Athletes And Statins

      30 Comments on Athletes And Statins

I spent a good chunk of today dealing with computer issues — both PC and Mac, so while I agree that Macs are generally more stable, the belief that they’re trouble-free has more to do with good advertising than with reality. Anyway, because so much of my day was eaten up, this will be a brief post.

It was yet another bang-up Super Bowl. I love it when the game is in doubt until the very end … although as a Bears fan, I didn’t mind seeing them blow away the Patriots back in 1986. I like the pomp of the Super Bowl, the hype, the buzz, the commercials, the halftime shows, the whole experience. And of course I enjoy the game itself, watching athletes at the very top of their games giving it everything they’ve got.

As I was watching recaps of the game today, it occurred to me that I recently downloaded an article from the British Journal of Clinical Pharmacology on how statins affect professional athletes. I think the title pretty much says it all:

Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

The paper’s authors are from Austria and examined case histories of Austrian professional athletes who attempted to go on statin therapy to treat genetically high cholesterol. Out of 22 athletes, only three were able to tolerate the first statin they were prescribed. Three more were able to eventually tolerate a statin other than the first one prescribed. The remaining 16 — 72% of the total — ended up refusing statin therapy. You can probably guess what it was about statins that most of the athletes couldn’t tolerate: muscle pain and muscle weakness.

The authors noted that in reviews of multiple clinical trials, muscle problems were reported in 5% of those taking statins on average. They also noted that in a study of statin-takers who engage in strenuous exercise, muscle problems affected closer to 25%. Now in this study we’ve got 72% of professional athletes (in an admittedly small sample size) saying they can’t tolerate statins of any kind because of muscle problems, with 86% percent unable to tolerate the first statin prescribed.

So here’s what I think is happening: statins are probably causing at least some degree of muscle weakness in a large percentage of those taking them. But not everyone whose muscles are weakened will feel pain or even notice the damage, as Dr. Duane Graveline wrote in an article on his web site:

In the Journal of Pathology 210: 94-102, 2006, Draeger A and others of the University of Bern, Switzerland report: Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia.

Draeger’s group did skeletal muscle biopsies from statin treated and non-statin treated patients and examined them using electron microscopy and biochemical approaches. They reported clear evidence of skeletal muscle damage in statin treated patients despite their being asymptomatic. Although the degree of overall damage was minimal, it was the characteristic pattern of damage, including rupture of critical structures that caught the attention of the investigators.

The more you depend on your muscles, the more likely you are to notice minor damage. Most people who sit for a living and aren’t dedicated to exercising could probably become a bit weaker without ever noticing, which would explain why only 5% percent of all statin-takers report muscle problems. But if you limit the study to people who engage in strenuous exercise — and are therefore more likely to track their speed or strength — the number goes up to 25%. Limit the study to professional athletes, and now you’re looking at 86% reporting muscle problems.

For professional athletes, an almost-imperceptible loss of muscular ability can mean the difference between winning and losing. Think about some of the key plays in last night’s Super Bowl, if you watched. A wide receiver catches a pass because he managed to outrun a cornerback by an extra six inches over the course of 30 yards. A linebacker misses a tackle because the tailback was a split-second quicker. “It’s a game of inches” is a cliché in sports, but it’s a cliché because it’s true. The professional athlete who loses a tiny fraction of his speed or strength can find himself sitting on the bench or looking for another job.

So I don’t think professional athletes are especially vulnerable to statin-induced muscle damage. I think they’re just far more likely to notice that damage is being done.

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30 thoughts on “Athletes And Statins

  1. Marilyn

    Didn’t Dr. Graveline get new symptoms some time after he had discontinued the statins? Who’s to say that all those folks out there who are “tolerating” the statins now aren’t going to develop symptoms some time in the future?

    He stopped having memory problems after giving up the statins, but some of the muscle damage was permanent. I believe lots of people will suffer muscle damage, most of which will be attributed to old age.

