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Cholesterol: Part 2: The Great Statin Debate
Part 2: The Great Statin Debate
Benefits, tradeoffs, and the dangers that are often glossed over
If cholesterol is the most misunderstood molecule in modern medicine, then statins might be the most emotionally charged prescription on the planet.
I personally believe, that statins are chronically over-prescribed and under-explained, and can be potentially dangerous when misused, overused, or used to avoid addressing the real underlying issue.
In the Bedrock/Rooted Faith lane, we believe in Informed consent. Context. Stewardship over fear.
Statins come with tradeoffs—and too many people never hear the full story.
This article is about the dangers that often get minimized—so you can ask better questions and make a decision that fits you.
The dangers and tradeoffs that often get glossed over when speaking with your prescribing physician:
1) Muscle symptoms and exercise intolerance (SAMS)
Muscle pain, cramps, weakness, and fatigue are among the most common reasons people stop statins—whether due to the statin itself, other causes, or a mix (including nocebo effects). Major expert panels still treat SAMS as a real clinical issue and provide guidance for evaluating it. PubMed+2OUP Academic+2
Statins cause muscle pain (myalgia) likely due to disrupting muscle cell energy (reducing CoQ10), causing calcium leakage for cell function, potentially affecting muscle proteins, and increasing sensitivity, says the Mayo Clinic, Verywell Health, Healthline, and the National Institutes of Health.
Key theories on why statins cause pain:
Bedrock take: If you feel worse on a medication, you deserve a clinician who takes it seriously and helps you problem-solve—not one who dismisses you.
2) Blood sugar and diabetes risk (small, but real—and dose-related)
The “statins slightly increase diabetes risk” conversation is not conspiracy; it’s in the medical literature.
A large meta-analysis of randomized statin trials found a ~9% increased risk of incident diabetes. PubMed+1And a separate meta-analysis found intensive-dose statin therapy carried a higher new-onset diabetes risk than moderate-dose therapy. JAMA Network+2PubMed+2
Statins can increase blood sugar by causing insulin resistance, making it harder for cells to absorb glucose, and potentially affecting pancreatic beta-cells that release insulin, often through pathways like the mevalonate pathway, leading to higher blood sugar and an increased risk of Type 2 diabetes, especially with high-intensity statins
How Statins Affect Blood Sugar
- Insulin Resistance:
- Pancreatic Function:
- Mevalonate Pathway:
- Inflammation & Signaling:
Bedrock take: If someone is already insulin resistant or prediabetic, this deserves a real conversation—because lowering one risk marker while worsening metabolic terrain is not a win.
3) Cognitive symptoms
The FDA has documented post-marketing reports of memory loss and confusion with statin use, noting these events were generally not serious and resolved after stopping. U.S. Food and Drug Administration
Is this common? Is it worth mentioning up front? Yes—because people deserve to know what to watch for. The brain is one place where we store cholesterol as a necessary antioxidant protectant of the brain, and for the myelin sheath in the brain and around nerve endings. Statins have been linked to memory loss, dementia risk, Alzheimers and even mimicking Parkinson's like symptoms.
4) Drug interactions (this one is very glossed over)
Some statins have significant interaction risks with certain medications (and sometimes even dosing limits) because of how they’re metabolized. The FDA specifically calls out contraindicated combinations and interaction concerns (for example, with lovastatin). U.S. Food and Drug Administration
Bedrock take: “Take this forever” without a medication interaction review is sloppy medicine. Statins are actually only approved for use for 2 years or less, yet people are often put on them for a decade or more. Prescription drugs are not for "maintenance."
5) Pregnancy and breastfeeding (the rules changed)
In 2021, the FDA requested removal of its strongest “contraindication” warning for statins in pregnancy, but still advises that most pregnant patients should stop statins once they learn they’re pregnant, and that breastfeeding is generally not recommended for those who must remain on statins. U.S. Food and Drug Administration+1
Breast milk is rich in cholesterol, vital for an infant's brain and nerve development, with levels highest in colostrum and decreasing as lactation progresses, influenced by maternal diet, ethnicity, and location. This essential nutrient helps build brain tissue, nerves, and supports fat metabolism, making breast milk a primary cholesterol source for babies, with higher concentrations than infant formulas.
Why it's important:
Cholesterol Levels During Lactation:
- Colostrum: Highest levels (around 27-31 mg/dL or 200 mg/L).
- Mature Milk: Levels decrease to about 10-18 mg/dL (126 mg/L) as lactation continues.
Bedrock take: any woman of child-bearing age should not be prescribed a statin.
6) Liver damage
In the liver, cholesterol is crucial for making bile acids (to digest fats and excrete cholesterol), building cell membranes, and creating vital substances like hormones (steroids), Vitamin D, and lipoproteins (like HDL/LDL) to transport it throughout the body. The liver is the main site for both producing and eliminating cholesterol, converting it into bile salts for removal or packaging it into lipoproteins for delivery to other cells.
Key Uses of Cholesterol in the Liver:
- Bile Acid Production: The liver converts cholesterol into bile acids, which are essential for breaking down fats in the intestine and a primary way the body excretes excess cholesterol.
