Ask the Doctor – March 2011Dr. Zoltan P. Rona, MD, M.Sc. March 1, 2011
Questions Asked and Answered On: Statin Drugs, Fosamax, and Vitamin D
(In this occasional series, Dr. Rona shares some of the most common questions asked by patients, along with subsequent answers.)
Why You Don’t Need Lipitor and Company
Dear Dr. Rona:
I read your article in Vitality about cholesterol lowering drugs. I showed my family doctor the article but he told me to keep taking my Lipitor because I had a strong family history of heart disease. Both my parents died of heart attacks in their 50s and my cholesterol was very high before I started taking Lipitor about 5 years ago, but I have never had any heart disease. I am a woman of 64 years and concerned because I feel more and more depressed since taking this drug. Should I continue taking my prescription or are there things I can do to lower cholesterol naturally? Regards, A.B.
In an article I wrote in September 2009 [Challenging the Statin Drug Dogma], I made a strong case for abandoning the use of statins in all but the highest risk cardiovascular disease patients. Since that time there have been a number of studies that support exactly this point of view:
On January 19, 2011, The Montreal Gazette, the CBC, and numerous other media outlets reported on a study concluding that there was insufficient evidence to recommend the widespread prescription of statin drugs (e.g. Lipitor, Crestor, and company) to people who had elevated cholesterol levels but no previous history of heart disease. In other words, there is no scientific evidence that the lowering of blood levels of cholesterol will actually prevent heart disease in healthy people. According to the researchers (the Cochrane Heart Group at the London School of Hygiene and Tropical Medicine in London, UK):
“It is not as simple as just extrapolating the effects from studies in people who have a history of heart disease. This review highlights important shortcomings in our knowledge about the effects of statins in people who have no previous history of CVD. Investigators tended to cherry pick significant findings, rather than presenting all the findings. The decision to prescribe statins in this group should not be taken lightly.”
Of particular interest is the fact that all but one of the trials reviewed were industry-sponsored.
“We know that industry-sponsored trials are more likely to report favourable results for drugs versus placebos, so we have to be cautious about interpreting these results. The numbers eligible for treatment with statins are potentially great so there might be motivations, for instance, to stop trials earlier if interim results support their use.”
The researchers concluded that the prescription of statins “is both wasting money and exposing people to potential adverse effects.”
Since conventional doctors are fond of constantly repeating the mantra that all therapies must be “evidence based”, why are the majority of them still advocating and prescribing this toxic class of drugs to patients with non-existent illness? Over 30 million prescriptions for statins were filled in Canada last year, and considerably more than that throughout the world, making statins a 30 billion dollar a year business.
Doctors have been successfully brainwashed by the drug companies to continue to prescribe statins. They mistakenly believe it is good preventive medicine. If you have a “high cholesterol” level and are taking a statin drug, please reconsider what you are doing and at least discuss the issue with your doctor. There is no evidence that this class of drugs prevents anything in anyone without a history of heart disease.
So what are the alternatives? My recommendations for alternatives to statin drugs are as follows:
DIET – The so-called Ape Man Diet (primarily vegan as demonstrated by what gorillas eat) has been demonstrated to lower cholesterol as well as any statin. But, can we really eat like apes? If you cannot fancy yourself as an ape, at least consume two or more servings of each of the following proven cholesterol-lowering foods every day:
• Organic fermented products like tempeh and miso contain saponins which prevent the absorption of excess cholesterol from the gastrointestinal tract.
• High pectin fruits like pears, apples, grapefruit and oranges also prevent cholesterol absorption. And drinking pomegranate juice lowers cholesterol because of its antioxidants and polyphenols.
• Garlic, onions, carrots, walnuts, almonds, oat bran cereal, milled (ground) flax seed, seaweed products like kelp, dulse and kombu lower cholesterol via their content of fiber, antioxidants and trace minerals.
SUPPLEMENTS – cholesterol lowering with most of these natural remedies can take three months or longer to achieve. Unlike drugs, side effects of such products are minimal:
• Soluble fibres like psyllium, guar gum and pectin – 15 grams or more daily.
