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Adverse effects of statins

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3306 (Published 15 May 2014) Cite this as: BMJ 2014;348:g3306

Rapid Response:

Re: Adverse effects of statins

Statistics are highly relevant if you are the one who suffers an adverse or a positive reaction, whether from a medicine such as a statin or a vaccination. All parties need to be furnished with the full and honest facts. Surely this is not something to be argued with?
The use of statins is just one small part of the whole cholesterol debate which has divided opinion for the last thirty to forty years.
How much damage has been wreaked by the low fat diet fad (often accompanied inexplicably by a high carbohydrate diet) which has been aimed to stem the tide of obesity and associated diseases?
A wealth of evidence has established that cholesterol lowering statin drugs, widely used for the prevention of cardiovascular disease, do increase the risk of new-onset diabetes. (Type 2) (1)
How do efforts to reduce cholesterol levels in existing cases of diabetes effect these individuals? Type 2 diabetes constitutes a high risk factor for developing cardiovascular disease. Diabetes has therefore been a prime target market for statin therapy, including type 1 diabetes; a disease with an entirely different aetiology.
Statin therapy is not the only method involved in cholesterol management. Low fat ‘functional foods’ need urgent investigation too. Cholesterol lowering spreads and low fat margarines are recommended for inclusion within the diabetic diet. This adds a further cholesterol lowering element to the diet. Despite cholesterol lowering spreads not being recommended by organisations such as NICE. (2) These products are blatantly advertised in medical centres.
Commercialised/medicalised marketing of various low far spreads and margarines claim efficacy in cholesterol lowering and therefore being heart friendly. The link between the food and drug industries and these products is unacceptable. How much of the perceived problems of ‘good and bad’ cholesterol have been hyped by commercial interest and bias?
It is widely acknowledged that omega 3 essential fatty acid (EFA) plays a vital role in homeostatic functions within the human body, notably the eicossanoid balance. Omega 3 (balanced with the correct ratio of omega 6) is essential,
The modern diet has overemphasised the need to consume polyunsaturated fats in the belief that they were a healthy choice, particularly in cholesterol management.
The biological mechanisms (delta 5 and delta 6 desaturases) required for the uptake of essential fatty acids such as omega 3 and 6 are impaired in those with diabetes (particularly type 2 diabetes (T2DM), a population group at high risk of cardiovascular disease).
The successful absorption of EFAs also relies on adequate levels of certain vitamins and minerals. The poor absorption of EFAs is further confounded by consuming a high carbohydrate diet such as recommended to those with T2DM. High blood glucose levels also impair the absorption of EFAs
Over nutrition triggers the onset of oxidative stress in the liver due to higher availability and oxidation of fatty acids, with development of hyperinsulinemia and insulin resistance, and omega 3 long-chain polyunsaturated FA depletion, with enhancement in the omegas 6/3 LCPUFA ratio favouring a pro-inflammatory state. (3)
Commercial food processing destroys a significant amount of EFAs, along with their oxygenating ability. Consumption of good quality omega 6 and 3 EFAs is a haphazard affair. Polyunsaturated oils are unstable and very quickly become rancid. Oxidized fatty acids are dangerous to our health. Lipid peroxidation and oxidative stress are important factors in this damage. (4)
Further damage is also caused by heating polyunsaturated fats in cooking (particularly frying foods).
A high fruit and vegetable consumption has a favourable effect on plasma antioxidant concentrations. (5) However, vitamin content of food is variable with age, conditions of storage and cooking methods. Modern farming methods and soil depletion have also left many foods nutritionally barren.
.Many omega 3 research trials did not consider the omega 3/6 essential fatty acid ratio which is vital to the eicossanoid balance. The correct omega 3/6 ratio is fundamental to holistic health for all. I believe that with simple dietary intervention diabetes complications such as retinopathy, nephropathy and cardiovascular problems could be ameliorated or prevented. Would it not be advisable to correct the inadequacies in the diet and lifestyle than rely on the actions of a cholesterol lowering drug such as a statin?
Further concerns of statin use have also been highlighted in the BMJ by Dr Ellen Grant who points out statins block the endogenous production of co-enzyme Q10 (CoQ10) (6) Others have also shared her concerns.(7)(8)(9) Studies conducted on CoQ10 levels provide a gathering body of evidence highlighting the importance of CoQ10 in diabetes management.(10)(11)(12) Further studies in the role of co-enzyme Q10 are obviously needed.
The vital importance of the homeostatic balance cannot be underestimated in human health. Unfortunately this is all but a small aspect of a diet related disease epidemic which is threatening world health. The statin debate which has arisen from the article by the BMJ editor Fiona Godlee (13) is very welcome and will hopefully bring positive developments in public health

(1) Do statins cause diabetes? Goldstein MR1, Mascitelli L. Curr Diab Rep. 2013 Jun;13(3):381-90. doi: 10.1007/s11892-013-0368-x. http://www.ncbi.nlm.nih.gov/pubmed/23456437
(2) Lowering cholesterol to reduce the risk of heart ... - Nice www.nice.org.uk/nicemedia/live/11982/40712/40712.pdf
(3) Valenzuela R, Videla LA.The importance of the long-chain polyunsaturated fatty acid n-6/n-3 ratio in development of non-alcoholic fatty liver associated with obesity. Food Funct. 2011 Nov;2(11):644-8. doi: 10.1039/c1fo10133a. Epub 2011 Oct 19.
(4) Moore, K., and L. J. Roberts 2nd. 1998. Measurement of lipid peroxidation. Free Radic. Res. 28: 659–671
(5) John J et al (2002) Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood.
(6)Ellen CG Grant,Rapid response. Inevitable adverse effects due to blockage of co-enzyme Q10?
http://www.bmj.com/content/348/bmj.g3306/rr/698281
(7) David L Keller Rapid response. Discussion of Dr. Grant's point regarding coenzyme Q10
http://www.bmj.com/content/348/bmj.g3306/rr/698414
(8) Sergio Stagnaro. Rapid response. Adverse effects of statins. http://www.bmj.com/content/348/bmj.g3306/rr/698206
(9) Andrew N Bamji. Rapid response. Adverse effects of statins.http://www.bmj.com/content/348/bmj.g3306/rr/698457
(10) Mitochondrial factors in the pathogenesis of diabetes: a hypothesis for treatment. Lamson, D.W.. Plaza S.M. Altern Med Rev, 2002. 7(2): p. 94-111.
(11) Brownlee, M., The pathobiology of diabetic complications: a unifying mechanism. Diabetes, 2005. 54(6): p. 1615-25.
(12) CoEnzyme Q10:The State of the Science in Diabetes Ryan Bradley, ND, MPHDiabetes Action Research and Education Foundation February 2007 http://www.diabetesaction.org/site/PageServer?pagename=complementary_2_07
(13) Godlee F. Adverse effects of statins. BMJ 2014;348:g3306

Competing interests: No competing interests

23 May 2014
Jane E Collis
Independent Researcher
No affiliation
Penrhyn Close, Kenilworth Warks UK