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  2. Jake

    One dirty secret about these statin trials is that researchers use pre-trials. During a pre-trial, they toss out of the trial all the people who show side effects from the drug.

    Thus a Liptor research trial can show less than 5% of the patients show side effects at a given dosage, while Dr. Davis, the cardiologist, reports that 80% of his patients showed severe side effects at that same dosage.

    That’s right. The researchers exclude people known to suffer drug reactions, and of course a lot of doctors never make the connection when patients complain of muscle aches — my mom’s doctor just gave her a painkiller — so the side-effects are almost certainly underreported.

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  3. Kate

    If some genius is putting pro athletes on statins, it really pokes a hole in the theory that exercise protects against heart disease/heart attack/stroke. After all, since pro athletes exercise for a living, they certainly wouldn’t need to pop for the same thing!

    Funny how often this is not pointed out.

    These athletes had familial hyperlipidemia, so that’s the concern.

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  4. Danny

    I would love to see a controlled study on statins and injuries from falling amongst those 70 and older. Since serious falls in the home are due–almost always–not to a lack of balance but poor muscular strength, the results could be…very interesting.

    Those would be interesting results, but we know Pfizer isn’t going to fund that one. Most doctors probably write off falls to old age.

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    1. Walter Bushell

      And the mental confusion. And the doctors have everyone on satins so statin damage looks like normal aging.

      I think this applies to the rest of the frequently prescribed drugs. I’ve seen middle age defined as when it is no longer possible to obey the instructions on when to take your drugs due to interactions between them. By that criterion, I haven’t reached middle age yet, which is absurd.

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  5. Galina L.

    Your previous post on statins was issued at the same time with CNN article on the ineffectiveness of statins and I thought that if you and CNN started to sing the same song you would be relieved of your self-inflicted job of criticizing bad medicine very soon because mass media usually just can’t stop reporting the same thing over and over again until everybody would be hypnotized with their current tune (like eating fruits and veggies non-stop while awake). Not in the satin case. At my husband’s job virtually everyone older then 45 is taking statins and several other medicines for blood pressure, anxiety, acid reflux…-7 – 8 peals a day. How people on such cocktail of drugs could honestly report that they are having problem with some of the ingredients, is beyond me. They don’t know any more how it feels to feel well.

    Most of my good friends are taking one drug or another — two are on statins, despite my best efforts to educate them on the dangers. I’m just a guy they know, but THEIR DOCTORS (everyone down on your knees in a worshipful position) told them they need statins to avoid a heart attack.

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  6. Kent Cowgill

    I often wonder about this damage, and exactly how long it lasts.

    For what it’s worth, I’m currently exercising pretty heavily, as well as chasing around after an unruly 2.8 year old and a 6 month old.

    I was put on statins (Crestor, if I recall correctly) for a month – twice, about a month apart – in an attempt by my then doctor to do something about my highish cholesterol (long before I learned better). That was a couple of years ago, but I’ve had increasing back pain and extreme lack of back muscle endurance since then – and it’s been getting progressively worse. Compounded by having two young kids running around the house 🙂 I recall suffering from a little back fatigue right as I was put on the Crestor since my son had just been born at that time. But it’s been getting worse and worse since then. I feel like pretty soon it’ll be unmanageable.

    Can statins possibly have done that much long lasting damage in so little an amount of time?

    I’d love to know.

    According to Dr. Graveline, could be, depending on the dose. You might want to read his articles at http://www.spacedoc.net.

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    1. Maguerite

      Kent, my family have FH and they’ve tried all the statins and fibrates in the book. On statins, we WILL die of kidney failure. My entire family is intolerant. Our rhabdomyolises develops within a WEEK and kidney failure is the natural culmination. VERY few doctors, bar one, have taken as seriously on this. And the one who did thought for us it was extremely dangerous. THUS, I am on totally keto diet, but I struggle to get my sons on it, and men are just simply more at risk. We know this from our large family patterns. I have NO idea why doctors take this thing so lightly, something is very amiss in doctordom!