• Milled flax seed – 15 grams or more daily.
• Curcumin (1000 mg 3 times daily) is strongly anti-inflammatory and liver protective. It aims at lowering inflammation, tissue damage and ultimately high cholesterol levels.
• Omega-3 oils (2000 mg twice daily) prevent abnormal blood clotting and reduce the risk of heart disease. Higher doses may be required by some individuals.
• Garlic (1000 mg. or more daily) – Eating real garlic cloves is preferred but social interactions may necessitate the alternative use of supplemental capsules.
• Coenzyme Q10 (200 mg. twice daily) is a strong multi-purpose antioxidant with especially good cardiovascular protective properties.
• Niacin (1000 – 3000 mgs. daily) – Niacin can cause a red or flushing reaction, usually temporary and harmless, which lessens with regular use; may cause liver irritation.)
Timed release forms of niacin may cause less flushing and may be better tolerated.
• Inositol hexaniacinate (600 – 1800 mgs. daily) – a compound of niacin and inositol which does not produce flushing or liver toxicity but costs at least three times more than regular niacin.
• Tocotrienols (600 mgs. or more daily) – a form of vitamin E originating from rice bran oil which blocks the cholesterol synthesizing enzyme in the liver. Most vitamin E complex formulae include tocotrienols as part of the complex.
• Vitamin C (3000-6000 mgs) lowers cholesterol, regenerates and reactivates vitamin E. Vitamin C protects the body from oxidant stress, thereby lowering cholesterol.
• Beta Sitosterol (500 mg daily) – Over 50 human and animal studies since the 1960s, published in scientific journals, show that beta-sitosterol has a powerful hypocholesterolemic effect in humans. It has a similar chemical structure to cholesterol. Beta-sitosterol interferes with cholesterol absorption, which prevents the rise in serum cholesterol. In one study (American Journal of Clinical Nutrition) there was 42% decrease in cholesterol absorbed when taking beta-sitosterol before eating scrambled eggs. Beta-sitosterol is also believed to reduce serum cholesterol by inhibiting the intestinal re-absorption of circulating cholesterol, which is secreted in the bile.
• Berberine (1000 mg. 3 times daily) – an extract of several herbs used for their antibiotic properties as well as cholesterol- and triglyceride-lowering ability. The extract also has antioxidant benefits.
• Artichoke leaf extract (1000 mg. 3 times daily) works by enhancing bile acid production by the liver from cholesterol.
• Guggulsterones (1000 mg daily) – a resin from the Guggul tree with antioxidant properties; also able to lower cholesterol by regulating bile metabolism.
• Ferulic acid (1000 mg daily) – lowers cholesterol by an as-yet-unidentified mechanism; known to be a strong antioxidant.
• Green tea extract (Theaflavin) (500 mg 3 times daily) – a polyphenol derived from catechins found in green tea that has both cholesterol lowering and antioxidant effects.
• Red Yeast Rice (1000 mg twice daily) – If you are between 50 and 75 years old and have proven coronary artery disease or have had a heart attack, you may want to take this naturally occurring statin as an anti-inflammatory preventive remedy. Side effects are minimal according to a 2005 study.
It has correctly been pointed out to me that Red Yeast Rice contains lovastatin, identical to the active ingredient of most statin drugs. The difference between Red Yeast Rice and the drug versions is that the natural product is complexed with nutrients that dilute the harmful side effects. It is actually a whole food. While it is still possible to react adversely to Red Yeast Rice, reactions are far less severe and typically, rare. I would use it as a drug alternative in confirmed heart disease cases as well as in those where all other measures have failed.
Kirkey, Sharon. Statins Widely Overprescribed Study Suggests. The Montreal Gazette. Jan 19, 2011.
Taylor F, Ward K, Moore THM, Burke M, Davey Smith G, Casas J-P, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2011, Issue 1.
