Folic Acid and Cancer

March 24, 2015 by Dr. Steve Chaney

Does Folic Acid Increase Cancer Risk?

Author: Dr. Stephen Chaney

You’ve seen the headlines. “Folic Acid Supplements May Increase Colon Cancer Risk in People Over 50” and “Folic Acid Supplements May Increase Prostate Cancer Risk in Men”. And I’ve seen articles telling people over 50 that they should take their multivitamin tablets every other day to avoid getting too much folic acid.

I’ve even heard of doctors telling their patients to avoid any supplements containing folic acid. So what’s the truth? Is there a cause and effect relationship between folic acid and cancer?

Why Do People Say Folic Acid Increases Colon Cancer Risk?

Perhaps a bit of historical perspective is in order. A number of population studies had suggested that high intakes of folic acid might protect against cancer, especially colon cancer, so several placebo controlled clinical studies were initiated to test that hypothesis. Those studies had mixed results, with some suggesting that folic acid might be protective and others suggesting that it had no effect. None of those studies suggested that folic acid supplementation increased the risk of any kind of cancer.

In 1998 mandatory folic acid fortification of grain products was introduced. In addition, the number of Americans taking supplements with folic has increased dramatically in recent years. As a consequence total intake of folates (folic acid from fortified foods and supplements plus folates naturally found in foods) has increased significantly. By one estimate blood levels of folates have increased 2.5-fold between 1994 (before fortification) and 2000 (after fortification).

So it was just natural to ask if this increase in folate intake might have unintended consequences. And one clinical study seemed to suggest that it might (JAMA, 297: 2351-2359, 2007)

That study looked at colorectal adenomas and reported high folate intake was associated with an increased risk of more advanced adenomas. [It is important to note that adenomas are benign tumors. They are thought to be precursors to colorectal cancer but they are not actually cancerous].

Some experts immediately started warning about getting too much folic acid in the diet – with some going so far as to warn that people over 50 should only take a multivitamin every other day.

And several papers were published speculating on how differences between the way that folic acid and the other folates were utilized by the body could cause folic acid to increase the risk of colorectal cancer while naturally occurring folates decreased the risk.

Let me put this into perspective. Any good scientist knows not to trust a single clinical study. Individual clinical studies can provide misleading results. Sometimes it is possible to pinpoint the cause. For example, the study may have been poorly designed, may have included a non-representative population group, or the statistical analysis may have been incorrect. But, sometimes we never know why an individual clinical study came to the wrong conclusion.

That is why good scientists generally say that more studies are needed and base their recommendation on the preponderance of many studies rather than a single study.

The problem was that all of this hype and hypothesizing about folic acid increasing the risk of colon cancer was based on a single study, and that study didn’t actually look at colorectal cancer. A Norwegian study four years later found no evidence for increased colorectal cancer at folic acid intakes of up to 800 ug/day (AJCN, 94: 1053-1062, 2011) – but it was largely ignored.

The background is similar for the claims that folic acid may increase prostate cancer risk. When a small meta-analysis that included some, but not all, published clinical studies suggested an increased risk of prostate cancer, some experts went as far as to suggest that men should completely avoid supplements with folic acid.

The problem is that even meta-analyses can be misleading if they only examine a small sub-set of clinical studies because they can be unduly influenced by a single misleading clinical study.

Does Folic Acid Increase Colon Cancer Risk?

Should We Avoid Supplemental Folate?

The American Cancer Society decided to resolve the uncertainty about folic acid intake and colon cancer risk once and for all (V.L. Stevens et al, Gastroenterology, 141: 98-105, 2011). They designed the study to answer two very important questions:

1) Has the increased folate intake by Americans over the past several years actually increased their risk for colorectal cancer?

2) Does the chemical form (folic acid versus folate) influence its effect on colorectal cancer risk?

And this study had two very important firsts:

1) This was the very first study to investigate the association between folate intake and colorectal cancer entirely in the post-fortification period.

2) This was also the very first study to separate out the effects of folate and folic acid on colorectal cancer risk.

And it was a very large study. They followed 43,512 men and 56,011 women aged 50-74 for 8 years between 1999 and 2007.

Folate intakes from food ranged from 175 ug/day to 354 ug/day while folic acid intakes from food fortification, supplements and multivitamins ranged from 71 ug/day to 660 ug/day. Total folate (both naturally occurring folates and folic acid) intakes ranged from 246 ug/day to over 1014 ug/day.

When they analyzed the data they found that high intakes of neither folic acid nor natural folates were associated with any increased risk of colorectal cancer. In fact, they found high intake of total folates was associated with a significant decreased risk of colorectal cancer.

Does Folic Acid Increase Cancer Risk?

What about prostate cancer and other types of cancer? Could folic acid increase the risk of other cancers? To resolve this issue once and for all, a group from Oxford University (Clarke et al, The Lancet, doi: 10.1016/S0140-6736(12)62001-7) did a meta-analysis of every study published through 2010 that compared folic acid supplementation to a placebo, lasted at least 1 year, included at least 500 people and recorded cancer incidence – some 13 studies with over 50,000 participants.

The results were clear cut. As for folic acid and cancer, supplementation did not increase the overall cancer risk, and when the incidence of individual cancers was analyzed, folic acid supplementation did not increase the risk of developing colon cancer, prostate cancer, lung cancer, breast cancer or any other site-specific cancer.

