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Cholesterol - The Statins and Diabetes

By David Mendosa

Last Update: June 2, 2006

I would do just about anything to bring down my cholesterol levels. High cholesterol is just too closely associated with heart attacks and strokes for my taste. I’m so serious about this that I even went on vacation this month. I drove 440 miles roundtrip to Yosemite National Park. It was my first visit in half a century.

Give me anything but a statin!

Vacationing has got to be good for lowering the bad kinds of cholesterol. Even though I failed to scale Half Dome or El Capitan on this trip, the exercise as I walked to the base of Yosemite Falls, along the Merced River, to the Museum and Ansel Adams Gallery from the Ahwahnee Hotel certainly had to bring down those numbers. Sniffing the negative ions from the 2,425 foot falls, the highest in North America, had to help. So too did the stress management in such a setting.

There is a stress-cholesterol connection, according to Prevention Magazine. The effects are both direct and indirect.

At the same time I started taking fish oil again. Each teaspoon of the highly recommended Carlson fish oil from the cold Norwegian waters contains 1600 mg of omega-3 fatty acids, including 800 mg of EPA (Eicosapentaenoic acid) and 500 mg of DHA (Docosahexaenoic Acid). To get the recommended dose for my weight I take 2 tablespoons per day divided into two doses.

The most reliable source for alternative treatments is The Natural Pharmacist. It links almost 30 studies of the benefits of fish oil in controlling high cholesterol.

Earlier, I had used Jarrow’s Max DHA. This fish oil is concentrated by increasing DHA four-fold to 50 percent while maintaining EPA at only 20 percent.

I took that fish oil on the recommendation of Yvonne Denkins, then of the Pennington Biomedical Research Center in Baton Rouge, Louisiana. She presented her research at the Experimental Biology 2002 conference in New Orleans. It indicated that DHA appeared to improve the function of insulin in people who are overweight. However, she never published her research, which has not been subsequently confirmed by others.

I am also improving my omega 3:omega 6 ratio (higher is better) by eating more bison (buffalo) and less beef. Bison is also much lower in fat, typically containing 2 grams in a 3 ounce serving, compared with 15 grams in a lean beef steak.

A study that The National Bison Association funded found that bison was not just healthier than beef in terms of cholesterol. It was also healthier than soy protein, which in 2000 the FDA found decreased the risk of coronary heart disease. So, I make sure to take ample soy in my daily diet too.

Studies also show that taking large quantities of soluble fiber such as psyllium, glucomannan, pectin, guar, barley, and oat bran reduce cholesterol. I use psyllium.

I also start my day with a bowl of oatmeal, which also has proven cholesterol-lowering benefits. I prefer McCann's Irish oatmeal and give my recipe at My Favorite Low Carb and Low GI Foods.

The cholesterol-lowering benefit of stanols is well documented. I once used Benecol, but stopped, because it has some transfat.

Kefir is the most recent addition to my diet (see http://www.mendosa.com/diabetes_update_71.htm. Among kefir’s many benefits are its ability to reduce cholesterol, according to three studies cited in The Natural Pharmacist.

So what I don’t do to treat my high cholesterol is accept the medical establishment’s usual recommendation to take one of the statins. Over the past two years I have tried almost all of them, and all of these I tried caused terrible muscle pains in my right leg. Zocor was the worst. I couldn’t sleep for hours until heavy duty pain killers kicked in. Next in their pain quotient were Lipitor, Pravachol, and Mevacor. The only ones I didn’t try were Lescol and Crestor, but when I saw a pattern I decided to skip them. The muscle pains I experienced fall in the adverse reactions category of myalgia, “Muscular pain or tenderness, especially when diffuse and nonspecific” as reported in each of these drug’s Prescribing Informations. Zocor users reported it is 1.2 percent of the cases, which wasn’t much, particularly when you consider that users of a placebo reported it 1.3 percent of the time. Of the people on Pravachol in one study 0.6 percent myalgia was attributed to the drug compared with 0 percent of those on a placebo.

