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Dear Dr Cannell: Will D decrease statin side effects?

Posted on: October 24, 2012   by  John Cannell, MD

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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?

Thanks,

Bill, Nebraska

Dear Bill:

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

1 Response to Dear Dr Cannell: Will D decrease statin side effects?

  1. Ron Carmichael

    For more than 18 years of my life I had elevated liver enzymes, and a series of physicians (specialists as well as GPs) during that time could not tell me why. My lipid ratios were extremely good, my cholesterol slightly elevated during this time. One physician prescribed a statin, which doubled my enzymes (not good) and I too encountered slight calf muscle issues, so with his agreement I stopped the statin.

    At the behest of my spouse I agreed to essentially improve my diet, to eat 25 raw fruits, vegetables, and berries daily (in a capsule form so quick and easy, a plus for my busy lifestyle), and at my next quarterly lab tests, roughly a month later, my enzymes were normal for the first time in yes, 18 years. Lacking any other reason for the sudden and radical improvement, I STOPPED the healthy stuff as a “rechallenge”, and 6 weeks later did an early set of liver and lipid panels, and the enzymes were once more elevated. Interesting, I thought. So I resumed the improved diet, and in another 6 weeks, tested and Lo! they were again normal! This was well before I was aware of vitamin D’s effects, but I was naturally on the high end of D levels due to my lifestyle in central Texas, always getting a lot of sun and tanning well. I even found that I could then tolerate a statin (which I took for about a year before stopping).

    Yes, D3 is incredibly important and without enough of it, one’s body will not function optimally. A chronic lack of it will lead to a variety of pathologies, and the science shows us this more and more every day with new published/reviewed studies.

    Perhaps just as importantly for your overall health, though, is whether you chronically deprive your body’s cell-building factories of all the micronutrients needed to build strong and healthy cells – nerve cells, kidney, liver, muscle, pancreas, bone, etc….which a majority of Americans apparently do. We are a nation of over-caloried and under-nourished individuals!

    Our bodies are capable of working far better with much less pain and diseases if we only provide it with the right building blocks (diet, fresh air, sunshine), exercise it prudently, hydrate it adequately, and recover it (sleep) sufficiently, and stop stuffing it with useless calories.

    What worked for me may not be the solution for anyone else, but if you are not eating properly then fixing THAT makes far more sense than taking another drug instead. And if my physician was as close-minded as to refuse to consider gaining knowledge about the effects of a steroid like cholecalciferol (vitamin D3) then I would explain to him that was why I was firing him. Come to think of it, I did just that years ago with a dermatologist who said about vitamin D proponents, “oh, they’re just trying to make money”. Considering that I knew personally as a pharmacist that she thought nothing of prescribing/requiring a brand-name drug (Monodox) that costs $800 to $1000 per 60 caps (seriously!), when there are generic equivalents at $15/60 caps, I found that pretty much a “you’re fired!” moment. She was confusing hypocrisy with hippocratic, perhaps…

    You are the one in charge of your health – Getting right with your D level is important, but so is getting your diet right. good things can happen.

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