Statins, Probiotics, and All That Stuff

I have never come to terms with a “right” decision when it comes to statins and have mostly refused them. But I have read research articles in the last year or two that specifically address Type 1 and indicate that statins are beneficial and I need to be more open minded. For sure it makes my internist visits easier when I take statins and I don’t get “the lecture.”

I am currently taking a statin (Pravastatin—only 2 pills per week) and have the same digestive side effects (OK, constipation) that I had with Atorvastatin. I am working hard to eat lots of fiber and that does help. At the same time I refuse to start using things like Metamucil because I didn’t need it before statins. But I am open to taking probiotics.

Do any of you have recommendations on a good probiotic and do you think it will make a difference?

And as always I am interested in discussing statins as I walk the tightrope of not embracing them while CMA and taking them in limited doses.

I take Atorvastatin and also had constipation issues. A combination of Chia seeds, chopped walnuts and almonds that I buy in bulk at a big box retail store totally cured my issue. Just need to watch out and limit intake of these or you will end up with the reverse issue. You can get very creative where to add these items in your food plan.

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I was floored when the pharmacist called me at home to ask why I wasn’t on a statin. As a person with fibromyalgia and immaculate cholesterol, I just have no desire. I don’t need any muscular issues. Oh, and then there are the confrontations at the cash register…um, no. Just no.

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I’m very similar to you. Initially I refused statins, but when I really read the research in a truly unbiased way, I decided to take them. I’d rather take them and find in 30 years that they’ve prevented heart issues than not take them and find in 30 years they could have prevented heart issues. I could always stop taking them or switch to another medication if side effects were an issue, but that hasn’t been an issue thus far.

I’m taking a minimum dose of 5 mg a day of Crestor. It’s lowered my cholesterol so much that if it’s any lower next time it’s checked, I’m going to ask my doctor if I can take half a pill a day, as that may be just as effective.

Metamucil is just psyllium husk powder. I use psyllium husks all the time in my cooking. You can buy psyllium husks or psyllium husk powder at places like Whole Foods. So it might be something you can just incorporate into your cooking or eating plan without having to start a new “medication” to mitigate side effects.

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I hesitated to comment as I thought you might want to only discuss the digestive side effects of statins and adding fiber supplements. But this part of your post seems to open the door to the whole issue of whether to take statins or not.

I quit taking statins about seven years ago after taking atorvastatin (Lipitor) 40 mg/day for about 10 years. I didn’t suffer any obvious side effects but reasoned that taking a drug to treat a cholesterol number didn’t make any sense to me.

Of course, my endocrinologist then and now as well as the cardiologist I’ve seen more recently, don’t agree with me, at all. With all the reading of the medical literature that I’ve done on this topic, I remain unconvinced that high cholesterol causes adverse cardiac events like heart attacks and strokes.

I had read many times that researchers and academics think that there is some, yet to be identified, positive effect, an “x-factor” so to speak that makes taking statins a good idea. I’ve read the word, “pleiotropic,” associated with statin use. It simply means that a statin produces more than one effect and implies that this extra effect is a positive therapeutic one.

The doctors emphasize the cholesterol lowering effect of statins since that allows them to stand on firm scientific ground. Statins do lower cholesterol. But this extra effect does interest me. In one interview of a UK general practitioner who has done extensive reading of the medical literature on this topic, he said he believes that statins may end up producing nitric oxide in the blood.

Nitric oxide is a known vaso-dilator and exerts a positive effect on the heart. It helps blood vessels relax and also can lower blood pressure. This UK doctor is a statin skeptic but thinks that statins are appropriate in secondary prevention. In other words, in case where a heart attack, stroke, or arrhythmia has already occurred. Some doctors view diabetes as an equivalent event and places diabetics in the secondary prevention class of patients.

Since I am a T1D and, more importantly, received a high score on a coronary artery calcium (CAC) scan, my cardiologist feels strongly that I should be taking a statin. I felt strong disagreement a year ago but now I’m wondering that maybe this pleiotropic benefit should persuade me to reconsider.

What holds me back is the incidence of bad side-effects, not just the muscle ache ones. Statin use is associated with cognitive impairment in the elderly. What really worries me are deleterious side effects that may build up over time and later declared irreversible.

