Question:
I have been taking Zocor for 5 months. About a month ago, I started to have severe leg cramps. Could Zocor be causing this pain? My cholesterol was 240 and is now about 130. Are there any problems with stopping for awhile and starting again? What are the risks?
Answer:
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), cerivastatin (Baycol) and lovastatin (Mevacor) are all statins. Statins reduce cholesterol, and some of them have been shown to reduce the progression of heart attacks, strokes and death. Treatment usually is continued indefinitely. If Statin therapy is stopped, cholesterol levels will return to pretreatment levels. Statins may cause muscle and leg cramps, myalgia (muscle pain), myositis (muscle inflammation) and rhabdomyolysis (Muscle breakdown). Rhabdomyolysis is a serious condition that often starts as muscle pain and may result ultimately in kidney failure. Therefore, you should report unexplained muscle pain, weakness or tenderness to your doctor.
Other causes of leg cramps may include electrolyte abnormalities (Sodium, Potassium,Magnesium, Calcium) caused by a variety of disorders:
- Diarrhea
- Excessive heat causing dehydration
- Pregnancy, especially in the late months
- Liver Cirrhosis
- Renal dialysis
- Thyroid disease
- Heavy alcohol use
- Lead toxicity
- Sarcoidosis
- Peripheral nerve injury and nerve root compression.
It is important to differentiate leg pain from cramps. Neuropathy (nerve damage), sciatica, as well as clogged arteries in the leg (vascular disease) can cause leg pain.
Before you experiment with supplements, talk to a physician who knows something about nutrition and sports medicine – and don’t assume that they all do — or a registered dietician who has experience working with athletes and exercisers.
Prevention and management
Enhanced susceptibility to statin-associated cause muscle and leg cramps, myalgia (muscle pain), myositis (muscle inflammation) and rhabdomyolysis (Muscle breakdown) occurs more frequentlyin patients with renal failure, Cirrhosis of the liver, and poor thyroid function.
- Pravastatin (Pravachol®) and Fluvastatin (Lescol®; Lescol® XL) appear to have much less intrinsic muscle toxicity than other statins. Pravastatin or perhaps fluvastatin is the statin of choice in patients treated with gemfibrozil (Lopid®). However, these drugs should be used cautiously and only if the benefit is likely to outweigh the low risk of muscle toxicity.
- Fenofibrate (Antara®; Fenoglide®; Lipofen®; Lofibra®; TriCor®; Triglide®) is the preferred fibrate in patients who require combined therapy with a statin.
- Although there is only limited evidence for benefit, if a patient requires a statin and experiences muscle pain while on pravastatin or fluvastatin, a trial of with CoQ10 (Coenzyme Q10) supplements at 150 mg – 200 mg daily might be tried. CoQ10 is a naturally occurring nutrient found in each cell of the body. It is found in foods, particularly in fish and meats. In addition to playing a significant role in the energy system of each of our cells, CoQ10 is also believed to have antioxidant properties and may play a role in heart health.
In the absence of clinical symptoms, a blood test of CK level >10 times the upper limit of normal may be due to a statin is an indication to stop it. Patients should drink large quantities of fluids to facilitate excretion of CK. After the CK has returned to baseline, patients may be tried on pravastatin or fluvastatin with careful monitoring of the CK levels.
When cramping occurs, try these steps:
- Drink six to eight glasses of water daily to stay well hydrated (if your heart function is OK).
- Nocturnal muscle cramps can often be prevented by doing leg-stretching exercises, such as the one outlined below.
The one stretch recommended by almost every doctor and physical therapist is the “Calf Stretch” or “Wall Stretch.” Stand 2-3 feet from a wall, feet parallel to each other, and hands on the wall at head height or above. Keep your feet flat on the floor and lean forward until you feel a stretch – not to the point of pain – in your calves. Hold for 30 seconds and repeat at least once, maybe twice. Make this stretch part of your daily routine — once in the morning, once late in the afternoon, and one more time before you go to bed. Vary the exercise by doing a “wall pushup” from the same position.
- Beans, nuts, seeds and dark chocolate are rich sources of magnesium.
- Pyridoxine, vitamin B6, is also supposed to reduce leg cramps.
- Taurine, an amino acid in meat, can have an effect in the treatment of leg cramps. It is often used in combination with glutamic acid and aspartic acid.
- DL-Phenylalanine is supposed to dampen the pain when cramping.
- Vitamin E has a weak action and has to be taken in doses of circa 400 mg/day.
- Many persons recommend calcium (sometimes in the form of dolomite), potassium (bananas), anti-oxidants (like pycnogenols, grape-fruit seed extract) and to avoid dehydration (drink plenty of water).
- Peppermint has a weak action but can anyhow lessen cramps.
Sometimes the only way to stop Statin related cramps is by stopping to take it. There are ways to reduce cholesterol “the natural way”:
Diet can play an important role in lowering your cholesterol. Here are five foods that can lower your cholesterol and protect your heart.
Can a bowl of oatmeal help lower your cholesterol? How about a handful of walnuts or even a baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet — like these — may be enough to lower your cholesterol to a healthy level and help you stay off medications.
1. Oatmeal, oat bran and high-fiber foods
Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the “bad” cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes.
Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you’ll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.
2. Fish and omega-3 fatty acids
Eating fatty fish can be heart-healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — reduces the risk of sudden death.
Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:
- Mackerel
- Lake trout
- Herring
- Sardines
- Albacore tuna
- Salmon
- Halibut
You should bake or grill the fish to avoid adding unhealthy fats. If you don’t like fish, you can also get small amounts of omega-3 fatty acids from foods like ground flaxseed or canola oil.
You can take an omega-3 or fish oil supplement to get some of the benefits, but you won’t get other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.
3. Walnuts, almonds and other nuts
Walnuts, almonds and other nuts can reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy.
According to the Food and Drug Administration, eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Just make sure the nuts you eat aren’t salted or coated with sugar.
All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.
4. Olive oil
Olive oil contains a potent mix of antioxidants that can lower your “bad” (LDL) cholesterol but leave your “good” (HDL) cholesterol untouched.
The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread. Olive oil is high in calories, so don’t eat more than the recommended amount.
The cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But keep in mind that “light” olive oils are usually more processed than extra-virgin or virgin olive oils and are lighter in color, not fat or calories.
5. Foods with added plant sterols or stanols
Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.
Margarines, orange juice and yogurt drinks with added plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day.
Plant sterols or stanols in fortified foods don’t appear to affect levels of triglycerides or of high-density lipoprotein (HDL), the “good” cholesterol.
Other changes to your diet
For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle.
Cut back on the cholesterol and total fat — especially saturated and trans fats — that you eat. Saturated fats, like those in meat, full-fat dairy products and some oils, raise your total cholesterol. Trans fats, which are sometimes found in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise low-density lipoprotein (LDL), the “bad” cholesterol, and lower high-density lipoprotein (HDL), the “good” cholesterol.
Dr T