Dr. Duane Graveline - Questions and Answers
Newsletter readers submitted general questions mostly on statins and cholesterol. These are some selected questions with answers from Dr. Graveline.
Dr. Graveline is the author of Lipitor®, Thief of Memory; Statin Drugs, Side Effects and The Misguided War on Cholesterol; and The Statin Damage Crisis.
1. Question: What diet do you think is best for optimum health and longevity and do you think it makes any difference, or is it all in our genes?
Dr Graveline: The best dietary guidelines I know of are those diets called primitive or Paleolithic. Generally speaking these diets emphasize what our ancestors were eating immediately prior to our agricultural period, 10,000 years ago. Once we began to settle in communities we began to have an increased dependency on grains of all types. This was the beginning of our dietary indiscretion.
After 5 million years we were physiologically perfectly adapted to our pre agricultural diet and still remain so. It is our perfect diet with respect to balance of protein, fat, carbohydrate, vitamins and minerals and one which I emulate as much as possible. I believe this diet to be the best for anyone with chronic illness and that we all would be better off with this type of diet even if we are healthy.
2. Question: What is your take on Welchol as a substitute for statin therapy for high cholesterol?
Dr Graveline: Back when I was in medical practice, if I were caring for a familial hypercholesterolemia case with a family history of premature heart disease and stroke, this person would be on a statin to which I might add Welchol to get maximum LDL cholesterol response. For this severe disease state I would do all I could to get the cholesterol down and decrease thrombogenic influences such as smoking, transfats and oxycholesterol.
Having said that, I must add that the usual case of elevated cholesterol today, 99% of the time, is not associated with disease. The actual level of cholesterol is irrelevant in these cases. It is a God-given variable like one's height and irrelevant to atherosclerosis and increased cardiovascular risk. 40 years of brainwashing about cholesterol causation of heart disease, I believe, is completely wrong.
3. Question: Can clogged arteries become unclogged with diet change, lowering cholesterol, and exercise?
Dr Graveline: This has actually been demonstrated experimentally but another common occurrence is development of new circulation to the involved area by the opening up of pre-existing circulatory channels. We have to remember here that cholesterol level is irrelevant to atherosclerosis so the lowering of cholesterol mentioned above may not be a true contributor, The diet change, exercise and improvement in general health are likely to be the key factors involved
4. Question: If a person has high cholesterol but no plaque build up (result of a doppler ultrasound test) should he/she be medicated with statins?
Dr Graveline: Cholesterol level by itself is insufficient justification for statin therapy. If this person had family history of premature heart disease or stroke or personal history of ECG change, stroke warning or angina, a statin is indicated for its anti-inflammatory effect.
5. Question: I suspect my aching leg pain of 15 years is caused by statins.... Is there a test or any way to know for sure statins are causing it?
Dr Graveline: Although the statin may have caused this permanent myopathy (incidentally 68% of all myopathy associated with statin use becomes permanent despite cessation of the statin) proving it is incredibly difficult. The damage is to the mitochondria. Visualizing this process via special staining techniques is possible but separating the statin contribution to mitochondrial damage from that due to the process of aging is next to impossible.
Statins use the same pathways as normal aging to accomplish their damage, so that separating normal aging from abnormal statin effect will always be a challenge. Muscle biopsies are not pleasant which is another consideration over and above the cost.
6. Question: If someone with very high cholesterol were to remove sugar, wheat and corn products entirely from their diet, what effects could they expect on their cholesterol and triglycerides?
Dr Graveline: I suspect both triglycerides and cholesterol would tend to normalize but that depends on the balance of the remaining food intake. Triglycerides are a function of carbohydrate consumption so to lower them one would naturally consider a carbo-restrictive diet.
Incidentally most of the time LDL cholesterol goes down also with this kind of diet. But remember, cholesterol is the most important biochemical in your body. I would be very reluctant to do anything that might lower my cholesterol.
7. Question: Do the plant sterols added to some vitamins that claim to lower cholesterol have the same negative effect as a statin? Or flax seed oil capsules?
Dr Graveline: The side effects of statins are based primarily on mevalonate blockade, a biochemical function not shared by sterols or flax seed oil. The cognitive side effect of statins are due to excess cholesterol lowering so might be a concern if sterol or flax seed had a specially vigorous effect on someone's cholesterol.
8. Question: If you are taking a statin, what supplements would you take and why?
Dr Graveline: I believe all statin recipients should take CoQ10. This is the major supplement. Everyone should start taking CoQ10 immediately after starting statins (the same day). One immediate effect of statins is to reduce the bioavailability of CoQ10. A major role of CoQ10 is to prevent free radical damage to mitochondrial DNA. Once this damage occurs, even large amounts of CoQ10 may find it difficult to reverse mitochondrial damage.
9. Question: You sometimes hear of professional athletes and marathon runners having heart attacks while competing or training. Can too much exercise be as bad as too little?
Dr Graveline: Often times this tragedy occurs because a person will have a constricted artery that under peak stress is unable to deliver the necessary amount of blood to an area of cardiac muscle. Under extreme demand ventricular fibrillation (excess excitation) or infarction occurs.
The only way to identify these ahead of time is to administer precautionary stress ECGs to all budding atheletes. Obviously this has pitfalls because the test may be not sufficiently stressful or in some rare instances may be excessively stressful, triggering an attack.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor