Statins & Diabetes. A Step-by-Step Guide
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- Опубліковано 20 чер 2024
- Do Statins cause Diabetes? What factors determine diabetes risk on a statin and how can we avoid it? A step-by-step guide to statin use and diabetes risk
Part II of the statin series focuses on diabetes.
In some trials statins raise risk of diabetes, in others statins have no significant effect, in others statins lower risk of diabetes.
some meta-analyses find statins raise risk of diabetes, others find no significant effect of statins on risk of diabetes.
risk of diabetes on a statin are determined by diabetes risk factors, statin dose and statin type.
people with risk factors for diabetes (obesity, Metabolic syndrome, pre diabetes; fasting glucose or glycated hemoglobin above normal but not in diabetic range), statins reduce cardiovascular risk (heart attacks, strokes) but increase risk of diabetes. For people without diabetes risk factors, statin reduces cardiovascular outcomes with no significant increase in diabetes risk
risk of diabetes on a statin mainly a concern for people already at risk of diabetes; both with and without diabetes risk factors the benefits of the statin outweigh the risks
“cardiovascular and mortality benefits of statin exceed diabetes hazard, including among those at higher risk for developing diabetes”
absolute terms: 2 cardiovascular events avoided per new case of diabetes, in people at higher risk of diabetes
Some statins raise diabetes risk, some don't. e.g. Pravastatin and pitavastatin
talking to a cardiologist I would factor in diabetes risk factors, consider lower dose or a statin that doesn´t raise risk and follow fasting glucose and HbA1c, glycated hemoglobin
why do some statins raise risk of diabetes? they may raise BMI which raises insulin resistance & diabetes. maintaining healthy body weight via diet and exercise while on a statin may lower risk
Sometimes people claim statins double risk of diabetes based on observational studies. when adjusted, the effect is cut in half and fasting blood glucose becomes non significant. Also, the effect differed by statin type, it was strongest with atorvastatin and not significant with most other statins like pravastatin or pitavastatin
most long observational studies show a diabetes risk of atorvastatin and rosuvastatin, while pravastatin and pitavastatin show no significant effect
based on this, I would assess diabetes risk factors, obesity, pre-diabetes, i´d lean toward statins that don´t increase risk, e.g. pravastatin or pitavastatin, If we need atorvastatin or rosuvastatin, i´d favor moderate dose. If it doesnt bring cholesterol down enough, i´d rather add ezetimibe or pcsk9 inhibitors rather than crank up statin dose.
and keep an eye on glycemia and keep lifestyle healthy
Connect with me:
Facebook: / drgilcarvalho
Twitter: / nutritionmades3
Animations: Even Topland @toplandmedia
References:
www.nejm.org/doi/full/10.1056...
diabetesjournals.org/care/art...
www.ahajournals.org/doi/full/...
onlinelibrary.wiley.com/doi/p...
plaza.umin.ac.jp/~juku-PT/phar...
www.bmj.com/content/bmj/374/b...
jamanetwork.com/journals/jama...
www.ncbi.nlm.nih.gov/pmc/arti...
www.ncbi.nlm.nih.gov/pmc/arti...
www.sciencedirect.com/science...
jamanetwork.com/journals/jama...
www.thelancet.com/journals/la...
www.ahajournals.org/doi/epdf/...
www.sciencedirect.com/science...
care.diabetesjournals.org/con...
link.springer.com/article/10....
cardiab.biomedcentral.com/art...
academic.oup.com/eurheartj/ar...
Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
#NutritionMadeSimple #GilCarvalho
0:00 Introduction
0:52 Disclaimer
1:20 The setup
3:12 Statins & Diabetes risk
5:24 Diabetes risk factors
10:39 Statin dose
12:53 Statin types
15:24 Putting them together
16:46 Mechanisms
17:20 Observational evidence
20:08 Funding
20:52 Summary
22:24 Importance of information quality
The most underrated but best channel on nutrition/health!
IMO one of the best videos ever on the subject of statins and potential side effects. Neither my PCP or cardiologist would ever take the time to discuss the issue at this level of detail. They make recommendations but I have no idea how current their knowledge is or what factors they considered. So I’ve refused statins and am making a heroic effort to control my cholesterol through lifestyle choices. But now, with the benefit of this new information and a better understanding of relative risks, I may reconsider my choice. Keep up the good work and thanks.
Low dose is the key.
I'm on 5mg of crestor per day. No side effects. Also, crestor is an anti-inflammatory. Another benefit👍👍
How is your lifestyle change helping you now, @doernerrr? I hope it is going well. I made a lifestyle change to fix mildly high cholesterol (210 mg/dl with high being > 199) and 120 LDL, high being > 99. For 6 years they have been fixed at 120 mg/dl and 70 mg/dl. I have some changes to make them even better because they have been very slowly creeping up. Best wishes.
This is outstanding. Period. Nothing I've read/watched comes close to how well you have organized, reviewed, and presented the information. That says a lot - I'm a retired health care provider!
Well done Gil. Stellar video. Statins can be a lifesaving treatment. Going through the side effect research like this so that people can make more informed decisions is such a valuable service
Anti-aging folks think Metformin has great potential for longer life span? Would love your research on Metformin for non-diabetics & afing. Thanks Shaun
Why doesn’t drug companies allow and make public independent research about statens?
And no clickbait.
This was amazingly helpful. I've been paralyzed with indecision over this very topic, with no way to sort through all the conflicting info. Thanks so much. I can't imagine how many lives you might save with this video.
Great content, I combine ezetimibe 10mg with rosuvastatin 10mg, I take ezetimibe every day and rosuvastatin every other day and my LDL is 62.65, my age is 61 and I am very happy with this regime, keep spreading the truth to the good people.
Thank you for systematically putting the logic and proof on the same dish!
I’ve watched several videos since my cardiologist put me on a statin and this was by far the best. He’s a great teacher.
This is the best description of this problem for diabetics. Thanks.
You are the voice of reason, your message needs to heard by many others!
Awesome video, Gil! Simple to understand and I love the way you used your mom to show how to make the analysis of whether/which statin would be best for her. It's a shame that everyone doesn't get this kind of information. Super helpful and I can't wait till the next one. Thank you!
Such a great video. I re-watched it a year later to check my memory of it.
Beautifully explained, thanks so much! Love your vídeos ❤
Another brilliant and responsible video. Thank you!
Excellent video thank you!
Wow great video as always Gil. That last bit gave me chills 😄 love seeing the silver UA-cam award in the background too. You deserve it and more!
This was very helpful. I understand so much better now. Thank you very much!!!
I'm so grateful to you, Gil, for making these videos. I feel I won the lottery when I discovered your channel. I am one of the countless who have tried to navigate health information on the internet, and was constantly swayed by conflicting information. Who to believe? What decision to make? How to navigate the endless information? i finally feel that I found a way to navigate the information, with the help of your videos. Thank you from the bottom of my heart. By the way, your Mom is one lucky lady to have you in her life!
Great video! Thank you for all you do!
Thanks for doing this analysis.
As usual a lot of good info here. I'm another one that has had this on my mind for quite a while. It hasn't cured my condition but has given me much peace of mind. Thanks Doc
Very informative, thanks for the video!
Thanks, very informative series!
best video. Many thanks
Love your videos, keep up the amazing work
Thank you so much for this information! Great content!!
Thank you so much for your information and sharing all your hard earned insights.
I am so grateful for your videos. You are saving lives. Thank you for this great information.
Good video. Thank you!
You get my like for this video sir Gill. I am so done with these false dichotomies all over the internet. We are just feeding the algorithms this way instead of our minds.
Excellent 👍 thank you
Some the most sensible and scientific info on UA-cam. 👍
Thank you for making this complicated topic so digestible, the format of the video was really easy to follow! really appreciate that this channel had expanded beyond nutrition and into pharmacology, since the explanations and breakdown are really valuable! :)
You are amazing. You are helping so many people. Thank you thank you thank you. ❤
Great information, thanks a lot for bringing it up to people. Love your videos. ♥🙏
This helps a lot - there are so many confusing MDs and PhDs on youtube that make strong and totally contradictory statements about statins. This was a super clear and useful framework to understand the whole landscape.
Great video, Gil!
I am glad to find this reflection on the studies.
I was on Atrovastatins for over 20 years since I was 30, stuck to Mediterranean diet as recommended by my GP. Every two or three years my total Cholesterol count gone up a bit and so the GP elevated my dose up to 80mg/day.
With no family history of T2D or change in diet, now at the age of 53 I find myself with T2D and rising cholesterol levels.
My GP retired during the Pandemic and my be practitioner offered me to go on Iclesirian. I think I'll take her up on this offer but the T2D is here to stay.
I bet this video will hit a million views in a month. Excellent information. Thank you Doc.
Great channel and information, thanks 🙏
Such an underrated channel!
This is the best video on Statins!
Great video
Thanks for this crash course in everything I need to know to advocate for my own health. I just started taking a statin.
Omg this guy does an amazing job! Great presentation
thank you so much for this video
Excellent and informative vid. Shared to my SM.
Interesting series.
Edit: I really wish those statin trails that looked at the risk factor for diabetes also took lifestyle into account. There are plenty of people that will think "Oh, I've got statins, they solve the problem." and then continue their unhealthy lifestyle. There are also people who take it super seriously and start living a lot healthier. That could explain the big differences between studies, since lifestyle is a big factor in diabetes as well.
I'd like to know. It makes all the difference in the world to me.
No statin is going to "cause" type 2 diabetes if you are fit.
Me too. My doctor says that my motivation to look after my own health and question things, is refreshing. Most patients just say ‘ give me a pill’ and continue living the life they led, which was a major factor in the origin of the presenting problem.
This man is leveraging on his love for his mother(and of course on his knowledge) to help literally thousands of people. Just wonderful.
Great content again.
Thanks for explaining this very well, I have been put in statins meditation two weeks ago and I was very scared to take this medication because what I have been reading about this medication, but now watching your videos I’m going to start taking my medication ❤thank you very much
You mom will be proud of you. Thanks
Congrats on the silver play button
You are a gift to the world. This is incredible information communicated with brilliance.
Wow!!
Excellent!!
👍🎩👍
Well done Dr Gil!! Dr who studied PhD is really different when talk about health matters!!
Outstanding video. Thank you. Currently on 40mg rosuvastatin for secondary prevention (stable angina/CAC=3200), since that's what I need to hit my LDL target of ~50 mg/dl. But will explore option of (lower rosuvastatin dose + ezetimibe) with my cardiologist. Lifestyle is largely optimized already. Can't wait for your next video in this series!
Definitely add the Ezetimibe. Peter Attia recommends an apoB level of 20-30 ng/dl!
Thank you for this information. This a far more understandable format than the small amount of time we usually have with our primary care doctors. Will you do a video on the station risk factor concerning memory and confusion issues?
yes, planning to cover brain & cognitive function concerns in the series
I would hope your mum also has a say in what she wants. A great video thanks.
4:54 yesss I love this way of thinking. 😎
Thanks doc for detailed video. How about if someone already has diabetes? How to lower LDL and APOB with diabetes?
Thank you Dr. Gil! Your channel has been a literal answer to my prayers.
Have you done the Part 3 video you mentioned, of the other side effects of statins like muscle pains, etc?
Thanks. God bless!
yes! we covered most of the side effects including muscle & cognitive function toward the end of this 1: ua-cam.com/video/IFGvs1Qe7cA/v-deo.html
A persons authenticity also important to take his/her information into account.
Doctor, Your videos are top shelf!!! Please keep making them. This one in particular was very helpful to me. Please address rhabdomyolysis & how often it occurs with statin use along with other muscle or organ related problems. You're my go to physician to get quality & reliable information online! Thanks for all you do for humankind!
awesome stuff doc. Can you make a video on blood pressure? What is optimal..since every body is different. Cheers!
My heath journey started 8 months ago, I wish I would have found you then, would have saved me a lot of time! Thank you.
👏👏👏👏
Thank you for this video!
Thank you Gil, i have been very critical on statins in the past...
It good to see you make things clearer about it...
Please can you do video on the controversies of white meat?
It's also another blurred area for the masses
Liver damage uncontrolled blood sugar and muscle aches. Went on a statin twice.Has taken me two years to recover my liver and I still haven’t completely recovered
I so appreciate your video-new to me although it’s a year old. Thank you! Do you still read these comments? If so, have you ever addressed the problem of research suppression when the results don’t agree with the funders? I’m looking forward to seeing more of your excellent, balanced content. Yours is a voice of reason in a very chaotic universe.
In 2020 I experienced 3 strokes and was put on 40mg statin but could not tolerate them. I now take only 10mg of ezetimbe and follow lowfat plantbased diet. I have so much to thank you for. All your excellent advice and information has helped me understand how to look after myself. Thanks again!
3 strokes? Damn, hope you weren't disabled or something. Hope you are doing fine these days
Fascinating. How about interactions between statins and metformin?
Nice video and I'm going to go by what you showed and said. Thank you much although I'm still curious if there's any reasoning about exactly what the statins are doing chemically in your body to cause a little risk of diabetes and many other side effects.
I independently came to the same conclusions as what you are recommending to your mother after consulting a cardiologist who recommended rosuvastatin 5mg + baby aspirin. I was a diehard keto diet fan who was able to bring my A1C down significantly (insulin resistant). I have since modified my diet to tend towards a Mediterranean diet. However, I had a calcium score of about 225. The reason for rosuvastatin instead of an alternate statin?? Side effects are minimal with it.
Your video was reassuring to me, and REALLY cleared up a lot of confusion about these studies.
BTW, I do also take supplements and exercise regularly. Cardiologist tells me that I should live a long life, and as you pointed out, would I rather die, or live with diabetes? Won't necessarily get diabetes, but that is the real deciding factor in all this. Thank you.
One caveat...My cardiologist said that my LDL will come down quickly, so he ordered a lipid panel in about a month. However, IF my blood glucose or A1C goes way up, I will have to revisit this whole decision.
Great information once again! Thank you so much! Question: Why would doctors still prescribe atorvastatin if the others are have less risk? Other benefits?
potency. some of those can have a stronger cholesterol-lowering effect. but things are moving away from high dose statins and toward combining with one of those non-statin drugs
@@NutritionMadeSimple Ok, good to know. Thanks so much for the reply!
Could you make video on finasteride and minoxidil mediations(to combat hairloss). Its safety and risk factors. It would help a lot a men. Thanks
Thanks so much for your thorough analysis. I love your objectivity, and I learn a lot from your videos. I am of your mother's age and I have pre-diabetes and high cholesterol. I am hearing so many conflicting opinions on the benefits of Statins, and I'm really torn on what is the best approach. What I missed in your analysis is the phenomenon of muscle pain from statins, which I suffer from. If there are other non-statin choices, why is it that Statins seems to be the first go-to choice? Thank you for all that you do for us. It is very much appreciated!
Great info as usual thank you….in my experience, people who take statins is they feel free to eat anything. I wonder how much that contributes to the increase in likelihood they will develop diabetes…
Thank you so much for your fulsome analysis of the research. This is one to listen to a few times. I am currently trying to persuade my Cardiology Pharmacist to put allow me to transfer from an 80 dose of Atorvastatin to combination therapy involving Ezetimibe. My BMI is good, I have a plant based diet and I exercise regularly, so I’m hoping that switch will be sufficient to save me from a further HA and/ diabetes.
I take it this all is on diabetes type 2? Just to clarify for everyone.
You briefly touched on it, but to elaborate on #3: the statin type.
There are of course other (side) effects of statins that can complicate the choice of statin, not just diabetes. Especially for the elderly with multiple medication use, CYP450 interactions can be worth looking into. Definitely discuss this with your GP, or rather, the pharmacist!
Love the detail and thoroughness man! The benefit-risk asessment is key to medicin.
Thanks Doc you are the best. So I’m on simvastatin. is that a good one? I am a healthy thin 65 year old with high cholesterol. Trying to get my apo b reading, but wasn’t on my last blood test. Also, I have heart disease in my family. My oldest brother died at 62 on a high fat Atkinson diet. My dad and mom live to 79.
You so right about how ironic it is that people are making such important health decisions on a paucity of good information (i.e. relying on social media), while spending more time deciding on a new phone! 🙄
we need a meta-meta analysis to solve this issue! :P
Very interesting! A year ago my liver enzymes were very high, I took myself off the statin, cut out pork, beef, fried foods and went on a low carb diet. My blood sugar went way down and I was hoping to get off meds. 3 months ago my cholesterol was very high and I had to go back on statins. Just had my liver checked, all is fine, but my blood sugar went up considerably. I am so discouraged and don’t know what else to do.