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  7. Rebecca

    My mom didn’t notice any signs of muscle damage until she took up walking. She was a housewife who was always in motion, but her day to day activities didn’t tax her muscles to the point that she noticed the weakness. Her doctor didn’t prescribe pain-killers, though. “Would you rather have weak muscles or a heart attack?” Compare this to the doctor’s statements on Norvasc – “Would you rather have swollen ankles or a stroke?” The wonderful, curative effects of modern medicine!

    Perfect example of what I’m talking about. Think of all the sedentary people who are probably losing strength without noticing.

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  8. AllenS

    Not to be a nit, but actually 86% of the athletes reported muscle problems (19 of the 22.) Eventually three more of the athletes were able to tolerate statins, but these three did report muscle problems.

    When you put it that way, I’d have to agree. I’ll update the post.

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  9. Joe Brown

    As a former statin user – 1988 until March of 2010 – I keep looking for folks who have been on this stuff and now have muscle pain/weakness. With my cholesterol levels, I would probably qualify for FH but, as I told my primary care doctor, I’d rather pass away while on the golf course or treadmill rather than staying alive and confined to a wheelchair, unable to walk. The pain is real and it does end up being interpreted as “old age”. During the last 3 years that Iwas on statins, Simvastatin became availabe in generic form. You save big bucks by taking this instead of Lipitor. The only problem is the dosage is way different. My 40mg of Lipitor became 80 mg Simvastatin. Even the FDA has warned on that dosage (just recently). Off the stuff, I’m better, but I don’t think the pain will ever go away. For the past year I have not eaten wheat. I follow a very low carb diet, have lost 42 pounds. Keep spreading the word on this stuff – I can only hope that the truth will be known someday. It might help with my pain.

    I wish you well and hope the pain goes away someday.

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  10. HealthyPickyEater.com

    High level athletes, who are usually in excellent health, are more sensitive to the things going on in their bodies, like the effects of statins, as you so well pointed out.

    Some people are so used to feeling bad, that feeling bad is normal. Folks who are placed on some type of drug therapy, after some time, the side effects feel normal to them. In other words, they get used to it, and have no real idea what it is doing to them and their long-term health.

    These sincere people choose not take charge of their health and instead, put all of their faith and trust in the doctors and the medical community, who are primarily taught drug protocol as the primary means of treatment.

    Good point. When my energy was lower back when I was on a lousy diet, I just assumed it was the natural result of getting older.

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  11. Judy B

    I’ve always thought that 5% figure was a crock. Most people get put off by their doctor pooh-poohing their symptoms. I suspect that only those who are very persistent finally get any notice – hence the 5%!

    Most statin-takers are older, and doctors routinely write off their complains about muscle pain, attributing the pain to “old age.” I’m sure the 5% figure is the result of underreporting.

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  12. Kate

    Are people with familial hyperlipidemia really at a higher risk for CV events? I mean really at risk, not just the paranoia surrounding the word “cholesterol”? Have there been studies that were controlled for diet, age, smoking, etc?

    I have vague memories of Dr. Eades saying that if you are eating well and you have familial hyperlipidemia, don’t worry too much about it. Perhaps he meant, “it’s doesn’t matter, you’re sunk,” or, “worrying will make you more likely to have a heart attack.”

    Yes, they’re at higher risk. They have a genetic mutation that results in their LDL receptors not functioning. Depending on whether they inherited one copy or two copies (both parents) of the mutation, they can die from heart disease at a very young age. Statins reduce the risk somewhat, but of course pharmaceutical companies use relative risk instead of absolute risk to make the numbers seem more impressive than they are.

