Posts Tagged ‘cholesterol’

Do Statins Decrease Or Increase The Risk Of Parkinson’s Disease?

Written by Dr. Steve Chaney on . Posted in Drugs and Health, Issues

The Fine Print Behind The Misleading Headline

 Author: Dr. Stephen Chaney

 Human NeuronsI hadn’t paid much attention to the headlines saying “Statin Use May Decrease Parkinson’s Risk” until the other day when I happened to glance a couple of lines below the headline and spotted a statement saying “Study Shows That Discontinuation of Statin Therapy Increases Risk of Parkinson’s”.

 I immediately said to myself “That’s bizarre. There is a total disconnect between the headlines and the study.” If you really wanted to determine whether statin use reduced the risk of Parkinson’s, you would compare the incidence of Parkinson’s disease in a group of statin users and a matched group who did not use statins.

It turns out those studies have been done, and they were inconclusive – some studies showed a slight increase in Parkinson’s in statin users, some showed a slight decrease, and most showed no correlation between statin use and Parkinson’s.

In that context, this study could equally well have been interpreted as suggesting that statin use increased the risk of Parkinson’s, but somehow none of the headlines mentioned that possibility.

Are Both Possibilities Plausible?

 Let’s look at each possibility in detail. The reasoning is complex, but let me try to walk you through it.

 Could Statins Decrease The Risk Of Parkinson’s

 Parkinson’s is caused by the progressive degeneration of the brain neurons that produce a chemical messenger called dopamine that controls muscle movement. However, the causes of nerve degeneration in Parkinson’s patients are largely unknown.

Genetics may play a small role. Environmental toxins may play a role. But most experts feel that Parkinson’s patients produce an excess of free radicals, and it is the oxidative damage caused by those free radicals that results in the loss of the ability of neurons to produce dopamine.

But even that is not the whole answer. The brain is normally able to use coenzyme Q10, which is very abundant in brain, and other antioxidants to destroy free radicals before they damage brain neurons. Somehow in Parkinson’s patients free radical production and antioxidant production have gotten out of balance.

Advocates of the theory that statins may decrease the risk of Parkinson’s, point out that statins decrease oxidative damage. So if a person was predisposed to developing Parkinson’s and oxidative damage is a major cause of Parkinson’s, it is theoretically possible that statins could slow the progression to Parkinson’s while they were taking the drug. Of course, once they stopped taking the drug the oxidative damage to dopamine-producing neurons would resume and Parkinson’s would eventually develop.

In this model- Let’s call it Model A:

1)     Oxidative damage of dopamine-producing neurons was caused by some unspecified external agent.

2)     Statins protected the neurons from oxidative damage while they were being used.

3)     Once the statin drugs were discontinued oxidative damage resumed and the risk of developing Parkinson’s increased.

This is the model favored by the authors and repeated in all of the headlines you saw.

Could Statins Increase The Risk Of Parkinson’s?

Statins also interfere with the synthesis of cholesterol and coenzyme Q10, and these are both absolutely essential for brain function. Let’s start with cholesterol:

  •  20% of the body’s membrane cholesterol is found in the myelin sheath that coats the brain’s neurons (You can think of the myelin sheath as analogous to the plastic coating that insulates an electrical wire).
  • Cholesterol can’t cross the blood-brain barrier, which means that the brain cannot utilize cholesterol from the bloodstream . It has to make its own cholesterol.

As for coenzyme Q10:

  • It is not only a powerful antioxidant. It is also absolutely essential for cellular energy production.
  • The brain has tremendous energy requirements. The brain accounts for 20% of the energy utilization of our body. Neurons burn 2 times more energy than other cells in our body.

For both of these reasons, many experts have cautioned that statin drugs have the potential to cause neurodegenerative diseases such as Parkinson’s.  In this model – Lets call it model B:

1)     The statin drugs themselves are damaging the dopamine-producing neurons by inhibiting cholesterol and coenzyme Q10 synthesis in the brain.

2)     The antioxidant effects of the statin drugs were masking the damage caused by the statins while the drugs were being used.

3)     Once the statin drugs were discontinued the underlying damage was unmasked and the patients quickly developed Parkinson’s.

What Did The Study Actually Show?

The study (Lee et al, Neurology, 81: 410-416, 2013) looked at 43,810 statin users on the island of Taiwan. The Taiwanese Health System keeps extensive records of prescription use and health conditions of everyone on the island. It also requires that statin use be discontinued as soon as the patient reach their target of < 100 mg/dL LDL cholesterol, so they had the perfect population base to study what happens when you discontinue statin therapy.

The results were:

  • The patients who discontinued statin therapy were 42% less likely to develop Parkinson’s that those who continued on statin therapy. That result is consistent with both models A & B.
  • The increased risk of developing Parkinson’s when the drug was discontinued was only seen for the statin drugs like simvastatin and atorvastatin that are able to cross the blood brain barrier. That result is actually a bit more consistent with model B (Remember that the brain has to be able to make its own cholesterol and statins block cholesterol production).
  • When the study compared people using statin drugs to those not using statin drugs there was no significant difference in the prevalence of Parkinson’s – even for those statin drugs that cross the blood brain barrier. That means that merely being on a statin drug did not influence the risk of developing Parkinson’s. It was only when patients were on statin drugs for a period of time and were subsequently taken off statins that the risk of developing Parkinson’s was affected – and the effect was to increase risk! In the context of the first two findings, that result is also a bit more consistent with model B.

The Bottom Line:

If I were writing one of those medical blogs, I would have probably have gone with the party line and told you that statins decrease your risk of developing Parkinson’s. And if I were one of those health bloggers who never let the facts get in the way of a good story, I’d probably be scaring you with headlines saying that statins increase your risk of Parkinson’s.

But, I’m a scientist. I actually read the article, and I tell it to you like it is. Here’s your bottom line.

1)     Ignore the headlines. The study they are talking about can’t distinguish between statins increasing or decreasing the risk of Parkinson’s. Don’t let anyone tell you that reducing the risk of Parkinson’s is a side benefit of statin therapy. That simply has not been proven.

2)     The study does clearly show that discontinuing the statin drugs simvastatin and atorvastatin is associated with increased risk of developing Parkinson’s. That’s a big red flag for me, because 53% of patients discontinue statin therapy because of side effects, cost or other reasons.

3)     However, statin drugs do save lives, especially for people who have already had a heart attack, so talk with your doctor about the benefits and risks of statin drugs, and which statin drugs are best for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

How Much Exercise Do You Need?

Written by Dr. Steve Chaney on . Posted in Exercise, Fitness and Health, Issues

“Exercise” Versus “Lifestyle Activity”: 

How Active Are You—Really?

Author: Dr. Pierre DuBois

canotThe most frequent questions I get are: “How much exercise do I need?” and “What’s the best way of getting that exercise?” If you are like most people, working out just for the sake of working out does not really appeal (although there are many dedicated gym buffs who couldn’t live without their daily workouts!).

We all know that it’s important to exercise regularly if we want to live a long and healthy life. However, if you find the idea of trotting along on a treadmill for 15 minutes and then spending half an hour of working out on Nautilus machines to be about as exciting as a trip to the dentist, then this article is for you!

What the Experts Recommend:

Experts recommend that we get at least 150 minutes of exercise each week to stay in shape. But many people find taking this much exercise at once (or in three 50-minute stretches) too daunting.

The good news is that a recent study conducted by researchers at Boston University that was published in the journal Medicine & Science in Sports & Exercise found that bouts of exercise lasting less than 10 minutes a couple of times daily, such as the kind you get when cleaning the house, were sufficient to meet your weekly exercise needs.

What the Study Showed

Over 2,000 participants were included in the study, more than half of whom were overweight. Motion detectors were attached to each of the subjects for eight days, and an average of half the participants met their weekly exercise quota of 150 minutes. The average participant met his or her quota with exercise that lasted less than 10 minutes at a time. The types of exercise ranged from moderate (heavy cleaning, walking briskly and sports such as golf and badminton) to vigorous (running, hiking, shoveling and farm work).

As long as the participants met their 150-minute per week quota, no matter the length of their exercise, they had lower body mass index, smaller waists, lower triglycerides and better cholesterol levels than those who did not meet the quota.

Assistant professor at Boston University’s School of Medicine, Nicole Glazer, says “This study really speaks to the idea that some activity is better than nothing. Parking a little bit farther away, getting off the bus one stop early—all of these little things can add up and are related to a healthier profile.”

For years, researchers have studied the effects of exercise from practicing sports or visiting the gym. However, according to Glazer, “This idea of lifestyle activity is one that is under-measured in research studies.” Activities such as taking the stairs instead of the elevator, using a push mower instead of a riding mower, etc. can add up to a significant amount of energy expenditure. Experts still stress that it’s important to also get in some traditional forms of exercise and not merely replace it with lifestyle activity. Still, any exercise is useful.

“The levels of sedentary behavior in this country are alarming. So the concern that someone’s going to stop exercising and instead just get off the bus a stop earlier, that’s not my concern,” Glazer says. “The real concern is, is this a stepping-stone? Is this the way we can get inactive people to do any sort of activity? People will come up with any excuse to not exercise. I don’t need to worry about my giving them one. They’ll be able to think of something.”

The Bottom Line:

  • Experts recommend 150 minutes of moderate intensity exercise a week
  • That doesn’t mean that you need to be a gym rat or marathoner. Ten minute exercise intervals centered around everyday lifestyle activities can be sufficient.
  • So you are out of excuses. You have the time. You have all the equipment you need. You don’t even need special workout clothes.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Does Magnesium Optimize Vitamin D Levels?

Posted February 12, 2019 by Dr. Steve Chaney

The Case For Holistic Supplementation

Author: Dr. Stephen Chaney

 

Does magnesium optimize vitamin D levels?

magnesium optimize vitamin dOne of the great mysteries about vitamin D is the lack of correlation between vitamin D intake and blood levels of its active metabolite, 25-hydroxyvitamin D. Many people who consume RDA levels of vitamin D from foods and/or supplements end up with low blood levels of 25-hydroxyvitamin D. The reason(s) for this discrepancy between intake of vitamin D and blood levels of its active metabolite are not currently understood.

Another great mystery is why it has been so difficult to demonstrate benefits of vitamin D supplementation. Association studies show a strong correlation between optimal 25-hydroxyvitamin D levels and reduced risk of heart disease, cancer, and other diseases. However, placebo-controlled clinical trials of vitamin D supplementation have often come up empty. Until recently, many of those studies did not measure 25-hydroxyvitamin D levels. Could it be that optimal levels of 25-hydroxyvitamin D were not achieved?

The authors of the current study hypothesized that optimal magnesium status might be required for vitamin D conversion to its active form. You are probably wondering why magnesium would influence vitamin D metabolism. I had the same question.

The authors pointed out that:

  • Magnesium status affects the activities of enzymes involved in both the synthesis and degradation of 25-hydroxyvitamin D.
  • Some clinical studies have suggested that magnesium intake interacts with vitamin D intake in affecting health outcomes.
  • If the author’s hypothesis is correct, it is a concern because magnesium deficiency is prevalent in this country. In their “Fact Sheet For Health Professionals,” the NIH states that “…a majority of Americans of all ages ingest less magnesium from food than their respective EARs [Estimated Average Requirement]; adult men aged 71 years and older and adolescent females are most likely to have low intakes.” Other sources have indicated that magnesium deficiency may approach 70-80% for adults over 70.

