How to Avoid a Statin

Michelle Routhenstein, MS, RD, CDE

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April 1, 2023

Statins are medications commonly prescribed to help lower high cholesterol levels. They block the enzyme your liver needs to make cholesterol, causing it to be removed from your bloodstream. Examples include atorvastatin (Lipitor), simvastatin (Zocor, FloLipid), and rosuvastatin (Crestor, Ezallor).

Statins are prescribed when there’s concern about high cholesterol levels increasing the risk of a heart attack or stroke. Your healthcare provider will determine the need for a statin depending on individual numbers and risk factors. It’s possible to come off of statins, but your doctor will evaluate your readiness and appropriateness to do so. 

For more on statins, see The Most Common Questions About Statins. Now, let’s talk about why someone might want to avoid taking a statin and how to lower cholesterol without statins. 

Why You May Want to Avoid a Statin

Statins can be life-saving, but they don’t cure existing cardiovascular disease or risk factors you may have. It’s important to identify and prioritize lifestyle factors that can impact your heart health positively. Daily habits like good nutrition are critical.  

As with other medications, there are potential side effects to consider when taking statins. Some of these include: 

  • Muscle pain and damage
  • Increased blood sugar or risk of developing type 2 diabetes
  • Liver damage
  • Neurological side effects

There are factors that can make someone more susceptible to side effects. If you’re taking multiple medications to lower your cholesterol, there’s always a risk for drug interactions. It’s important to tell your healthcare team all of the medications you’re using. 

Other risk factors include being female, having a smaller body frame, existing liver or kidney disease, excessive alcohol consumption, age 80 or older, and certain conditions like hypothyroidism or neuromuscular disorders.

How to Avoid a Statin

I’ve had clients tell me, “I don’t want to take statins.” Wondering what can I take instead of statins to lower cholesterol? Here are some tips that may help keep your cholesterol in check naturally. 

1. Know Your Risk Factors

If you don’t address underlying inflammation, blood vessel health, insulin resistance, and other root causes, risk factors and conditions (such as high blood pressure, high blood sugar levels, and excess abdominal weight) through science-based nutrition and adding therapeutic foods into your diet, your arteries can still become inflamed, blocked, and clogged. 

It’s important that whether you are or aren’t on a statin, you take a proactive science-based, heart-healthy nutrition and lifestyle medicine approach to improve your heart health.

A heart-healthy diet can often optimize your heart disease risk factors and prevent plaque buildup in the arteries. However, some people also need to take statins because they have a genetic lipoprotein metabolism disorder (such as familial hypercholesterolemia) or other reasons indicated by their physician.

It’s not uncommon for people to be told to take a statin when they have a high coronary artery calcium (CAC) score. Some studies show that taking a statin reduces cholesterol but also increases the calcium score by making soft plaque into hardened, more stable plaque. While this seems counterintuitive, in this case, a rising calcium score may actually indicate successful statin treatment. Either way, it’s important to stay in communication with your healthcare team regarding trends and adjustments that may need to be made. 

Furthermore, newer research published in Lancet showed that people who were on statins but had inflammation, measured by hsCRP, still had heart disease. This suggests that whether someone chooses to use a statin for cholesterol control or not, adopting a diet to reduce inflammation is a vital process to prevent atherosclerosis.

Overall, just because you are on a statin does not mean you won’t have a heart attack. Again, any medication is not a quick fix for a health problem that has many underlying lifestyle factors. In fact, many of my clients with a heart attack were on a statin for 5-15 years before they had a heart attack. We therefore need to stress the importance of assessing and addressing the other root causes of heart disease, such as inflammation, insulin resistance, and oxidative stress, that can cause heart disease.

2. Work With Your Healthcare Team

Optimizing your heart health, with or without the use of medications like statins, takes an integrative team approach. It’s important to work closely with your healthcare team and cardiovascular dietitian, weigh the pros and cons of statins, and determine additional ways to monitor and improve your heart health.

3. Take Action

It’s empowering to know that you have control over many aspects of your health. If you feel overwhelmed, choose 1-2 things to start focusing on before adding others. 

Maintaining a healthy weight is important for heart health and reducing your risk for other chronic diseases. However, you can still have high cholesterol even at a normal weight, so monitoring your bloodwork remains important. 

Nutrition is a key natural alternative to statins. Everyone’s needs are different, so working with a cardiovascular dietitian to personalize your plan and reach your target goals can help. This might include reducing saturated and trans fat intake, and increasing fiber, whole plants, and foods rich in omega-3 fats. 

The Portfolio Diet can help lower cholesterol levels, focusing on soy protein (tofu, edamame), plant sterols, tree nuts (almonds, cashews, walnuts), and soluble fiber. These can help reduce total and LDL cholesterol and triglycerides and offer other heart health benefits.

This is an ideal time to find ways you enjoy moving your body. Aim for at least 150 minutes of moderate-intensity exercise per week, like jogging, walking, biking, swimming, and yoga. 

Resistance training, like strength training with dumbbells, weight machines, and resistance bands, can also help reduce high LDL and reduce cardiovascular mortality by 40%.. One study found that LDL cholesterol was more quickly cleared from the bloodstream among men who did strength training compared to those who didn’t. 

This may be because exercise helps increase LDL particle size. This matters because larger LDL particles are less likely to penetrate the arterial wall and lead to plaque formation. 

If you smoke, this is a good opportunity to work on quitting. When vapors are absorbed into your lungs, this can contribute to lower HDL, higher LDL, damage to blood vessels and arteries, and a higher risk of blood clots. A compound in cigarette smoke called acrolein keeps the HDL in your blood from transporting the LDL out of your body. 

Replacing Statins with Nutrition and Lifestyle Improvements: A Client Success Story 

​​​​​​​​In my practice, I’ve been fortunate to be a part of many real-life success stories among people who have worked hard to implement science-based nutrition and lifestyle changes that ultimately replaced medications like statins. Here’s one of my favorites. 

A 45-year-old gentleman came to see me because he had just had a couple of stents placed in his LAD and wanted to prevent any future complications. He said he had a physical with his primary doctor about 8 months prior, and his doctor had no concerns. ​​​​​​​​

​​​​​​He joined my individualized VIP program for 4 months, and we worked together to optimize his cardiovascular function and to keep his stent patent. Upon review of his medical history, it was apparent that he had borderline blood pressure values (128/80mmHg), high LDL cholesterol levels (129mg/dL), and a strong family history of heart disease that could have accelerated the plaque formation in his arteries.​​​​​​​​

​​​​​​​​We worked to optimize all of his values, address blood vessel health, prevent further plaque formation, and build a true understanding of a science-based heart-healthy diet and how to implement it properly. ​​​​​​​​

​​​​​​​​Within 3 weeks, his blood pressure normalized, averaging 115/70mmHg, and he gained a lot of energy. His statin medications were reduced within 2 months of working together and then discontinued completely after the program (when his LDL reached 29mg/dL). ​​​

​​​​​​​​He called me about 5 months after completing the program to share that he was also able to get off of his beta blocker too. I’m so proud of how his hard work paid off!

Stopping Statins Safely 

If LDL is low enough, statins can be tapered or reduced by your physician. Working with a cardiovascular dietitian can help you achieve this goal in a way that is tailored to you, your lifestyle, and your specific nutritional needs.

If you’re ready to improve your cholesterol management and optimize your heart health, I’m here to help! Learn more about my 6-week heart optimization group program, where we discuss how to lower LDL and address the underlying root causes of heart diseases, through science based nutrition, in order to help reduce your risk of a heart attack. 

References

  1. Lee D, Joo HJ, Jung HW, Lim DS. Investigating potential mediator between statin and coronary artery calcification. PLoS One. 2018;13(9):e0203702. doi:10.1371/journal.pone.0203702
  2. Ridker PM, Bhatt DL, Pradhan AD, et al. Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials [published online ahead of print, 2023 Mar 3]. Lancet. 2023;S0140-6736(23)00215-5. doi:10.1016/S0140-6736(23)00215-5
  3. Ramdath DD, Padhi EM, Sarfaraz S, Renwick S, Duncan AM. Beyond the Cholesterol-Lowering Effect of Soy Protein: A Review of the Effects of Dietary Soy and Its Constituents on Risk Factors for Cardiovascular Disease. Nutrients. 2017;9(4):324. doi:10.3390/nu9040324
  4. Trautwein EA, Vermeer MA, Hiemstra H, Ras RT. LDL-Cholesterol Lowering of Plant Sterols and Stanols-Which Factors Influence Their Efficacy?. Nutrients. 2018;10(9):1262. doi:10.3390/nu10091262
  5. Del Gobbo LC, Falk MC, Feldman R, Lewis K, Mozaffarian D. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. Am J Clin Nutr. 2015;102(6):1347-1356. doi:10.3945/ajcn.115.110965
  6. Surampudi P, Enkhmaa B, Anuurad E, Berglund L. Lipid Lowering with Soluble Dietary Fiber. Curr Atheroscler Rep. 2016;18(12):75. doi:10.1007/s11883-016-0624-z
  7. Costa RR, Buttelli ACK, Vieira AF, et al. Effect of Strength Training on Lipid and Inflammatory Outcomes: Systematic Review With Meta-Analysis and Meta-Regression. J Phys Act Health. 2019;16(6):477-491. doi:10.1123/jpah.2018-0317
  8. Ali M. Albarrati, Mansour Saleh M. Alghamdi, Rakan I. Nazer, Maarab M. Alkorashy, Nora Alshowier, Nichola Gale, “Effectiveness of Low to Moderate Physical Exercise Training on the Level of Low-Density Lipoproteins: A Systematic Review”, BioMed Research International, vol. 2018, Article ID 5982980, 16 pages, 2018. https://doi.org/10.1155/2018/5982980
  9. Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16(1):132. Published 2017 Jul 5. doi:10.1186/s12944-017-0515-5
  10. Smoking and Heart Disease and Stroke. Centers for Disease Control. Reviewed 15 March 2023. Accessed 24 March 2023. Available from: https://www.cdc.gov/tobacco/campaign/tips/diseases/heart-disease-stroke.html 
  11. Chadwick AC, Holme RL, Chen Y, et al. Acrolein impairs the cholesterol transport functions of high density lipoproteins. PLoS One. 2015;10(4):e0123138. doi:10.1371/journal.pone.0123138

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