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    1. Maguerite

      Kate, my mom is the carrier in my family and my grandmother, etc. My sons have it. My mom only found out when she was in her sixties and have rarely taken the pills, she’s fine, and so too the other females with it in the family (except those who got fat and got diabetes II on top of everything). BUT shock horrors, unfortunately the doctors were alwarys right about my boys. My one son (34) just over Christmas underwent QUINTUPLE bypass surgery (no prior heart attack thank G-d!) but he felt extremely fatigued and his fingers went numb whenever he started exercising. My heart is thoroughly broken and I am trying to get him on to a keto diet since it made my total numbers drop dramatically! But he’s confused, since he has me on the one side and a bevy of doctors on the other side (who DID save his life) but who insists on statins and low fat diet and I absolutely believe it’s the wrong way. BUT then of course, a week after the operation, he got kidney infection from the statins (rhabdomyolises) and then they simply shrugh their shoulders as if to say: Oh well, that’s it then for you. WELL, NO, a keto diet can help them!! EYE know this. I am so cross – sorry everyone, but I feel so much is being said about lipids but we who have the REAL disease are left in the lurch when it comes to proper research. The motherload of these people live in SOuth Africa, as it is present in 3 different race groupings: The ashkenazi Jews, The white Afrikaner and our Indian population. Yip, I am angry, because for us it’s statins and that horrible low fat diet and I refuse TOTALLY! I refuse and THEY don’t care.

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  13. AP DUBYA

    Absolutely agree with the conclusion: athletes are more aware of their muscles & are perhaps better judges of any changes. Though, not to put a monkey-wrench in the discussion: just how consistent were training routines & how similar were muscles being used? As a former swimmer who logged hours of training at near-“Phelpsian” levels ( 7 + miles per day, 6 days a week, 300+ days a year) for 5 years, there wasn’t a day that some part of my body didn’t hurt (until pre-championship resting phase). Point being, a weakness in the argument may be that pain itself is pretty subjective & relies on self-reporting. A larger, more consistent study might alleviate some of these issues.

    That’s a relevant point, but I think athletes who’ve been training their whole lives could most likely distinguish between the usual post-workout pain and something more damaging.

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  14. gallier2

    There was once a long discussion on Peter’s hyperlipid blog about family hyperlipidemia. The conclusion that could be drawn from the studies of higher risks were tainted by selection bias, i.e. the families with higher heart incidences were more likely selected. There was something like a circular reasoning in the papers.

    That’s right. The point he made is that many people with familial hyperlipidemia feel just fine and dandy and live to a ripe old age, therefore are never diagnosed.

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  15. tracker

    ///“Would you rather have weak muscles or a heart attack?”///

    I’d rather die of a heart attack, than to be crippled up in a wheel chair for years. Why are doctors so stupid?

    Besides, cardiovascular disease has more to do with inflammation than cholesterol. Even with familial hypercholesterolemia, a lot of them live a long time, it just varies by individual. Sure some do die younger, but would they rather have a good quality of life while they’re here, or suffer debilitating side effects? I know what I pick.

    And another thing, I’d like to see a study of people with familial hypercholesterolemia put on an extremely low carb diet. I wonder if they’d live longer then? We’ll never find out. That will never happen.

    Dr. Ravnskov has pointed out that back when infectious diseases were the number one killer, people with familial hypercholesterolemia lived the longest.

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  16. Stacie

    Hi Tom and all. Firstly, I love your blog and loved the movie. Regarding statins, the bottom line is the only thing that matters. Since 2005, all the statin trials have been negative. I expect that future ones will also be negative. However, just to play the game, prior to 2005, the 4S Trial was the “most” successful for secondary prevention.(We all know statins are useless for primary prevention.) Statins have only been shown to benefit? men between the ages of 45-65 with established CVD. So according to this trial, if you have CVD and take this statin, you decrease your chances of dying each year by .61%. WOWWWWW!!!!! I am pretty sure that good old fish oil works much better. So, the bottom line is: statins are pretty useless!!