Rona, Zoltan. Challenging the Statin Dogma. http://www.vitalitymagazine.com/sept09_pg32feat
Drugs Don’t Build Bones – Nutrients Do
Dear Dr. Rona:
Ever since this experience I refuse to take any “wonder drugs” and rely on exercise to do what I can do to keep my bones relatively strong. Since I live in the country I garden all the time when the ground is not frozen, including lots of digging. And I walk in the winter. I am 68 years old now and do not claim that my bones are perfect, but (touch wood) I have not broken anything yet. Being a slightly built Caucasian female, I guess I am in a high risk category for osteoporosis, but this purported [Fosamax] “cure” is more frightening. Are there any natural alternatives? Regards, B. Spencer
Dear B. Spencer:
I’m sorry to hear that you had such a bad result using Fosamax. At some time in the near future, I expect drugs like it to be banned as a result of all the unacceptable side effects. The use of these drugs reminds me of the use of high dose fluoride drugs for osteoporosis heavily prescribed by the medical profession in the 1970s. These too were eventually banned as a result of their toxicity.
Weight bearing exercise is indeed beneficial in boosting bone mineral density. I am also increasingly recommending a mineral supplement called strontium for all my osteopenic and osteoporotic patients. Most of these people either cannot tolerate prescription drugs used to prevent hip and spine fractures, or are too frightened of side effects like stomach upset and jaw bone disintegration caused by the commonly prescribed drugs collectively known as the bisphosphonates (e.g. Fosamax, Actonel, etc.). Since I’ve started using strontium in my practice, I routinely see 5 to 10% improvements in bone density after a year without any of the usual drugs prescribed for osteoporosis, and without the side effects.
Not to be confused with radioactive (and toxic) Strontium-90, the nutritional version of strontium can be taken safely and without concern for years. In fact, strontium supplementation actually removes radioactive strontium from the body if it is present in any significant amounts.
The availability of strontium from food depends entirely upon the content of strontium in the soils of the areas where the fruit or vegetable is grown. As such, food is an unreliable source of this mineral.
Strontium works by drawing more calcium into the bones, enhancing bone density. Studies conducted at McGill University in the 1980s, as well as numerous studies from around the world in the past three decades, confirm the bone building (as well as the fracture preventive) properties of strontium.
Another remarkable benefit of strontium supplementation is pain relief and remineralization in bones affected by cancer metastasis, something that occurs with advanced breast or prostate cancer. Strontium supplements also reduce the incidence of dental cavities and improve cartilage metabolism in osteoarthritis. Research indicates that the optimal therapeutic daily dose of strontium supplements is 680 – 1000 mg.
Strontium should be taken on an empty stomach at least 3 hours away from any calcium supplements because calcium impairs strontium absorption. Most of the recent research has used strontium ranelate, but similarly good results can also be achieved with the gluconate, citrate, lactate and carbonate salts of strontium. As always, check with a natural health care practitioner before taking large doses of any nutrient supplement.
Wright, J.V., Fight – Even Prevent – Osteoporosis with the hidden secrets of this bone-building miracle mineral. (Reprint from Nutrition and Healing. Tahoma Clinic, 2008).
DeHart, S.S. (July 7, 2008). Strontium and Osteoporosis: A treatment not offered to American Women http://onlinejournal.com/artman/publisher/printer_ 3458.shtml
Dean, W. (May 2004) Strontium breakthrough against Osteoporosis www.worldhealth.net/news/strontium_breakthrough_against_osteoporo/
What’s the Best Vitamin D?
Dear Dr. Rona:
I have a question about Vitamin D3 – my doctor says I am low and he gave me pills, each having 50,000 IU. I should take it once a week. Then I read an article on Dr. Mercola’s website that says:
“A third option is taking a high-quality vitamin D supplement. The most important thing to keep in mind if you opt for oral supplementation is that you only want to supplement with natural vitamin D3 (cholecalciferol), which is human vitamin D. Do NOT use the synthetic and highly inferior vitamin D2. This is typically prescribed by many well intentioned doctors who seek to take advantage of a patient’s prescription coverage. Unfortunately this form is FAR more expensive than the real vitamin D3, which is one of the least expensive vitamins we have. But more importantly it does not work nearly as well as D3 and can actually block the real D3 from working properly.”