I could write more but don’t want to hijack the main intent of your post. I think you should be able to mitigate this digestive challenge, Laddie. I’ve used probiotics and have good luck with the ones I buy at a pharmacy where they’re stored in a refrigerator. Here’s the one I’m using now.

I also mixed up potato starch with water and drank every night before bed for many years. I thought it benefitted me but have fallen out of the habit recently. Potato starch is a resistant starch that is not digested until it get to the lower gastro-intestinal tract and feeds the good gut bacteria. There are studies going back decades that support this idea. I really should restart this habit.

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Laddie- as you we’ll know, there is no right or wrong dealing with anything in the diabetes sphere. If it works for you, it’s right for you.
I have been using a statin for a very, very long time. Lowest dose, no cholesterol issues ever but major family history of heart disease on both sides of the family. So for me prevention is key focus.
I had some digestive issues at the start but they faded quickly and don’t have any issues now. My only suggestion is just keep experimenting. You will find something that helps. Good luck with whatever you find that works for you.

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@Terry4, I absolutely wanted your opinions and thank you for chiming in. This is the 3rd or 4th time I’ve started statins and that’s proof of how “I just don’t know.” My cholesterol is not horrible but my LDL is minutely above range. My numbers were always fabulous when I was younger but changing as I age. But my doctor emphasizes the “pleiotropic" side of them and talks about cardiovascular disease in T1’s as often being diffuse and not amenable to things like stents and not always found through traditional coronary tests.

I started probiotics a week ago and think that they are helping. Since I am also on prescription-strength Nsaids for arthritis, it is probably a good idea to take probiotics. I really don’t want to start taking things like Metamucil and am working hard to increase fiber in what I already think is my high-fiber diet.

My doctor has given me permission to determine the dose of statins and my aim is to take 3 pills per week. Either that will be enough to get me the benefits without too many side effects or it will not be enough to get me substantial benefits and I’ll still have side effects.

I find it interesting that my doctor looks at me like I’m crazy when I talk about digestive side effects and this group talks as though it is very common.

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I am a whole foods type of person. The less processed the better. I also have celiac disease and insulin resistance. I do not take any stains and my cholesterol levels are reasonable. From my personal research, I think other factors play into developing heart disease. I do not take any probiotics, but instead look to fermented foods sources like yogurt. Here is the latest on possible dangers of probiotics.

I would personally avoid probiotics. The dangers of developing SIBO, which is common in celiac disease, are too great for me. When tested over 60% of probiotics contained gluten even when clearly marked gluten free or did not contain gluten. Supplements are another processed food that is not regulated by the FDA (and that might not help either based on my research of generic drugs almost all made or sourced from India and China).

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I just got back from visiting my endo and my diabetic control for this time of year is near perfect with an A1C and GMI of 5.6, standard deviation of 20 which is my normal for this time of year with many birthday, office and other parties and holidays. Then she says this was my last warning that my LDL had been steady at 70 for years before going on Low Carb diet and in past 1 year+ has slowly been rising first to 85 in July and now to 93 in December.

I have been on 40mg of Atorvastatin for several years and she says If I don’t start trending down, I am headed for 80 mg instead of my current 40mg. She has given me 6 months to work it down or at least stabilize it as we all agree a LCHF diet will raise LDL. There is huge controversy between us engineer minded folks and the medical field about the potential risks be they cognitive or heart-related caused by elevated LDL.

So rather than fight with my endo, I negotiated a 6-month hiatus at my current level and if I can’t stabilize, then I will take a higher dose. When I got home, I took a look in the fridge and freezer and realized that everything needs to be done in moderation and my cheese habits, as a native Swiss, are certainly not moderate. There were 18 packs of Philadelphia cream cheese ready to be turned into my next batch of cheesecake plus a couple of lbs + each of Mozzarella, Provolone, Cheddar, Parmesan,Romano, Swiss, Mascarpone and a few other esoteric cheese along with 2 quarts of heavy whipping cream and plenty of meats with lots of saturated fats, a fresh batch of homemade pesto and a freshly made Tiramisu semifreddo. Just looking at all that fat, it is hard to fathom how at 5’9" I remain at a steady 125 lbs. I do have lots of “good foods” in the fridge/freezer as well.

