Diet or Drugs: Do You Need Statins?

By Dean Ornish, MDFounder and President of the Non-Profit Preventive Medicine Research Institute and Clinical Professor of Medicine at the University of California, San Francisco For years, doctors have used statin drugs to help patients lower their cholesterol and prevent heart disease. However, many doctors, including Dr. Oz, disagree over how they should be used in clinical practice.

Posted on | By Dean Ornish, MD

There is a lot of controversy about whether treating otherwise-healthy people with statins is worth the risks and costs. On a recent show, Dr. Oz addressed the practice of some physicians prescribing statins because they have powerful anti-inflammatory properties that slow the aging process and because they may reduce the risk of certain chronic diseases.

However, the risks of taking statins include myopathy (muscle damage and pain), kidney failure, liver damage, and an increased risk of diabetes.  Some studies question if you can get your cholesterol level too low with statins, which may interfere with memory and hormone production.

I argue that regularly taking statins isn’t necessary, and that one can improve his or her health with positive lifestyle changes.

Let’s discuss this from several perspectives:

Taking a statin is easy, and most people will do it; however, changing diet and lifestyle isn’t that difficult according to the data.  Studies have shown that adherence to statin drugs (all statins) is only about 30% after only 3-4 months – even if someone else is paying for it, and even if there are no side-effects.

In contrast, we are finding 85-90% adherence to our intensive program of comprehensive lifestyle changes after 12 months in 24 sites. We’ve trained in West Virginia, Pennsylvania, and Nebraska – three of the more challenging parts of the country (where gravy is a beverage).  We have data on over 4,000 patients who have gone through our lifestyle program there.

Why? Because statins are fear-based: Take this pill that won’t make you feel better (and may make you feel worse if you develop a myopathy or liver damage) to prevent something really awful like a heart attack or a stroke many years down the road that you don’t want to think about, so you don’t.

However, when people make comprehensive lifestyle changes, they generally feel so much better – it reframes the reason for changing from a fear of dying to a joy of living. Unlike fear, joy and feeling good are sustainable motivators. 

What often happens is that a doctor says to a patient, “Yes, you could change your diet and lifestyle, but I know you’re not going to, and why would you want to anyway? Just take this pill.”  When the patient doesn’t change, the doctor says, “See, I knew they couldn’t do it,” and it becomes self-fulfilling.

Instead, I empower the patient.  If their cholesterol level is too high, I say, “You have a choice.  Begin by making moderate changes in your diet and lifestyle. If that’s enough to bring your LDL-cholesterol level down far enough, great, you’re there; if not, you can make bigger changes in your diet and lifestyle or you can go on a statin drug.” We discuss the risks, benefits, costs, and side effects, and then I support whatever they choose.  It’s their life; I just want to make sure that they make an informed and intelligent choice.

However, in people diagnosed with heart disease, they either need to make much bigger changes in diet and lifestyle than what most physicians recommend, or they need to go on statins.

In our 35 years of research, we, at the Preventive Medicine Research Institute have proved, for the first time, that comprehensive lifestyle changes could reverse even severe coronary heart disease without statins or other drugs. I describe this research in a New York Times article. Medicare is now covering “Dr. Dean Ornish's Program for Reversing Heart Disease” as a branded program, the first time that Medicare has done anything like this. We’ve trained 55 sites (most recently, The Cleveland Clinic) and have been able to get people off their statin drugs in many if not most cases, even though they were told that they had to take them forever.

In a randomized controlled trial published in the Journal of the American Medical Association, we found a 40% reduction in LDL-cholesterol with our program of comprehensive lifestyle changes without drugs – i.e., as good as what you can get with statins, but without the costs, and the only side effects are good ones.

Statins do have anti-inflammatory effects, but so do comprehensive lifestyle changes. We found significant reductions in C-reactive protein and other markers of inflammation in those who went through my program.

Furthermore, many people are surprised to learn that statins do not need to be taken every day.  Drug companies, who want to sell as much of these drugs as possible, do not want you to know that taking these medications just 2-3 times per week is adequate to dramatically reduce your cholesterol.  The benefits to taking the medication only 2-3 times per week are: 1. The drug is now less than half the price; and 2. This dosing schedule will dramatically reduce or completely eliminate the side effects of muscle pain (myalgia) and liver damage.

It is not the statin medication per se that lowers your total cholesterol and your LDL. It is your liver. Although the drug itself causes the side effects (like myalgia), the drug only acts as a messenger, of sorts, to give the liver the message to remove cholesterol from your blood and thereby lower your cholesterol. How does this work?

The statin drug goes into the liver and blocks the liver’s ability to make cholesterol by blocking a critical enzyme in the liver cell, which halts the cell’s ability to manufacture cholesterol. Cholesterol is needed in the body and in the liver, to be put into cell membranes, make hormones, etc. When the statin is in the liver cell it cannot make enough cholesterol in the liver cell. The liver now feels deprived of cholesterol since it’s own internal machinery has been disabled.

So, the liver decides to go get cholesterol and LDL out of the blood. When deprived of internally produced cholesterol, the liver turns on the machinery to make LDL “receptors” and put these receptors (proteins) on it’s own cell membrane. The liver cell (hepatocyte) turns on it’s messenger RNA that gives the instructions to make LDL receptors. The liver cell starts making a lot of these receptors and they migrate to the cell membrane of the liver cell. These new LDL receptors then filter the blood, literally sucking LDL particles out of the passing blood. This is how the statins have their potent effect in reducing the cholesterol and LDL in your blood.

Once your body has made these protein receptors, they last for at least 30 days on the liver cell surface. You do not need to tell the liver to make these new receptors everyday.  If you take the statin even every third or fourth day, you will keep up a great concentration of LDL receptors on the liver cells, and keep sucking the LDL out of your blood and away from harming your blood vessels.

If you are concerned about your heart health, read about The Ornish Spectrum, a proven program that helps to reverse and prevent chronic diseases through healthy, sustainable life changes. Only you have the power to change your health and your life for the better.

Article written by Dean Ornish, MD
Founder and President, Preventive Medicine Research Institute Clinical Professor of Medicine, University of California, San...