NMU 149 – Reducing Statin Drug Muscle Pain
Nutrition / Natural Medicine Update No 149 (Nov 14, 2019)
with Dr. James Meschino
Topic: Why Cholesterol-lowering Drugs (Statins) Cause Muscle Pain and How to Prevent It?
Source: American Journal of Physiology: Cell Physiology (October 2019)
As you know, many people have been prescribed statin drugs, like Lipitor or Crestor, to reduce their high cholesterol problem, as this helps to reduce the risk of heart attack and stroke. In fact, a recent survey showed that over 25% of U.S. adults over the age of 45 reported using a statin drug in the last 30 days, a roughly 10-fold increase over what was occurring during the period from 1988–1994. One of the undesirable side effects of statin drugs, however, is muscle aches and pain, which occurs in about 11% of patients using these drugs (some reports suggest as high as 25%), with 4% of patients reporting very severe muscle pain. To make things worse, muscle pain related to the use of statin drugs is often made much worse or triggered by exercise. This is quite paradoxical in that exercise is also an important way to reduce the risk of heart disease and stroke. Across society, we are trying to get people to exercise more. So, to tell people on statin drugs not to exercise to avoid severe muscle pain seems counterproductive.
So, in recent years researchers have looked for the cause of statin drug-induced muscle pain to see if they could find a way to prevent it. What has been discovered is that taking three vitamin supplements, along with statin drug therapy shows promise in reducing the drug’s muscle pain side effects. The three vitamins are Coenzyme Q10, Vitamin E and Vitamin D. The reason these vitamins may help is that statin drugs not only block the synthesis of cholesterol in the body but also block the synthesis of coenzyme Q10. A decrease in coenzyme Q10 inhibits energy production in muscle cells, produces higher levels of free radicals that damage muscle cells, creates mitochondrial dysfunction and allows the muscle membrane to leak products out of the cell into the surrounding environment. All these factors are associated with increased muscle damage and pain and are made worse when people exercise, as exercise puts an even greater demand on of the muscle’s energy system and creates even more free radicals. Secondly, the increased free radicals that occur in the muscle from statin drug use causes an efflux or exiting of the amino acid glutamate out of the muscle. In turn, glutamate stimulates pain nerve endings around the muscle (NMDA receptors), which also causes pain to occur. Studies show that taking vitamin E supplements can stop the muscle from shuttling glutamate out of the cell, which prevents pain from occurring via this mechanism. Vitamin E supplementation gives muscle cells more antioxidant protection to quench or neutralize free radicals generated from statin drug use. As such, muscle cells don’t feel the need to pump glutamate out of the cell in the process of trying to synthesize glutathione – antioxidant cells make to help quench free radicals. Also, studies show that individuals with low or sub-optimal vitamin D status are more inclined to have statin drug-induced muscle pain. When these individuals get their vitamin D blood level up into the more ideal range (over 75 nmol;30 ng/ml) through supplementation, they often can resume statin therapy without feeling muscle aches and pains.
Vitamin D has many positive effects on muscle function and integrity and so it stands to reason that adequate vitamin D can help maintain muscle cell integrity under the challenge of statin drug therapy. So, if you have been prescribed a statin drug, it may be wise to take 90-200 mg per day of coenzyme Q10, 200-400 IU per day of vitamin E and to get your blood vitamin D level checked. If your blood vitamin D level is below 75 nmol/L (30 ng/ml) then it may be wise to take an extra 1000-2000 IU of vitamin D per day until you get your blood vitamin D level into the more desirable range. Remember that you should always check with your physician before taking any new supplements, as there can be contraindications to the use of various supplements in certain cases.
I have included the references for this information in the text below.
1. Parker BA, et al. Effect of statin on skeletal muscle: Exercise, myopathy, and muscle outcomes. Exercise Sports Science Review-Journal. 2012. 40(4):188-194 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463373/
2. Rebalka I et al. Statin administration activates xC– in skeletal muscle: a potential mechanism explaining statin-induced muscle pain. American Journal of Physiology: Cell Physiology. 2019. Vol 317 (5): C894-899. https://www.physiology.org/doi/abs/10.1152/ajpcell.00308.2019
Eat Smart, Live Well, Look Great