I took a deep breath, eyes welling up, decided to cut my daily cheese consumption and saturated fats by 75% for the next several weeks and measure my cholesterol once a week to see if I can reverse or at least stabilize my LDL trend. My heritage also makes me a chocoholic but at least that daily consumption is small compared to cheese.

It will be interesting to see where this journey leads me, hopefully one to an even lower statin dose and I will even dream of the possibility of totally going off of my statin over time.

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It’s not simply the cholesterol number. It’s the vascular inflammatory process that causes plaque to build which is interrupted by statins. That is why they’re recommended for people who are determined to be at higher risk regardless of their cholesterol levels.

Yes, it’s the secondary benefit that’s harder to define but more important to many type 1s. It’s not just about lowering cholesterol.

It’s been a head shaker for me to read on these forums sometimes people noting studies where people on statins had greater mortality than those not on them. Well yeah! Duh! They’re on the statins because they’re at higher risk! it’s a false comparison… the valid comparison would be to study the outcomes of those for whom statins are indicated by their risk assessments (as determined by their doctors) and don’t take them vs those who do…

@Laddie I’d not hesitate to use a psyllium fiber supplement (watch out for added sugars though). Pretty good evidence that the more fiber you Can get the better regardless of whether they’re needed for regularity.

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CJ114, like you I was struggling to reach cholesterol goals. Rather than increase the dose of Lipitor, my doc added Ezetimibe to the mix and it has done wonders to lower my cholesterol level. Just amazing. Somehow it works in concert with other statins without larger doses. See if that might be an option for you.

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Laddie, in addition to me having T1 for almost 40 years now, every single male on my fathers side of the family has cardio problems. Many of them dead from cardio issues.

I did the research on cholesterol and meds and welcomed it when my docs recommending statins. And now that I’m AARP eligible I have no problem scheduling appointments with cardiologists and running stress tests.

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Tim, thank you. I am first going to try to reduce my saturated fats and monitor the results. I have a hospital grade lipid analyzer on order and plan to test my cholesterol at least once a week and see if I can adjust my food to alleviate my climbing LDL. I talked with my 98 year old mother who for years no matter what statins she was put on, her numbers were through the roof. I asked here how she was doing now and she told me that her problem with cholesterol totally went away after moving into a senior living facility a dozen or so years ago where she usually chooses to eat her meal in their dining room rather than prepare her own.

She had the same bad habit I have which is eating lots of cheese on a daily basis as well as other saturated fats.

This will be an interesting experiment and I will post results if I feel they can be of value to others on this board.

Thanks again for insights on how you were able to handle your cholesterol issue.

Agreed with both of these points. It seems likely that statins prevent cardiac disease not directly via lowered cholesterol but through anti-inflammatory effects. They also definitely lower cholesterol, but that’s not the mechanism. Which brings up whether this is ever even about “treating cholesterol” vs treating metabolic risk. Statins are probably most warranted for people with higher cardiac/metabolic risk, whether that’s prior cardiac events or multiple risk factors for metabolic disease or whatnot. Diabetes is definitely a risk factor, particularly T2 diabetes which is itself a metabolic disease. I think it’s harder to determine the extent to which well controlled T1, in absence of other cardiac risk factors, increases risk. Probably if I were not already on a slew of meds and already suffering from intense muscle pain as part of my regular life, I’d go on a statin preventatively and see how that worked for me, for similar reasoning as @Jen. However, given the potential cons/additional interactions for me, I’ve decided not to for now. That said, if my cardiac risk factors increased somehow (whether or not my cholesterol did), that would likely shift the pros/cons equation for me. But it’s all a bit of a guessing game as to where the right lines are, which is what your doctor is doing (usually erring strongly on the side of being conservative) when making recommendations.

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I agree it is frustrating that the research isn’t more specific as not all of the comorbidities of t1 and T2 are exactly the same… eg t2 are more likely statistically to also be overweight etc. but the best indicators we have is that in “people with diabetes” they are warranted due to their increased cardiac risk factors. I’d like to see those categories fine tuned a little more too.

Both of the last 2 doctors I’ve seen have told me I should be on low dose statins, even though I’m 37 and have normal cholesterol. I agreed to watch it closely and monitor it with the one I hired and will start statin therapy if that’s what they still recommend when I reach 40…

I’ve taken statins when initially diagnosed with diabetes, did not experience any side effects or muscle aches whatsoever

I find the idea of high cholesterol combined with inflammation and hyperinsulinemia as important markers of increased cardiac risk. My hsCRP, a blood test to detect overall inflammation, consistently measures in the mid-normal range. Since I have eliminated all grains in my diet, I believe that this minimizes chronic inflammation due to food.

HIgh levels of insulin drives insulin resistance and is a marker of the metabolic syndrome. Back in 2012, I was infusing 80 units/day and weighed 30 pounds more than I do now. These days my average daily dose of insulin is about 32 units. I think high insulin and high blood sugar both inflame blood vessels. I feel good about where I stand with these two measures.

I think there are a lot more problems with the side effects of statins than reported. I remember reading a statistic about the high number of people who drop their statins within the first year. The statin studies often employed a “wash-out” period whereby people with muscle aches and other side-effects were screened out before the study even started.

What I would fear is finding out after long-term statin use that I was experiencing non-reversible side effects with doctors exclaiming, “we just didn’t know.”

We all must make our treatment choices without all the information. I’m happy, however, that we have much more info on health issues than we had even a few years ago.

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Sam19, you are fortunate that you can take statins without having problems with side effects. I received two heart stents after 51 yrs of being a type 1. That was in 2010 after several years on the Bernstein diet. My LDL was about 160 and my HDL was 100. My A1C was 4.6.

I have tried many statins since then, but they cause me too many side effects. On a low fat, plant based diet by LDL is 117. Still supposedly too high. Now I am going to try an injectable drug to reduce my LDL. I am not excited about it. My carotid arteries are OK.

My husband has been taking statins for years and they have caused him to a have a borderline A1c.

Taking statins is not easy for everyone. The side effects can be brutal.

They can be, and they can be totally nonexistent. I am just concerned that the overwhelming cultural momentum online is to discourage their use in spite of all medical advice… and I think that can have very bad consequences that can reach far and wide.

And as I mentioned it’s not just about the ldl, that’s an afterthought when it comes to their real benefit… they break the chain reaction that leads to arterial plaque… which is why they’re considered standard of care for all diabetics over 40 without regard to their lipid levels… it’s not just lazy medicine or lack of thought on the matter that led to those recommendations.

Diabetics over 40 are the highest risk group for heart disease… even higher than people who’ve already had one cardiac event… So I certainly intend on giving myself every advantage against the illness that will statistically most likely ultimately take my life… and if I encounter side effects I’ll try hard to work through them in consult with my doctor to find other more tolerable doses or formulations…

I tried a very small dose, but Zetia and the generic Crestor gave me neuropathy which I had never had before. I later discovered that both of these medications list neuropathy as a side effect. Several gave me crippling muscle pain and another raised my liver enzymes. I hope that you never suffer with a horrible side effect.

I would definitely take a satin if I could.

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Sex is a factor too—pre-menopause, women are at lower risk, but post-menopause, that shifts to be more similar to men. So I think if I were male or post-menopause, that might also factor into my thinking.

One thing that does concern me in the conversations about statins is the focus on cholesterol given that that may not be the actual issue but almost a side effect of statin use. If anti-inflammatory factors are the issue, trying different things to lower cholesterol may be less important if statins don’t work and/or if someone wants to augment them than finding different ways to reduce inflammation (with diet, for instance). For example, chronic mental health problems increase cardiac risk over and above factors traditionally considered to be metabolic health issues and indicators, and we know that those mental health problems are also linked to increased inflammation. It may be that monitoring inflammatory markers (cytokines, IL-6, etc) is something we all need to be doing and more focused on than cholesterol as a way to monitor both overall and metabolic health. I would not be surprised if over time, this becomes less about “treating cholesterol” and more about treating chronic inflammation on as many fronts as possible. Statins will likely remain one tool in that, but are far from the only option.

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