- Lipoprotein Synthesis: It packages cholesterol and fats into lipoproteins (VLDL, LDL, HDL) to transport them via the bloodstream to other tissues that need it.
- Cell Membrane Component: Cholesterol is incorporated into liver cell membranes (and other cells) to maintain their structure and function.
- Hormone & Vitamin D Precursor: It serves as the starting material for synthesizing steroid hormones (like cortisol, testosterone) and Vitamin D.
The Liver's Role in Cholesterol Balance:
- Production: The liver manufactures all the cholesterol the body needs, even if you don't consume any in your diet.
- Excretion: It's the main organ for clearing cholesterol from the body by converting it to bile and eliminating it through the digestive system.
- Regulation: By managing production and removal, the liver plays a central role in maintaining healthy cholesterol levels, impacting heart health.
Bedrock take: we still want thoughtful baseline assessment and symptom-based follow-up, not fear—or neglect.
7) Hemorrhagic stroke risk in specific contexts (important nuance)
In the SPARCL trial (high-dose atorvastatin after stroke/TIA), atorvastatin reduced recurrent stroke overall, but analyses discuss an increased risk of hemorrhagic stroke in that context. New England Journal of Medicine+2PMC+2
Bedrock take: this is exactly why context matters. High-dose statin decisions after stroke deserve individualized risk review—not autopilot prescribing.
8) The “mitochondria/CoQ10” conversation
Because the mevalonate pathway also feeds other downstream compounds, researchers have long discussed statins’ potential impact on mitochondrial function and CoQ10 levels. AHA Journals+2JACC+2. In other countries, it is required that anyone on a Statin also be prescribed 100 mg of CoQ10 to offset this known danger.
Bedrock take: CoQ10 can be a reasonable individualized trial —but it shouldn’t be used to ignore the bigger question: Is the statin the right tool at the right dose for this person?
The 9 questions I want every patient to ask before starting (or staying on) a statin:
- What is my absolute risk (not just my LDL)?
- What is my expected absolute benefit over 5–10 years? NCBI
- Are we measuring metabolic risk (TG/HDL, fasting insulin, A1c trends) alongside lipids?
- Do I have insulin resistance—and are we addressing it?
- Is there a reason we’re choosing this statin, this dose (and not a lower-dose or alternative)?
- What’s the plan if I develop muscle symptoms? PubMed
- What’s the plan for blood sugar monitoring? PubMed
- What medications/supplements might interact with this? U.S. Food and Drug Administration
- What would make us reassess or change course?
Bottom line: the goal is let the body guide the process... God's design is infinitely wise, symptoms are the body's way of communicating with us. Listen. Learn. Adapt. Don't jump to a medication as a short cut before fully understanding the whole picture.
At Rooted Faith / Bedrock, we also don’t accept medication as a substitute for metabolic stewardship.
Statins may reduce events for some people. PubMed+1They also carry tradeoffs that deserve daylight. U.S. Food and Drug Administration+2PubMed+2
You deserve a plan that includes:
- real risk math (not fear)
- metabolic strategy
- side effect monitoring
- and terrain-building habits that move the needle long-term
Ready to make it personal?
If you’re on a statin (or you’ve been told you “need” one) and you want a second set of eyes on your full terrain—lipids, metabolic markers, lifestyle inputs, and risk context:
Take our complimentary assessment today and let one of our Bedrock team members help you map out your next best steps.
DM or reply “ASSESSMENT” and we’ll send it to you.
References
- FDA (Feb 28, 2012). Important safety label changes to cholesterol-lowering statin drugs (memory/confusion reports; blood sugar; interactions; liver enzyme monitoring updates). U.S. Food and Drug Administration+1
- CTT Collaboration (Lancet 2010). Efficacy and safety of more intensive lowering of LDL cholesterol (26 trials; ~170,000 participants). PubMed+2The Lancet+2
- CTT Collaboration (Lancet 2012). Effects of lowering LDL cholesterol with statin therapy in people at low risk (absolute benefit framing). PubMed+1
- Stroes et al. (Eur Heart J 2015). Statin-associated muscle symptoms (SAMS): EAS Consensus Panel guidance. PubMed+1
- Sattar et al. (Lancet 2010). Statins and risk of incident diabetes: collaborative meta-analysis. PubMed+1
- Preiss et al. (JAMA 2011). Intensive- vs moderate-dose statin therapy and new-onset diabetes. JAMA Network+2PubMed+2
- SPARCL trial (NEJM 2006) and reviews/summaries (atorvastatin 80mg post-stroke/TIA; hemorrhagic stroke nuance). New England Journal of Medicine+2PMC+2
- Ward et al. (Circ Res 2019). Statin toxicity (mechanisms; mevalonate pathway; adverse effects overview). AHA Journals
- Marcoff & Thompson (JACC 2007) + mitochondrial/CoQ10 discussion and mixed CoQ10 evidence. JACC+2AHA Journals+2
- FDA (Jul 20, 2021). Removal of strongest pregnancy warning; guidance for pregnancy/breastfeeding. U.S. Food and Drug Administration+1
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Cholesterol: Part 2: The Great Statin Debate
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