I am pleased to present this informative interview with author Jay Cohen, MD based on his new book, What You Must Know About Statin Drugs & Their Natural Alternatives (Square One Publishers). Dr. Cohen is also the author of the widely acclaimed book, Over Dose: The Case Against the Drug Companies (Tarcher), which was a precursor to the serious problems that eventually ended up with the removal of Cox-2 Inhibitors, Vioxx and Bextra, being removed from the market. He is an Associate Professor (voluntary) of Family and Preventive Medicine & Psychiatry at the University of California, San Diego. Cohen is nationally recognized for his expertise on medications, side effects and safe usage. All of Dr. Cohen’s work is done independently from the drug industry and government.
What prompted you to write this book?
I am a strong advocate of people's right of informed consent, which means having information about all of the scientifically-proven therapies -- mainstream and alternative -- that can be used for reducing cholesterol and promoting heart health. In my book, I wanted to provide people with information about how to use statins safely, how to avoid or handle statin side effects, how to decide whether you need a low-dose or high-dose statin, how to reduce statin costs substantially, how to decide when alternative therapies for reducing cholesterol might be used instead of statins, and how to decide the best heart-healthy diet for each individual. My goal is to present the full picture so that people and their doctors can make truly informed decisions.
Do you have high cholesterol?
My mother's family members all have elevated cholesterol levels. I did too until I adjusted my diet, as I explain in the book. Still, even with normal total cholesterol and LDL-C levels, I had a problem because my HDL-C level (the good cholesterol) was low. Some experts believe that a low HDL-C is just as important a risk factor as a high LDL-C. Statins are not very good at raising HDL-C. There are other therapies, mainstream and alternative, that I discuss in the book that can raise HDL-C markedly. When a patient is diagnosed with elevated cholesterol, should they panic? Not at all. Unless a person has just had a heart attack, reducing cholesterol is not an emergency. There is time to evaluate cholesterol levels and other risk factors. There is time to make informed decisions about treatment. Too often, patients are placed on stronger statins than they actually need, side effects occur, and people quit treatment. Overall 60% to 75% of people placed on statin therapy discontinue treatment. So it is important to take the time to make the right decisions about statin drugs and dosages or the use of natural alternatives.
A doctor will generally prescribe a statin drug to lower cholesterol. Is there any instance when a patient should question this decision?
Statins are not the answer to every situation involving cholesterol. Many people are receiving statins who may not actually need them. Many people are receiving strong statin doses when milder statin doses or natural alternatives would be safer and less expensive. People have a right to ask questions. People should seek information about their own heart health. Beyond statins and natural alternatives for reducing cholesterol, my book mentions many natural therapies that are helpful for maintaining cardiac health. These natural inexpensive therapies should be used by anyone whether they are taking statins or not. Yet doctors often do not suggest these natural therapies, even though the science on them is strong.
Do you feel that physicians are unintentionally uneducated about medication side effects, and what can be done to better educate doctors who are often rushed to make a medication decision based on inaccurate information from the drug companies?
Many people with obvious statin side effects are not diagnosed properly. This is a big problem and one of the reasons why people discontinue statin treatment so often. Yet, when handled properly, statin side effects are easy to avoid or stop. I have included a long chapter in my book explaining to readers how to recognize various statin side effects and how to get their doctors' attention and action. This shouldn't be such a big problem, but it is. Also, some of the natural therapies I describe seem to cause fewer side effects. In this era of rushed medical care, it is important to help our doctors become better informed about recognizing and handling statin side effects. That's why I wrote my book to be "doctor friendly," so that doctors can read the book and then better help their patients with these problems. Many people who discontinue statin medications are plagued by side effects long after their discontinuation of the medication.
Is there any specific blood test to determine if a patient has suffered any permanent muscle damage or degeneration?
Serious muscle injury can usually be demonstrated by a blood test known as the "CPK (creatinine phosphokinase)." If it is positive, it indicates muscle injury. If the level is very high, this is a serious situation that requires immediate medical evaluation. Often, however, the test is negative, and doctors interpret this to mean that there is no muscle injury or statin-related muscle pain. This is incorrect. It has been shown that statins can cause muscle pain without elevations in the CPK. The best way to tell if side effects such as muscle pain, joint pain, memory problems, or fatigue are related to statin therapy is to stop the statin for a few months.
What is the Side Effects Probability Scale?
I created this scale to help people determine whether a side effect is likely from a statin drug they are taking. The scale represents a scientifically-accepted method for identifying drug-related side effects, and it can help patients get their doctors' attention when side effects occur. I found it quite interesting that a patient can report side effects of a medication to the FDA. If a family physician does not report evidence of a medication’s probable side effects, do you feel it is important for patients to follow the protocol to report the side effects? It is easy and important to report side effects to the FDA. Currently, fewer than 5% of all side effects are ever reported to the FDA. The FDA can act on problems with drugs only if the FDA receives information showing there is a problem. I was put on two different statins to lower my cholesterol.
My doctor switched me from one to another due to side effects. She did not recommend any supplement such as Coenzyme Q10 for the muscle pain. My husband's doctor did specifically recommend he take Coenzyme Q10 along with his cholesterol medication. This troubled me. Do you think physicians in general need to get more involved in alternative and holistic medicine Vs just writing out a prescription for a drug?
When side effects occur, many doctors switch their patients from one statin to another and then another -- and more side effects occur. Doctors do not usually consider reducing the dosage or using a natural supplement instead. Many do not know that coenzyme Q10 can help prevent or reduce muscle pain. However, many doctors are interested in learning about alternative methods. The problem is that their main sources of information are controlled or underwritten by the drug industry. One of my goals in writing this book was to provide doctors with solid, scientifically-sound information about statins, including low-dose statins, and natural alternatives. I believe that high-quality medicine can be provided only when doctors have access to high-quality information.
Do you think that people should seek counseling with their pharmacist when given a new medication?
I am a strong believer in speaking to my pharmacist about my medications.I encourage people to obtain information from their pharmacists. Pharmacists are sometimes more informative than doctors about side effects or drug interactions. However, the information the pharmacist provides depends on the information he/she has received. Neither pharmacists nor doctors are usually aware of the information in my book about lower, safer, proven-effective dosages of statin drugs. These dosages are perfect for many people with mild-to-moderate cholesterol reductions, but these people are usually placed on much stronger, more expensive statins. I have published my low-dose data in medical journals and presented it at medical conferences and at the FDA, but most healthcare professionals still do not know about it. With my new book, patients can show their doctors and pharmacists about these lower, safer, less expensive dosages and ask about starting treatment with them. Many people get very good responses and avoid the extra risks and expense of higher statin dosages. In the book, I list my 10 principles for obtaining safe medication treatment. One of them is: "The best dosage of any medication is the least amount that works." By starting with the lowest, rather than the highest, dosage of a statin, many people find that they get good results, avoid side effects, and reduce their drug costs. If the low dosage isn't enough, it is easy to increase it gradually.
With the computer age in full tilt, there is an abundance of groups and chats online that discuss in great detail specific medications. Do you recommend patients to seek information from these sites?
These sites can be useful for identifying a problem or obtaining information about it. However, people have to be selective. The best information is that which has some scientific validity and can help guide treatment properly. In reading my book, you will see that I frequently mention studies and provide references so that people and their doctors will know that the information is scientifically based. People's doctors are much more likely to be receptive to information that is scientifically-based.
With the recent wave of panic over the pulling of the Cox 2 Inhibitor drugs, do you see the potential for statins to be removed also due to side effects?
Yes. I am very concerned about the over-exuberance of many mainstream doctors about statin drugs. Many consider statins as "miracle drugs" that everyone should take and that never cause any side effects. The result is that many people who don't need statins get them, and many people who need only low-dose statins get much stronger dosages. When people get side effects, their legitimate complaints are ignored. This is a potentially dangerous situation, because statins can cause muscle or liver injury or serious memory problems. As I discuss in the book, there is already talk about the potential of a backlash against statin drugs. We all know that prevention is the best medicine.
What are your recommendations for maintaining a healthy cholesterol level?
Today more than ever, it is possible to maintain cardiac health and prevent heart disease. This requires a combination of approaches that I describe in my book. It also requires an individualized approach, for we are all different, and the same diet or drug or natural therapy will not work for everyone. This is why I have also included sections in the book about statins and women, statins and older people, and on why some people are very sensitive to medications and how they can still get effective treatment without side effects. Rather than having doctors prescribe strong statin doses to everyone, good medical care and effective prevention require good information and a recognition of the needs and goals of each individual. I wrote this book to empower people to obtain the individualized, effective, safe treatment they deserve.
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