Ask Leyla: To take a statin or not take a statin? That’s the question

Q:  I want to eat egg yolks and other cholesterol containing foods but my LDL goes up!  Then my doctor wants to put me on a statin despite having low Lp(a), homocysteine, triglycerides, hs-CRP and a zero coronary calcium score.  I don’t want to take a statin but my doctor is insistent that I do despite never having had a cardiac event.
 
A:  This is a frequent dilemma among my patients/clients.  As you embark on a higher fat, lower carbohydrate way of eating, enjoying eggs, meat, shrimp, butter and other cholesterol containing foods, LDL tends to increase more often than not.  That’s why your doctor encourages you to take statin drugs like Lipitor or Crestor, despite having low risk factors as evidenced by other tests.  
 
Increasing fat and cholesterol containing foods can, in many cases, raise LDL.  But HDL levels also go up, the so-called good cholesterol which is deemed protective, keeping the cholesterol/LDL to HDL ratio the same, making it a wash, so to speak.  But even if LDL stays high, it becomes a less dangerous particle in the setting of a lower carb eating style.  Small, dense, atherogenic pattern B particles become large, buoyant, fluffy pattern A particles—which are less likely to get into any nooks and crannies causing calcification in coronary arteries.  This is observed in NMR or VAPs tests about three months after making diet changes.  
 
So you end up with a better LDL particle and higher HDL, and a good ratio, all of which are desirable in a lipid profile.  
 
Statin drugs have their problems.  Many people are unable to tolerate them—especially the muscle weakness and fatigue secondary to low CoQ10.  Liver function tests must be performed while taking statins to see if any adverse impacts ensue.  There is recent evidence that these cholesterol lowering drugs contribute to sarcopenia and hyperglycemia leading to diabetes.        
 
To take a statin or not take a statin? That’s the question.  I’ve observed so many patients and clients grappling with this issue lately.  The best advice I can offer is to have a conversation with your doctor weighing all the risks versus benefits of treatment.    
 
To your health!

Leyla Muedin, MS, RD, CDN