If the author’s hypothesis that magnesium is required for vitamin D activation is correct and most Americans are deficient in magnesium, this raises some troubling questions.

  • Most vitamin D supplements do not contain magnesium. If people aren’t getting supplemental magnesium from another source, they may not be optimally utilizing the vitamin D in the supplements.
  • Most clinical studies involving vitamin D do not also include magnesium. If most of the study participants are deficient in magnesium, it might explain why it has been so difficult to show benefits from vitamin D supplementation.

Thus the authors devised a study (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018 ) to directly test their hypothesis.

 

How Was The Study Designed?

magnesium optimize vitamin d studyThe authors recruited 180 volunteers, aged 40-85, from an ongoing study on the prevention of colon cancer being conducted at Vanderbilt University. The duration of the study was 12 weeks. Blood was drawn at the beginning of the study to measure baseline 25-hydroxyvitamin D levels. Three additional blood draws to determine 25-hydroxyvitamin D levels were performed at weeks 1, 6, and 12.

Because high blood calcium levels increase excretion of magnesium, the authors individualized magnesium intake based on “optimizing” the calcium to magnesium ratio in the diet rather than giving everyone the same amount of magnesium. The dietary calcium to magnesium ratio for most Americans is 2.6 to 1 or higher. Based on their previous work, they considered an “ideal” calcium to magnesium ratio to be 2.3 to 1. The mean daily dose of magnesium supplementation in this study was 205 mg, with a range from 77 to 390 mg to achieve the “ideal” calcium to magnesium ratio. The placebo was an identical gel capsule containing microcrystalline cellulose.

Two 24-hour dietary recalls were conducted at baseline to determine baseline dietary intake of calcium and magnesium. Four additional 24-hour dietary recalls were performed during the 12-week study to assure that calcium intake was unchanged and the calcium to magnesium ratio of 2.3 to 1 was achieved.

In short this was a small study, but it was very well designed to test the author’s hypothesis.

 

Does Magnesium Optimize Vitamin D Levels?

 

does magnesium optimize vitamin d levelsThis was a very complex study, so I am simplifying it for this discussion. For full details, I refer you to the journal article (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018).

The most significant finding was that magnesium supplementation did affect blood levels of 25-hydroxyvitamin D. However, the effect of magnesium supplementation varied depending on the baseline 25-hydroxyvitamin D level at the beginning of the study.

  • When the baseline 25-hydroxyvitamin D was 20 ng/ml or less (which the NIH considers inadequate), magnesium supplementation had no effect on 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D was 20-30 ng/ml (which the NIH considers the lower end of the adequate range), magnesium supplementation increased 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D level approached 50 ng/ml (which the NIH says may be “associated with adverse effects”), magnesium supplementation lowered 25-hydroxyvitamin D levels.

The simplest interpretation of these results is:

  • When vitamin D intake is inadequate, magnesium cannot magically create 25-hydroxyvitamin D from thin air.
  • When vitamin D intake is adequate, magnesium can enhance the conversion of vitamin D to 25-hydroxyvitamin D.
  • When vitamin D intake is too high, magnesium can help protect you by lowering 25-hydroxyvitamin D levels.

The authors concluded: “Our findings suggest that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. Further dosing studies are warranted…”

 

What Does This Study Mean For You?

magnesium optimize vitamin d for youThis was a groundbreaking study that has provided novel and interesting results.

  • It provides the first evidence that optimal magnesium status may be required for optimizing the conversion of vitamin D to 25-hydroxyvitamin D.
  • It suggests that optimal magnesium status can help normalize 25-hydroxyvitamin D levels by increasing low levels and decreasing high levels.

However, this was a small study and, like any groundbreaking study, has significant limitations. For a complete discussion of the limitations and strengths of this study I refer you to the editorial (S Lin and Q Liu, American Journal of Clinical Nutrition, 108: 1159-1161, 2018) that accompanied the study.