Now I do have these pills that are supposedly natural, but the pharmacy says they are from a plant and they are the closest form to human D3. Considering the yellow warning above. Should I really be taking these pills? What is the best source of D3 from your opinion? Farshad Taghavi
Dear Farshad: You ask some very good questions that are currently being debated by many world-renowned researchers. The following is information that was published last year in my book, Vitamin D, The Sunshine Vitamin. I hope you have the opportunity to read the whole book one of these days.
The vitamin D used to fortify milk is vitamin D2 (ergocalciferol). This is a synthetic form of vitamin D that is also used to fortify soymilk, hemp milk, almond milk, other plant milks, margarine, and orange juice. In nature, vitamin D2 sources are found only in plants and are very rare, but both mushrooms and dark green leafy vegetables do contain some. Vitamin D2 can also be obtained by eating various algae (such as spirulina, chlorella, and blue-green algae), although the levels of D are very low here too.
The other form of vitamin D is D3 (cholecalciferol), which is the kind your body produces as the result of sun exposure, and is also found in some foods. Food sources of vitamin D3 are all non-vegan and include egg yolks, butter, and oily fish like mackerel, salmon, sardines, and herring.
There is considerable controversy among vitamin D experts about the safety and effectiveness of oral supplementation with vitamin D2 (ergocalciferol) versus vitamin D3 (cholecalciferol). The basic difference between the two forms has to do with how they are manufactured. Vitamin D2 is derived from vegetarian sources, manufactured through the action of ultraviolet light on ergosterol from yeast. Vitamin D3, on the other hand, is manufactured from a cholesterol derivative of lanolin (an animal source). Vitamin D2 is cheaper and easier to make and has been used to fortify foods and make supplements.
Some of the world’s leading experts, like Rheinhold Vieth, associate professor at the University of Toronto, believe that vitamin D2 is less effective than D3. In a paper titled, “The Case Against Ergocalciferol (Vitamin D2) as a Vitamin Supplement,” published in 2006 in the American Journal of Clinical Nutrition, Vieth and co-author Lisa Houghton conclude that vitamin D2 should not be considered the equivalent of vitamin D3. They claim that vitamin D2 behaves differently in the body, creates different metabolic by-products, and may be more difficult for the body to eliminate. They also claim the shelf life of vitamin D2 is shorter than that of vitamin D3 and that this diminishes its potency and effectiveness.
According to the Vitamin D Council, D2 is two to four times less effective than D3 and produces potentially toxic metabolites. The following comes from the vitamin D Council web site: “However, D2 (ergocalciferol) is not human vitamin D, it may be a weaker agonist, it is not normally present in humans, and its consumption results in metabolic by-products not normally found in humans. It is also two to four times less effective than D3 (cholecalciferol) in raising 25(OH) D levels.”
Michael Holick, another leading medical researcher and expert on vitamin D, has concluded the opposite based on different data. His research at Boston University was published in 2008 and concluded that vitamin D2’s actions were the same as those of vitamin D3. According to Holick, “1,000 IU of vitamin D2 daily was as effective as 1,000 IU of vitamin D3 in maintaining serum 25-hydroxy vitamin D levels [the active form found in the bloodstream] and did not negatively influence serum 25-hydroxy vitamin D levels. Therefore, vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxy vitamin D status.” In other words, vitamin D2 supplements work every bit as well in maintaining adequate blood levels of vitamin D.
It’s difficult to make a definitive conclusion about the use of vitamin D2, especially when such different expert opinions exist. At present, unless I am proven wrong by new research on the subject, my conclusion is that vitamin D2 is as safe and effective as D3 as a supplement. Blood testing will certainly tell you whether or not you are getting adequate blood levels, regardless of the type and amount of D supplement you are using.
Once again, get your blood levels retested after a few months of taking any vitamin D supplement.
Dr. Zoltan P. Rona practises Complementary Medicine in Toronto and is the medical editor of The Encyclopedia of Natural Healing. He has also published several Canadian best-selling books, including Vitamin D, The Sunshine Vitamin. Visit his website at: http://www.highlevelwellness.ca For appointments, call (905) 764-8700; Office: 390 Steeles Ave. W. Unit 19, Thornhill, ON