The results for the other statins were similar:

  1. Lipitor: up to 5.6 percent for 20 mg dose compared with 1.1 percent for placebo.
  2. Mevacor: up to 3.0 percent for 40 mg dose twice a day compared with 1.7 percent for placebo.
  3. Lescol: up to 2.7 percent for 80 mg dose compared with 2.3 percent for placebo.
  4. Crestor: myalgia 2.8 v. 1.3 for placebo.

Officially, however, the big news this month is just the opposite. New clinical guidelines from the American College of Physicians, “Lipid Control in the Management of Type 2 Diabetes Mellitus,” Ann Intern Med. 2004 Apr 20;140(8):644-9, recommended on the basis of a meta-analysis of the literature that almost everyone with type 2 diabetes should take a statin drug.

Earlier this year the American Diabetes Association release new clinical practice recommendations, updated on the basis of recent studies. The recommendations included one that in people with diabetes over the age of 40 with a total cholesterol of 135 mg/dl, statin therapy should be used to achieve an LDL reduction of approximately 30 percent regardless of baseline LDL levels.

They say that the average person should try to maintain an LDL (bad) cholesterol level below 130 mg/dl. But those of us who have heart disease or diabetes, the goal is less than 100 mg/dl. Mine is still above that level. When it comes into range, I will certainly add an update to the Web page. 

New Update: Policosanol

We thought that policosanol was a natural remedy for high cholesterol. But a German study published in the May 17, 2006, issue JAMA, The Journal of the American Medical Association found that it doesn’t work. The abstract is online.

They studied 143 adults with low-density lipoprotein (LDL) cholesterol levels of 150mg/dl or more. At random the people studied took doses of 10, 20, 40, and 80mg of policosanol or placebo. But when the study finished three months later the researchers didn’t find any significant differences in the cholesterol levels of the people in the study.


Earlier Update: Policosanol

Right after I featured this article in the June issue of Diabetes Update, several correspondents wrote to tell me about their use of policosanol to control their cholesterol. Somehow in my research I had missed it, but I immediate investigated it. I found it to be effective, well-tested, and safe. I checked it out in The Natural Pharmacist, which is in my view the only reliable guide to alternative medicine, and found a very positive review. See http://www.memorialhospitaljax.com/healthcontent.asp?page=/choice/demonstration/TheNaturalPharmacist-Consumer. See also Dr. Michael Janson’s report at http://www.drjanson.com/djhl-html/2004/news-2004-01.htm.

Policosanol is a mixture of waxy alcohols derived from sugar cane and other sources, including beeswax. However, “there is reason for concern that such [beeswax] products may not be effective,” according to The Natural Pharmacist.

It appears that the best policosanol is derived from sugar cane. Policosanol contains several long chain fatty alcohols, including about 60 percent octacosanol, plus hexacosanol and triacontanol. One correspondent recommended the Source Naturals brand, with which I was already familiar and comfortable. They advertise that the source of their policosanol is sugar cane, but don’t mention the proportion of octacosanol. A call to their customer service staff, however, told me that they test it and that it is 61.23 percent octacosanol.

The recommended dose is two 10 mg tablets daily. It’s best to take them with the evening meal, one correspondent who has researched the literature tells me. It can take up to two months to see the result. I will let you know.

Policosanol is a blood thinner, enhancing the blood-thinning effects of aspirin. Consequently, you shouldn’t take it with aspirin or other blood-thinning drugs.

Another correspondent tells me that the best prices he has found for “Source Naturals” products is the Absolute Sports Nutrition website at http://www.asnutrition.com/details.asp?ProductID=9871&ProdgroupID=9871. I ordered it there.


Update: Niacin

You can find niacin or or nicotinic acid — another name for vitamin B3 — in dairy products, poultry, fish, lean meats, nuts, and eggs. Legumes and enriched breads and cereals also supply some niacin.

