking statin drugs. Statin drugs have many possible adverse reactions. In terms of energy, there's a couple of things that statin drugs do that deplete our energy. One of them I want to bring up, which a lot of people might not be so familiar with is the fact that statin drugs can lower testosterone levels. And both men and women have testosterone. And it's important for both sexes. Testosterone is a great source of energy. Not only that, testosterone is great for energy, memory, mood, sex drive, bone strength, muscle strength. So testosterone is really essential. And statin drugs lower testosterone levels. Now the need to be on a statin drug is very debatable too.
Something else about statins that really concerns me is just recently, the warning that we're seeing that statins increasing the risk of diabetes. So, if statins increase the risk of diabetes and elevate blood sugar, how much are we really doing to save people from heart disease? Because obviously elevated blood sugar is one of the risk factors of heart disease.
The other things statins do is they can raise the levels of LP little A. And LPa is a lipoprotein particle that is an independent risk factor for heart disease. So while statins correct cholesterol, they can put you at risk for a lot of other things. So the solution really in my opinion to all of this , Scott, is to do a, an expanded lipoprotein particle evaluation. Because the most important part of your risk for cardiovascular disease, in terms of cholesterol, is not the number of the LDL. It's the size of the LDL. So we can have small LDL particles, or we can have large LDL particles. Large, buoyant LDL particles, don't really stick together to form plaque. So you can have, that's why you hear of people who have a cholesterol of 300 and they have no heart disease whatsoever. And then people who, God forbid, drop dead of a heart attack with a cholesterol level of only 140. That's where the rubber meets the road really, it's in terms of this particle size and density. So large, buoyant, fluffy particles of LDL don't really get together, clump together to form plaque. Small, small, dense particles of LDL, those are the ones... that's what we consider oxidized LDL. And oxidized LDL is what gets together, clumps together to form that plaque to increase the risk of atherosclerosis, and therefore heart disease.
So to me, that's the real deciding factor for whether a person really needs statin drugs. First of all, of course, I put them on lifestyle therapies. I help them change their diet, especially eliminating red meat, processed meats, fried foods and dairy. Dairy is a big part of why people have elevated cholesterol, I find. There are also certain hormones imbalances that can lead to elevated cholesterol. Like hypothyroidism. Hypothyroidism is very, very common and even what I'd call suboptimal thyroid, which is not, it doesn't quite meet the criteria for hypothyroidism, but it's suboptimal. Correcting these thyroid abnormalities very frequently will bring cholesterol back into line. Changing the diet in the ways that I mentioned, exercise, of course will improve your cholesterol profile. And so I'll have my patients do all of that, and then I'll look at this not only quantitative but qualitative cholesterol test, looking for small or large particles. If my patients have large particles, I feel pretty comfortable not to really go toward a statin at all. If patients, despite all the lifestyle changes, still have small particles, well, then maybe you want to try and control that particle number a little bit. And maybe a very small dose of a statin might be indicated. But for me, I try and stay away from them when at all possible and I'd always rather have a patient change their lifestyle which will change so many other things for them rather than be on a medication.
Dr. Jennfier Landa discusses some lesser known possible adverse reactions from taking statin drugs. Some of them might actually cause risk factors of heart disease! She also talks about what you should know about cholesterol, not just your number, but something else that could be more important.
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