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Notes -
To statin or not to statin.
So... my cholesterol is not good. When I was doing keto my LDL spiked to extremely high levels. I've been off keto for awhile. My LDL is down, but now my triglycerides are high.
I think the standard medical advice here would be to start taking statins. What are the downsides (if any) to statins?
There are currently way more varieties of statin (medically hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors or HMG-CoA inhibitors) than ever. The enzyme inhibited by statin consumption (typically once a day, after a meal or before bed) is involved in synthesis, within the liver, of blood cholesterol. Many of the stories creating the bad rep for statins were from, say, thirty years ago (1987 was the first year statins were available, specifically Lovastatin). Mainly used now are atorvastatin, rosuvastatin, fluvastatin, and pitafastatin, and the differences in these and why they are used are more complex than I understand but involve how much cardiovascular risk is involved for individual patients.
Having written that, I will say that there are controversies over whether a change in diet (not necessarily reducing dietary cholesterol per se, but reducing saturated fats, and increasing fiber intake) and increase in exercise can do the same thing statins do, providing better overall health and QoL over a longer time. There are also cases of idiopathic reactions to statins that have more to do with individual differences than problems with the drug itself (the same reason you see death as a possible side effect of many drugs if you read the fine print. It is possible under the exact
rightwrong circumstances that a drug will kill you.)I was prescribed Rosuvastatin about a year ago, after my TC was up to like 290 and my LDL 170. I was taken off of it after three months of much improved cholesterol levels (my HDL notably did not really go down by more than one or two (mg/DL), which is good). Then after going off statins my levels went up again and I was put on them again by a new doctor. This new doc seems much more interested that I never ever skip a day (maybe he's being paid off by AstraZeneca.)
Doctors like Robert Lustig (an endocrinologist) will say the focus on LDL is unwarranted and we should be looking at VLDL and the HDL/Triglyceride ratio. (You mentioned your triglycerides are high. That is unequivocally a red flag and opens you up to a higher likelihood of a cardiac event of some kind). Peter Attia says we should be looking at Apolipoprotein B (Apo B) as the one to keep low. Neither of these are usually measured in routine clinical settings.
To answer your question, statin use has had side effects on some, but after a month of use typically a followup visit/blood test will detect whether you're having a bad reaction (fatigue, myalgia, problems in the liver, etc.) My answer as usual is to communicate clearly with your doctor and ask questions and insist on as unambiguous an answer as possible. Also don't be afraid to ask for certain checks/tests, though depending on where you are and insurance requirements, etc. I don't know how effective that will be.
Warning/caveat, this is not my specialty.
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IRRC once you are on statins, it’s dangerous to ever stop them. I could be wrong on that though, I’m not a doctor.
I'm not sure where you read that or if you may have read that this occurs in certain circumstances, but I know that in Japan, for instance, it is routine to stop prescriptions for certain statins (e.g. rosuvastatin) after 90 days to check then cholesterol levels after a period. There is no danger except for cholesterol levels rising again, as far as I am aware.
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