The amount of niacin in a reasonably healthy diet can prevent the most serious defficience, pellagra. Its symptoms include inflamed skin, digestive problems, and mental impairment.

Few Americans need to take niacin supplements for pellagra. But niacin is unique in its ability to reduce the total cholesterol, “bad” LDL-cholesterol, and triglyceride levels, while increasing the “good” HDL-cholesterol level.

There are three types of niacin: immediate release, timed release, and nicotinamide. Most experts recommend starting with the immediate-release form. This is what my doctor recommended. The nicotinamide form of niacin does not lower cholesterol levels.

These forms of niacin are available without a prescription. Another form of niacin, Niaspan, does require a prescription, and does reduce triglyceride levels and increase HDL, but has little effect on LDL or total cholesterol levels. A new study, reported at the 77th Scientific Sessions of the American Hearth Association, found that this extended-release niacin (together with a statin) slows the progression of atherosclerosis.

If you are taking niacin in doses large enough to help control your cholesterol, you must take it under medical supervision, because it has the potential of causing severe side effects.

The main concern is liver damage, but large doses can also cause peptic ulcers and perhaps increase blood glucose levels. Even normal doses can be associated with skin flushing. Large doses generally cause your face to flush and give you something like an itchy feeling. This sensation can last for just 10 minutes or as long as an hour.

I don’t find the itchy flushing to be particularly unpleasant. In fact, I sort of like it, because I know for once that a drug I’m taking is working for me. However, like most people who use niacin, I quickly developed a tolerance to the flushing. Taking it during or after meals helps.

When my doctor recommended that I take niacin, he said that it needs to be taken religiously three times a day, but that I had to start slow. He had me start at 250 mg once a day for two weeks, wait two weeks until I was taking 250 mg twice a day; then going to 250 mg three times a day. Since I purchased 500 mg tablets, this gave me a good opportunity to use my pill splitter.

My doctor had me work up to 500 mg three times a day, increasing the dosage by 250 mg every two weeks. He told me that I should have both my liver enzymes and cholesterol levels tested after about two months.

I got those tests and also my A1C. My liver enzymes initially were normal and all of my cholesterol levels are much better than they were three months earlier, even though I haven’t worked up to the prescribed niacin dose. My A1C was stable, remaining at 6.2.

However, in October 2005, one liver enzyme was elevated, and I stopped taking niacin.

My bad LDL cholesterol is down from 162 to 109, almost to the recommended level of under 100. My good HDL cholesterol, which has always been far too low, is up from 27 to 36 (it should be more than 40). My total cholesterol is down from 221 to 161 (the recommended level is below 200). And my triglycerides, which previously were 160, are now 82, well below the recommended level of below 150.

I am, of course, taking more cholesterol-fighting medicine than niacin. Among other things, I continue to take fish oil every day. I eat bison rather than beef. I use Benecol margarine rather than butter. I love my kefir and drink it regularly. And I take my policosanol with the evening meal. But clearly the niacin has caused the greatest improvement. It has proved to me at least that I don’t need any of those statins.


    David Mendosa is a freelance journalist and consultant specializing in diabetes and lives in Boulder, Colorado. When he was diagnosed with type 2 diabetes in February 1994, he began to write entirely about that condition. His articles and columns have appeared in many of the major diabetes magazines and websites. His own website, David Mendosa’s Diabetes Directory, established in 1995, was one of the first and is now one of the largest with that focus. Every month he also publishes an online newsletter called “Diabetes Update.” Twice weekly he writes for his blog at http://blogs.healthcentral.com/diabetes/david-mendosa. He is a coauthor of What Makes My Blood Glucose Go Up...And Down? (New York: Marlowe & Co., August 2003, and second American edition coming July 10, 2006, and other publishers in the U.K., Australia, and Taiwan).


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