In summary, this study needs to be replicated by larger clinical studies with a more diverse study population. In order to provide meaningful results, those studies would need to carefully control and monitor calcium, magnesium, and vitamin D intake. There is also a need for mechanistic studies to better understand how magnesium can both increase low 25-hydroxyvitamin D levels and decrease high 25-hydroxyvitamin D levels.

However, assuming the conclusions of this study to be true, it has some interesting implications:

  • If you are taking a vitamin D supplement, you should probably make sure that you are also getting the DV (400 mg) of magnesium from diet plus supplementation.
  • If you are taking a calcium supplement, you should check that it also provides a significant amount of magnesium. If not, change supplements or make sure that you get the DV for magnesium elsewhere.
  • I am suggesting that you shoot for the DV (400 mg) of magnesium rather than reading every label and calculating the calcium to magnesium ratio. The “ideal” ratio of 2.3 to 1 is hypothetical at this point. A supplement providing the DV of both calcium and magnesium would have a calcium to magnesium ratio of 2.5, and I would not fault any manufacturer for providing you with the DV of both nutrients.
  • If you are taking high amounts of calcium, I would recommend a supplement that has a calcium to magnesium ratio of 2.5 or less.
  • If you are considering a magnesium supplement to optimize your magnesium status, you should be aware that magnesium can cause gas, bloating, and diarrhea. I would recommend a sustained release magnesium supplement.
  • Finally, whole grains and legumes are among your best dietary sources of magnesium. Forget those diets that tell you to eliminate whole food groups. They are likely to leave you magnesium-deficient.

Even if the conclusions of this study are not confirmed by subsequent studies, we need to remember that magnesium is an essential nutrient with many health benefits and that most Americans do not get enough magnesium in their diet. The recommendations I have made for optimizing magnesium status are common-sense recommendations that apply to all of us.

 

The Case For Holistic Supplementation

 

magnesium optimize vitamin d case for holistic supplementationThis study is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No”. Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are they didn’t also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal.

That’s because most doctors and nutrition experts still think of nutrients as “magic bullets.” I cover holistic supplementation in detail in my book “Slaying The Supplement Myths.”  Other examples that make a case for holistic supplementation that I cover in my book include:

  • A study showing that omega-3 fatty acids and B vitamins may work together to prevent cognitive decline. Unfortunately, most studies looking at the effect of B vitamins on cognitive decline have not considered omega-3 status and vice versa. No wonder those studies have produced inconsistent results.
  • Studies looking at the effect of calcium supplementation on loss of bone density in the elderly have often failed to include vitamin D, magnesium, and other nutrients that are needed for building healthy bone. They have also failed to include exercise, which is essential for building healthy bone. No wonder some of those studies have failed to find an effect of calcium supplementation on bone density.
  • A study reported that selenium and vitamin E by themselves might increase prostate cancer risk. Those were the headlines you might have seen. The same study showed Vitamin E and selenium together did not increase prostate cancer risk. Somehow that part of the study was never mentioned.
  • A study reported that high levels of individual B vitamins increased mortality slightly. Those were the headlines you might have seen. The same study showed that when the same B vitamins were combined in a B complex supplement, mortality decreased. Somehow that observation never made the headlines.
  • A 20-year study reported that a holistic approach to supplementation produced significantly better health outcomes.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. When we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to our diet. I mentioned earlier that whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies of nutrients, phytonutrients, specific types of fiber, and the healthy gut bacteria that use that fiber as their preferred food source.

The Bottom Line

 

A recent study suggests that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. This is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No.”  Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are he or she did not also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal. That may be why so many of those studies have failed to find any benefit of vitamin D supplementation.

I cover holistic supplementation in detail in my book “Slaying The Supplement Myths” and provide several other examples where a holistic approach to supplementation is superior to taking individual supplements.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. Whenever we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to what we eat. For example, whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies.

For more details about the current study and what it means to you read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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