Using Supplements To Lower Heart Risk Isn't Backed By Evidence
DEAR DR. ROACH: I recently had a CT scan, and my score was 184. My cardiologist put me on 40 mg of Lipitor, which I reluctantly took for three weeks until I developed severe pain in my feet and hands. I stopped taking it, and the pain went away. I'm a 64-year-old male in excellent shape. I'm currently taking a chelation supplement, vitamin K2 (MK-7), and red rice yeast with CoQ10. Do you have any suggestions for the treatment of my issue? -- A.D.
ANSWER: I'm sorry to say that I disagree with all of your choices. Lipitor is a reasonable choice for the prevention of heart attack and stroke in a person at an increased risk, such as a 64-year-old man with a coronary calcium score of 184. (I can't give a better assessment of your risk without knowing a lot more about you, such as your blood pressure and cholesterol.)
Muscle aches are not uncommon with statin drugs like Lipitor, but research has shown that in most people with muscle or joint aches who take statins, the statin is not the underlying cause. (In one study, when a person didn't know whether they were taking a statin, the symptoms disappeared. In another, a person who changed from a statin to a placebo every two months was very likely to have no more pain on the placebo than they would on the statin.)
Nonetheless, there are other statins that might not cause pain, as well as alternatives like ezetimibe and bempedoic acid, which do not increase the risk of muscle aches and have been proven to reduce heart risk.
A recent large trial on chelation using powerful intravenous infusions did not show any improvement in hospitalizations for heart disease, heart attack, stroke or death compared to a placebo. I recommend against an unregulated oral supplement.
Although people who take menaquinone-7 (also called vitamin K2) have a lower heart disease risk than those who don't, a randomized trial to prevent calcification of the aortic valve found no benefit. I did not find a trial showing that treating people with vitamin K2 led to a reduced heart risk.
Red yeast rice contains the same active ingredient as the statin drug lovastatin -- but at such a low dose that cholesterol levels were not substantially lowered in a recent trial. CoQ10 has been repeatedly shown to be no better than a placebo at reducing statin side effects.
In addition to medication therapy, it's important not to underestimate the effects of a healthy, plant-based diet and regular moderate exercise.
DEAR DR. ROACH: I read your recent column on stevia. It was interesting and helpful, but what I did not see mentioned was the fact that stevia side effects "might include bloating." Boy howdy! We're talking gas city when I ate some sugar-free chocolates that contained stevia instead of sugar. The flatulence resulting from these stevia chocolates lasted for hours. Stevia produces worse gas than refried beans, onion rings or Brussels sprouts.
My advice for anyone eating any food supplemented with stevia is to make sure that you stay home during the hours following ingestion so that you can pass gas in private. -- Anon.
ANSWER: Stevia itself doesn't cause gas in most people. But when I looked up the brand of sugar-free chocolates you mention (which I'm not going to print), I found that they have a large amount of maltitol and sorbitol. These are sugar alcohols that are sweet, do not get absorbed, and are very well-known for causing bloating, gas and diarrhea.
Not everyone will get these side effects, but I am almost sure it was the sugar alcohols, not the stevia, that caused your symptoms.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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