Familial Hypercholesterolemia: Is Taking A Statin Drug The Only Solution?
Posted Jul 20 2010 5:29pm
It’s almost impossible to flip through the channels on your television set these days without seeing some kind of advertisement about what to do about a condition commonly labeled as “high cholesterol.” From Lipitor to Crestor, these popular cholesterol-lowering medications have been highly touted by seemingly intelligent and respectable people like physicians and patients who claim to have been helped by regularly taking these statin medications. If you ask most people if taking a statin drug is good for you or not, it would not be surprising to hear upwards of 9 out of ten respond in the affirmative. Such is the power of the marketing of these drugs in modern society.
While many patients with a poor lipid panel (low HDL, high triglycerides, and high levels of small, dense LDL particles) got that way from consuming a high-carbohydrate diet according to a 2007 study , there are more rare instances of cholesterol issues stemming from genetics that some people need to be concerned about. It’s called familial hypercholesterolemia (FH) and it is indeed something that can run in families causing their LDL cholesterol levels to skyrocket and put them at a greater risk for premature cardiovascular disease as early as 30 years old. This is known as familial heterozygous hypercholesterolemia (FHH) and impacts approximately one out of every 500 people. So if 50,000 people are reading this column, then 100 of you statistically speaking have FHH. One such reader contacted me about this condition after he was diagnosed with it last year and he asked me to write about it so that others can benefit from the knowledge he is still building on this subject.
For a little background on my reader (who will remain anonymous), he is a first-year medical school student who I had the privilege of meeting in person at the Nutrition & Metabolism Society Symposium in Seattle, Washington in April 2010. Looking at him, you’d probably say he’s a fit 24-year old man who takes care of himself physically through regular physical activity. Most people would have no idea that he has FHH due to a maternal genetic mutation that has impacted his mother, two older brothers, uncle, grandmother, and two great uncles. Both of his great uncles have had heart bypass surgeries while his grandmother had a pacemaker put in and died due to complications from Alzheimer’s disease (one of the possible side effects of being on a statin drug as Dr. Duane Graveline has noted ). Everyone else in his family is already on statin therapy, including his brothers who are only in their 30s.
My reader has been taking 20mg of Lipitor as well as Zetia since the age of 18 and never experienced the most common side effects , namely the joint and muscle pain associated with taking them. But he also voraciously followed his doctor’s advice to eat a low-fat diet while doing tons of cardiovascular exercise, but eventually realized that was not working for him. In late 2009, he embarked on a journey that led him to the Paleo/low-carb way of eating thanks to his local CrossFit gym and this inquisitive med school student started soaking up everything he could find on the subject of nutrition. What he discovered shocked him to the core and it was convincing enough for him to stop taking the statin drugs as of December 2009. He embarked on a lower-carb version of the Paleo diet (around 75g carbohydrate daily), started taking 8,000IU of Vitamin D daily (raising his levels to fantastic 66), and began fish oil supplementation for healthy omega-3 fats as well. His HgA1c, a key marker measuring blood sugar control, came in at a very respectable 5.1. Interestingly, despite the genetic predisposition for high LDL cholesterol that is in his family history, my reader said they also have high HDL and low triglycerides as a whole.
However, he became concerned about coming off of Lipitor when a heart scan test conducted in early 2010 showed a score of 16 despite being on his newfound Paleo lifestyle change. After hearing an interview I conducted on my podcast with Dr. William Davis from “The Heart Scan Blog” he decided to contact this highly-respected cardiologist who knows a thing or two about dealing with heart health concerns about what he should doing regarding his FHH and whether taking a statin drug everyday for the rest of his life is the only solution to his condition or not.
Here’s what Dr. Davis wrote:
While I believe that statins are miserably oversold, overprescribed, overhyped, and overused in the general population, I believe that the one clear-cut beneficial application is in your condition, familial heterozygous hypercholesterolemia. However, statins alone do not cut it. You have already taken the extra steps that I would have advocated: reduce carbohydrate exposure, especially wheat, sugars, and fructose to maintain small LDL to a minimum; vitamin D normalization; fish oil. One of the common pitfalls in FHH is people take a statin but follow a low-fat diet that increases the proportion of small LDL that then gets underestimated by Friedewald LDL. Also, be mindful of thyroid status. At the very least, being sure you get iodine is helpful. It would take very little thyroid dysfunction for me to advise thyroid replacement, since LDL drops like a stone when you do this. Unfortunately, I would be doubtful that no statin in your program will control your plaque growth. Also, bear in mind that in FHH, your calcium score may underestimate the “plaque burden,” meaning you are the exception in which there may be more non-calcified “soft” plaque than suggested by a calcium score.
Hmmmm, now that’s interesting! Despite his rigorous opposition to statin medications for the general public (and most of the medical professionals in the low-carb community), Dr. Davis maintains that taking them is an essential element in treating FHH. He did note that my reader should probably take both Lipitor and Crestor every other day in order to “minimize side effects” as well as supplementing with at least 100 mg CoQ10 since statins are known to deplete this in the body (interestingly, he said his mom’s doctor “didn’t know much about” CoQ10 when she brought it up with him–YIKES!). Dr. Davis was extremely impressed that a first-year medical school student would have such skepticism regarding medications when most of his future colleagues are already likely to latch on to prescription drug fever hook, line and sinker.
It is great that you are starting your career without the starry-eyed “drugs are great” attitude shared by most of our colleagues, difficult to resist when the drug rep in your office is model-beautiful with a big smile. They are very, very clever people, or else our colleagues are very, very gullible. You’re off to a great start.
Indeed, it is refreshing to find such openness from a future physician regarding questioning conventional wisdom which has failed so many people. But is this really his lot in life to be on statin drugs with all of their questionable neurological and physical side effects until the day he dies? Call me crazy, but that seems like an extreme solution to the problem of FHH looking at it from my layman’s perspective. Perhaps my anti-pharmaceutical drug bias is kicking in here and my questioning of this treatment option is ill-advised for someone like my reader. I welcome the input of any medical professionals or experts on the subject who would like to weigh in on this issue as well as anyone else who has an educated opinion to share. Please leave your comments below.