Dear Dr. Cannell:
I am supposed to be taking Lipitor for my high cholesterol. However, every time I take it or try another statin my muscles hurt and sometimes I get a fever. My doctor did a blood test and tells me it’s myositis.
I have asked him to check my vitamin D level but he tells me he doesn’t believe in vitamin D!
I went ahead and started taking 1,000 IU per day anyway but it does not help.
How can I convince my doctor to order a vitamin D blood test so my insurance will pay for it?
Myositis is a general term for inflammation of the muscles. It is also a side effect of the statins. Your doctor probably did a creatine kinase blood test, where elevations are indicative of myositis.
Studies show low vitamin D blood levels are associated with myositis and a large open study of 150 patients with myositis from statins found vitamin D (50,000 units of vitamin D twice a week for 3 weeks, and then once a week) resolved the problem in 87% of the patients. However, only half the patients obtained a level above 40 ng/ml, and they used D2 not D3 in their study.
Glueck CJ, Budhani SB, Masineni SS, Abuchaibe C, Khan N, Wang P, Goldenberg N. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin. 2011 Sep;27(9):1683-90. Epub 2011 Jul 6.
As far as convincing your doctor, print out the abstract of the above paper and see if he will read it. If not, and what I would do anyway, is simply go to the drug store or a discount big box store and buy 5,000 IU capsules of vitamin D and take one per day. That will both prevent the myositis and improve your blood lipid profile. 5,000 IU per day cannot make anyone toxic so you don’t need a blood test. The problem is that some people need more vitamin D to obtain natural levels.
A recent randomized controlled trial from Iran found that even 1,000 IU per day of D3 in overweight and obese women improved the lipid profile and lowered PTH and fat mass as well.
Salehpour A, Shidfar F, Hosseinpanah F, Vafa M, Razaghi M, Hoshiarrad A, Gohari M. Vitamin D3 and the risk of CVD in overweight and obese women: a randomised controlled trial. Br J Nutr. 2012 Feb 9:1-8.
However, a recent highly publicized study found no effect from 1,000 IU per day in healthy adults on cardiovascular disease (CVD) risk factors. The more recent Iranian trial included more detailed lipid profiles with the main improvements in one of the components (apoA-1) of “good” HDL cholesterol. So far, no study has used adequate doses of D3 to study CVD risk factors but at least one is completed using 40,000 IU per week and awaiting publication. I wish they would use 5,000 IU a day instead, as that is how our ancestors got their vitamin D, daily.
Good luck with your doctor.
John Cannell, MD