I absolutely appreciate your information on these health issues, but I would also like to know who has financed the studies and if there are financial links to pharmaceutical companies between those who have carried out and published the studies. I have seen so many side effects of statins like extrem muscle loss and deteriorating brain capacity and neuropathys that I sometimes wonder if the attributed positive effects really outweigh the side effects.
I do not rely on sound bites or commercials or UT videos to make my medical decisions. I always drop down to the comments for the best available advise!
😂
Can you PLEASE please please please do one about the Iodine Crisis by Dr Brownstein and the others? There are tooonnns of positive rewievs on the stuff they claim it's same as vitamin D where the recommended amount is much much lower than the one we should have.
Thank you!
Omg yes I would love to know his take on iodine supplementation
In 2019, I was diagnosed with diabetes with an A1c of 10.1 and very high risk cholesterol. After a year I was able to get my A1c down to 6.0 using a GCM to monitor my blood glucose to tweak my diet especially when eating out (many hidden sources of carbs and sugars). Now it is 2023, my A1c is between 6.0 - 6.5 depending on how strict I am with my diet. I'm walking 1.5 miles a day and my non-HDL cholesterol is 111 mg/dL. I'm currently taking 40 mg rosvastatin (sp). What source of information would give me good guidance to know when I could lower that to a lower dosage of the statin?
That’s a really excellent explanation of the various studies on statins Gil. Thanks a lot. But my question is - why do doctors still bother to prescribe atorvastatin and rosuvastatin when there are other statins that don’t seem to raise the diabetes risk?
potency is one consideration. but things are moving away from high dose statins and toward combining with one of those non-statin drugs
5mg rosuvastatin + 10mg ezitimibe for the win 🏆
i have high triglycerides. when I reduce it through excercise, ldl sky rockets. can you please give an explanation? my ldl is 208, triglycerides is 276. previous it was 160 and 321 respectively.should i take statins ? No history of diabetes.
I am on Atorvastatin 20mg . Keen to get off it by improving my diet . however listening to your unbiased analysis gives me reassurance that my worry is over stated . My big anxiety ! Over statins is memory loss . Is there any useful info on statin memory loss . I recall the nasa astronaut losing his memory when on statins ?. Any info on this Statin - memory topic would be great 👍 thanks for sharing your wisdom
we do plan to cover brain & cognitive function concerns in the series
@@NutritionMadeSimple thanks much appreciated 🙏 👍🙂
What if you have already developed diabetes II and high bp and have very high cholesterol? My doctor prescribed Metformin, losartan, and rosuvastatin. I have since lost 30 lbs on low carb and intermittent fasting. Checking levels at doctors office in 6 weeks.
Though monitoring glucose levels may seem diagnostic, it's crucial to recognize that elevated fasting glucose readings typically manifest after decades, indicating a progressive cellular deterioration, particularly within the pancreas (myacondra)
Can you tell me if the high blood pressure pill Hydrochlorothiazide can cause Type 2 diabetes?
Hey doc, I found the Dose part to be somewhat confusing as high or low dose is different for different statins. Like 10mg and 80mg are the low and high dose for Atorvastatin, whereas 1mg and 4mg are the low and high dose for Pitavastatin. Talking strictly in the context of dose, would high dose Pitavastatin (4mg) lead to higher incidences of diabetes than low dose Atorvastatin (10mg)? Please clear this confusion! Thanks for the great video.
5mg rosuvastatin + 10mg ezitimibe and tirzepatide seems a winning trio to keep cholesterol and A1C in check?
My only question: why would you trust a cardiologist to prescribe drugs for your mother .. the few I’ve seen don’t even test for apoB or lp(a) .. as for an NMR panel or a cholesterol absorption test .. never … not even non-HDL-C .. and I’ve NEVER been offered dietary advice.
Gil, do statins cause calcium buildup in the arteries? A function of dose and duration?
yes, they can increase calcification to some extent as part of the plaque stabilization process
Bruh, the most sensible, fact driven analysis (by FAR!!) on the internet. Very sensible and well researched. Thank you.
Subscribed!
That was great. Thank you. Can you look into the claims that statins can cause memory loss or early onset dementia? I know of two people in their mid 70’s that have memory problems since taking statins.
Had the memory problems ,induced diabities ,stoped statins.
They need to switch to hydrophilic statins (rosuvastatin, pravastatin) and/or Ezetimibe.