Use of nutraceuticals to manage the side effects of statins

Use of nutraceuticals to manage the side effects of statins

Use of nutraceuticals to manage the side effects of statins

By Prof. Gene Bruno, MS, MHS, RH(AHG) Huntington College of Health Sciences

In allopathic medicine, statin drugs (HMG-CoA reductase inhibitors) are the standard therapy for the treatment of hypercholesterolemia. Certainly there is a significant body of research showing that statins are effective for this purpose, although such therapy is not without the risk of side effects. To some extent, the risk of side effects can be managed through the use of specific nutraceuticals.

Statins, myopathy and coenzyme Q10
Musculoskeletal symptoms (e.g., myopathy) are perhaps the most commonly reported side effects associated with statin therapy.1 Myopathy may be related in part to statins' inhibition of endogenous synthesis of coenzyme Q10 (CoQ10), an essential cofactor for mitochondrial energy production.2 Therefore, it is not surprising that there are studies showing that a CoQ10 supplementation may reduce muscular side effects caused by statins. In some research, patients with statin-induced myopathy taking 100 mg/CoQ10 had significantly reduced pain intensity compared to baseline, and compared to a control group after 30 days of treatment for cancer, coenzyme Q10 supplementation reduced dose-limiting statin toxicity in myopathy.4-5 However, it should be noted that other research did not find this have found that CoQ10 significantly improves pain associated with statin-induced myopathy compared to placebo.6-7

Statins and beta-sitosterol absorption
Beta-sitosterol and other plant sterols have been shown to be effective in reducing the absorption of dietary cholesterol and therefore serum cholesterol levels.8-9 In fact, the research is so convincing that the FDA (US Food and Drug Administration) has actually approved a health claim for plant sterols, indicating that their consumption (in combination with an appropriate diet) reduces the risk of May reduce heart disease by lowering cholesterol levels. In addition, there are several studies demonstrating the effectiveness of beta-sitosterol in reducing lower urinary tract symptoms (LUTS) in men (particularly in cases of BPH).10-16

Since a 2016 systematic review and meta-analysis found that men with LUTS are at increased risk of major adverse cardiac events (P = 0.01), 17 it is likely that men using beta-sitosterol supplements for LUTS may also be taking medications for LUTS to help lower serum cholesterol levels. This can be problematic because the statin drug pravastatin (another cholesterol-lowering drug) can also reduce blood levels of beta-sitosterol by about 60 percent after four weeks.18 Theoretically, this could occur with other HMG-CoA reductase inhibitors, although this does not appear to be the case with simvastatin.19 Likewise, the cholesterol-lowering drug has been shown to Ezetimibe lowers blood levels of beta-sitosterol by about 40 percent.20-21 This is the case for men who use beta-sitosterol for LUTS, it is worth increasing the dose by 40 to 60 percent if they are also taking statins or ezetimibe.

References
1 Backes JM, Ruisinger JF, Gibson CA, Moriarty PM. Statin-associated muscle symptoms – dealing with those who are highly intolerant.J Clin Lipidol. 2017 Jan – Feb;11(1):24-33. 2 Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of Coenzyme Q10 on Myopathic Symptoms in Statin-Treated Patients.Am J Cardiol. May 15, 2007;99(10):1409-12. 3 Kelly P, Vasu S, Getato M, McNurlan M, Lawson WE. Coenzyme Q10 improves myopathic pain in patients treated with statins (abstr).J Am Coll Cardiol2005;45:3A. 4 Thibault A, Samid D, Tompkins AC, et al. Phase I study of lovastatin, a mevalonate pathway inhibitor, in cancer patients.Clinic Cancer Res1996;2:483-91. 5 Kim WS, Kim MM, Choi HJ, et al. Phase II study of high-dose lovastatin in patients with advanced gastric adenocarcinoma.Invest in new medicines2001;19:81-3. 6 L. Marcoff, P.D. Thompson. The role of coenzyme Q10 in statin-associated myopathy: a systematic review.J Am Coll Cardiol2007;49:2231-7. 7 Young JM, Florkowski CM Molyneux SL McEwan RG Frampton CM George PM. Coenzyme Q10 does not improve the tolerability of simvastatin in patients with dyslipidemia and previous statin-induced myalgia.Traffic2007;114:II41. 8 Racette SB, Lin X, Lefevre M, Spearie CA, Most MM, Ma L, Ostlund RE Jr. Dose effects of dietary phytosterols on cholesterol metabolism: a controlled feeding study.Am J Clin Nutr.2010 Jan;91(1):32-8. 9 Hendriks HF, Weststrate JA, van Vliet T, Meijer GW. Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol reduction in normocholesterolemic and mildly hypercholesterolemic individuals.Your J Clin Nutr. 1999 Apr;53(4):319-27. 10 Klippel KF, Hiltl DM, Schipp B. A multicenter, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH Phyto Study Group.Br. J. Urol1997;80(3):427-32. 11 Berges RR,wickeler J, Trampisch HJ, Senge T. Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Beta-Sitosterol Study Group.lancet1995;345(8964):1529-32. 12 Fischer A, Jurincic-Windlder CD, Klippel KF. Conservative treatment of benign prostatic hyperplasia with high-dose b-sitosterol (65 mg): Results of a placebo-controlled double-blind study.Uroscope1993;1:12-20. 13 Y. Kobayashi, Y. Sugaya, A. Tokue. [Clinical effects of beta-sitosterol (phytosterol) on benign prostatic hyperplasia: preliminary study] [Article in Japanese]Hinyokika Kiyo1998;44(12):865-8. 14 Berges RR, Kassen A, Senge T. Treatment of symptomatic benign prostatic hyperplasia with beta-sitosterol: an 18-month follow-up.BJU International2000;85(7):842-6. 15 Wilt TJ, MacDonald R, Ishani A. Beta-sitosterol for the treatment of benign prostatic hyperplasia: a systematic review.BJU International1999;83(9):976-83. 16 Wilt T, Ishani A, MacDonald R, Stark G, Mulrow CD, Lau J. Beta-sitosterols for benign prostatic hyperplasia.Cochrane database of systematic reviews1999;(3)Art. No.: CD001043; DOI: 10.1002/14651858. CD001043. 17 M. Gacci, G. Corona, A. Sebastianelli, S. Serni, C. De Nunzio, M. Maggi, L. Vignozzi, G. Novara, KT McVary, SA Kaplan, S. Gravas, C. Chapple and meta-analysis.Your Urol.July 20, 2016. pii: S0302-2838(16)30405-5. 18 Hidaka H, ​​Kojima H, Kawabata T, et al. Effects of an HMG-CoA reductase inhibitor, pravastatin, and bile-sequestering resin, cholestyramine, on plasma plant sterol levels in patients with hypercholesterolemia.J Atheroscler Thromb1995;2:60-5. 19 Ntanios FY, Jones PJ, Fröhlich JJ. Effect of 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor on sterol absorption in patients with hypercholesterolemia.metabolism1999;48:68-73. 20 Salen G, von Bergmann K, Lutjohann D, et al. Ezetimibe effectively reduces plasma plant sterols in patients with sitosterolemia.Traffic2004;109:966-71. 21 Sudhop T., Lutjohann D., Kodal A., et al. Inhibition of intestinal cholesterol absorption by ezetimibe in humans.Traffic2002;106:1943-8.

Professor Gene Bruno, MS, MHS, the provost for Huntington College of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 37 years, he has educated and trained natural products retailers and healthcare professionals, researched and formulated natural products for dozens of dietary supplement companies, and written articles on nutrition, herbal medicine, nutraceuticals, and integrative health topics for trade and consumer magazines and peer-reviewed publications. He can be reached at gbruno@hchs.edu.

• Allopathische Medizin
• Beta-Sitosterol-Absorption
• Coenzym Q10
• coq10
• FDA
• HMG-CoA-Reduktase-Inhibitoren
• Symptome der unteren Harnwege
• LUTS
• Muskel-Skelett-Symptome
• Myopathie
• Patienten
• Pflanzensterine
• Prof. Gene Bruno Blog
• Senkung des Cholesterinspiegels im Serum
• Statin-Medikamente
• Statin-Therapie
• Behandlung
• US Food and Drug Administration

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