    I completely agree. I wish I could convince my friends who are taking them, but after a couple of attempts, sending links to articles and such, I knew it was time to just let it go.

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  17. Marilyn

    Galina L wrote: “How people on such cocktail of drugs could honestly report that they are having problem with some of the ingredients, is beyond me. They don’t know any more how it feels to feel well.”

    My impression is that it is not at all unusual for people going into hospice for their final hours/days/weeks to suddenly feel better than they have for years once all their drugs are withheld. There’s something terribly wrong with this picture!

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  18. Katy

    Muscle weakness from any one of a variety of causes can sneak up on ya. My grandmother started to experience weakness when she was about 70, but we just thought it was due to aging and so raised her sofa and got her a portable toilet for the main floor of her house. We thought she should get more exercise, but she was never a fan of that sort of thing. When I was 35-40 years old, I began having a difficult time going up stairs, but I also thought I just needed to do more squats, etc. A few years later, I decided to get in better shape, so I started using my Nordic Track and took up running. My legs became weaker. Then my eyes no longer closed tightly, a symptom identified by my optometrist (hey, it was dark behind my “closed” eyes, so why would I think otherwise?). Off I go to the family doc, who sends me to a neurologist. I have muscular dystrophy, and more than likely, so did Grandma. But since she never exercised, she didn’t compound the injury to her muscles, so they didn’t deteriorate as quickly. Nine years later and I’m now 56; I can’t go up stairs at all; my sofa is raised, as are my toilet seats. If I want to go out, I have to carry a ton of equipment with me as the world is not set up for my challenges. Anyway, my point is that the muscle weakness occurred so slowly over the years that I hardly noticed, until one day I squatted down in a store to get something off of a lower shelf and couldn’t get up. I can’t imagine voluntarily taking a drug that would cause the same problems!

    Sorry to hear about your muscular dystrophy. If I didn’t lift weights at a gym, I’m sure I could lose some strength and never notice. I spent most of my day in front of a computer.

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  19. Be

    Your point is 100% valid and well taken. But I certainly hope you weren’t thinking about Statins during the Super Bowl!

    Not one bit. I was enjoying the baby back ribs my wife cooked up and rooting for the Packers.

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  20. Steven

    Glad this has come to light. A friend of mine lost the first couple of years of his career as a professional triathlete a few year ago due to what he described as “all over body cramps” … eventually he managed to find a doctor that pointed out it was the statins he was taking. Once he found a doctor that knew what he was talking the doctor was stunned anyone thought someone as fit as him should be taking statins.
    The view that cholesterol above a certain level needs treating no matter of any other risk factors is getting out of hand from what I can see. For me I just don’t give a monkeys what may cholesterol levels are.

    He was lucky to find a doctor who actually knows about the side effects.

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  21. YossiD

    I am 53 years old and have been taking a statin for a number of years. My total cholesterol is about 300 without the statin and about 200 with.

    My memory was never terribly good but I’ve noticed it getting worse, and I get muscle cramps, sometimes quite severe, from time to time. I have no idea if either of these is connected with the statin, but I wouldn’t be surprised.

    From what I’ve been reading, there are lots of reasons to stop taking stains, but few (if any) to continue.

    My problem is that I have life insurance for my mortgage and in the medical form I had to report my cholesterol level and treatment. If I stop taking the statin and something happens to me, I’m afraid the insurance company won’t pay and my wife will be left in the lurch.

    Is anyone trying to convince the insurance companies that they’re setting their policies based on bogus data?

    Wow, that is a pickle. I know there was a lawsuit filed jointly by an insurance company and a union health plan against (I think) a pharmaceutical company for recommending statins to women without any evidence that they do any good. I don’t know if anything has come of it. Lawsuits like that tend to drag on for years.

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  22. Jane M

    I just don’t see this mentioned very often: my husband suffered from erectile dysfunction within weeks of starting Crestor. I begged him for 6 months and finally got him to go off it. It took many, many months for him to recover, and now, two years later, he’s finally pretty much back to his old self. He is 61. I mentioned this to my doctor (when I refused again to go back on statins after being on Lipitor for 5 years) and she said, “oh, well that’s because of his high cholesterol”! I said, are you kidding? He’s never had that problem before.

    I’ve heard that’s a common side-effect. Works for the pharmaceutical companies. They get to sell another drug to handle that one.

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  23. WSB

    Would muscle pain/weakness include a increased tendency to pull muscles?

    I hadn’t thought of that, but it seems likely now that you mention it.

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  24. Josef Brandenburg

    My cholesterol is weird: when I was fat and unhealthy it was low/normal. This is when I was a sickly vegan with moobs + love handles + eczema + allergies + acne + gas all day. When I went on a “moderate diet” – skinless chicken + egg whites + oatmeal I got fatter and my cholesterol went up to the 200’s..

    At my fattest (on the above “moderate diet” – 240 (5’10”) with a 40+ inch waist – I think it was 260-ish. My MD said “do more cardio” – I was doing 12hrs/wk.

    Now that I’ve lost 45+lbs of body fat, and am in really good shape, all allergies gone, all eczema gone, it’s up in the high 300’s… like 360-380.

    For my clients, when they stop being fat their cholesterol goes down and their MD’s give them permission to drop the statins. They all drop their cholesterol by eating tons of red meat, bacon, eggs, butter, etc and ceasing aerobics.

    I think its odd that my not being fat seems to have had the opposite effect on me – would it go down if I got really fat again? Or maybe my cholesterol is simply going up with age and that’s how the genes on mom’s side play out?

    That’s an interesting case. Have you had particle size measured? Jimmy Moore has “high” cholesterol, but his LDL is nearly all the large, fluffy variety and he had a calcium score of zero.

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  25. Gustav

    Do you know if Red Yeast Rice would cause similar symptoms? Red Yeast Rice is a “natural” statin found at health food stores and recommended by some doctors as a first step solution to lowering cholesterol.

    I’m not sure. I have no interest in forcing down my cholesterol, so I’ve never looked into the stuff.

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  26. Peggy Cihocki

    Yeah, some people on Statins are just plain stubborn and won’t listen to anyone but their doctor, regardless of the number of sources of information I provide. I have a friend like that who has been ignoring everything I’ve given her for over 5 years, including Dr. Ravnskov’s books. I guess his MD credentials don’t apply because she doesn’t know him. I guess I should let go, huh? It’s hard, but I will. I recommended she watch Fat Head or watch Big Fat Fiasco and haven’t heard from her. Wonder if I finally pissed her off! Another friend who is on Statins did at least listen and asked what happens if you go off them after taking them for a while? I didn’t really know how to answer because I only have anecdotal information on that. Any studies I could point her to? I never took Statins and never will and am glad my hubby won’t, either. We are both active and have enough muscle aches and pains just from that!

    Some people have a serious case of white-coat awe, and there’s not much you can do about it. My best friend is also on statins, and none of the articles I sent him changed his mind. He wants his cholesterol lowered, period. So I gave up.

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  27. Bruce

    Doctors are in the position of being liable if a patient has high cholesterol test results and suffers a heart attack and the doctor did not proscribe a statin. Although a diet that is low on animal protein and has lots of fruits and vegetables, doctors know when they are looking at obese patients in their offices that these people are not likely to change their behavior but are likely to take a pill once a day.

    Americans are the fattest people on the planet by a wide margin and it is largely due to overeating. When I was growing up there was only one fat kit in my school but now I see more than half the kids waddling around that are severely obese and often accompanied by an equally fat mom. Traveling through Europe I am always struck by how rare it is to see a fat people unless they are American tourists (which are easy to discern by their outfits as well as their profiles.

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