To put this in perspective the average dose of folic acid used in these clinical studies was 2 mg/day, which is 5 times the RDA and 5 times the dose in most supplements. And one of the clinical trials used 40 mg/day, which is 100 times the dose in most supplements.

The Bottom Line

Forget the warnings and the hype. You can be confident that folic acid does not increase the risk of colorectal cancer, prostate cancer, or any other kind of cancer.

The American Cancer Society recently performed a very large clinical study looking at the effect of folic acid intake from supplements and folate intake from foods on colon cancer risk. That study found that high intakes of neither folic acid nor natural folates were associated with any increased risk of colorectal cancer. And, they found high intake of total folates was associated with a significant decreased risk of colorectal cancer.

The authors of that study concluded: “The findings of this study add to the epidemiological evidence that high folate intake reduces colorectal cancer risk.” “More importantly, no increased risk of colorectal cancer was found, suggesting that the high levels of this vitamin consumed by significant numbers of Americans should not lead to higher incidence rates of this cancer in the population.”

A second meta-analysis of every clinical study looking at folic acid intake and cancer risk through 2010. The results of that study were clear cut. Folic acid supplementation did not increase the overall cancer risk, and when the incidence of individual cancers was analyzed, folic acid supplementation did not increase the risk of developing colon cancer, prostate cancer, lung cancer, breast cancer or any other site-specific cancer

Like any good scientist I am aware that future studies could change our understanding, but for now I am confident in saying that there is no credible evidence that folic acid supplementation increases your risk of any kind of cancer. If the science changes, I will be the first to let you know.

But it will be really interesting to see how long it takes all those web sites, blogs and so-called “experts” to acknowledge that the science has changed and they should stop issuing false warnings about folic acid supplementation.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

No Viagra Side Effects?

January 6, 2015 by Dr. Steve Chaney

A Big, Fat Problem With Testosterone

Author: Dr. Stephen Chaney

You can’t turn on the TV nowadays without seeing ads for medications to prevent erectile dysfunction and allow you to be ready “when the moment is right.” You have probably also heard the ads for testosterone creams to treat “low T”. Similar ads seem to find their way into our email inbox almost every day. Evidently, we guys must have a problem. Drugs that increase sexual potency appears to be a topic of much relevance to many of us.

But if you listen to the ads carefully, you will discover that all of these drugs have serious side effects. Here are some of the viagra side effects.

Sudden drops in blood pressure
Sudden decreases or loss of vision or hearing
Chest pain, dizziness and nausea
And many more

What if there were a way to increase your testosterone levels and enhance your sexual potency without side effects? In fact, there is a proven way to do that, and it involves treating the cause of the problem – not just the symptoms.

Can Obesity Affect Your Sex Drive?

While millions of American women are on a diet at any one time, many men just ignore those extra pounds. Things like heart disease, cancer and diabetes seem to be much more distant threats to us. The male ego also allows us to stand in front of a mirror, pot belly and all, and visualize ourselves as we were in our college years.

But, what if obesity lowered your testosterone levels and caused erectile dysfunction? Would that get your attention?

That is why a recent study in the Journal of Clinical Endocrinology and Metabolism should be of great interest to all of us. This study looked at 1700 men of all weights and showed that weight gain of 30 pounds lowered testosterone levels as much as if the men had aged 10 years.

Low testosterone levels in men lead to depression, loss of muscle mass and bone density, feminization, and that all important loss of sexual drive and performance.

Viagra – Without The Side Effects

So guys, if you are concerned about your sexual performance, but don’t want to take drugs that may have viagra side effects, you have another option. Just take off some of that extra weight you have accumulated over the years. That may just increase your testosterone levels and your sexual performance naturally. And you won’t have any side effects, just side benefits.

The Bottom Line

So guys, if you are not motivated to lose those extra pounds by how you look or by the increased risk of heart disease, cancer & diabetes, now you have yet another reason to shed those extra pounds. Perhaps this should be the year that you actually stick to your new year’s resolution to lose weight.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Can Antioxidant Supplements Cause Cancer?

December 2, 2014 by Dr. Steve Chaney

The Truth About Vitamins C & E

Author: Dr. Stephen Chaney

I am always amazed at how certain nutrition myths take on a life of their own. A single study gets sensationalized. The study may not be very good, but some nutrition guru publicizes it even though it may be contradicted by other studies that come to the opposite conclusion.

Other blogs and news feeds pick it up. It gets repeated over and over until it becomes generally accepted as true. It becomes what I call an “urban nutrition myth”. Once these myths become well established they are hard to correct. When contrary information is published, it is ignored because everyone already knows the “truth”.

Can Antioxidant Supplements Cause Cancer?

The risks of antioxidant supplements are a perfect example. Most web sites and health experts warn that you should be careful about using antioxidant supplements. You are told that they may just increase your risk of cancer. They may just kill you!

The antioxidant vitamins C and E have generated the most scrutiny in recent years. There were a number of reasons to suspect that they might decrease cancer risk:

1) They destroy free radicals.
2) They decrease cancer risk in animal studies.
3) Increase consumption of vitamins C & E is associated with decreased risk of cancer in human population studies.

Because there was so much circumstantial evidence that vitamins C & E might decrease cancer risk, there have been a number of double-blind, placebo controlled human clinical trials to test that hypothesis.

• 6 clinical studies showed no effect of vitamin C and/or E on cancer incidence.
• 1 study suggested that vitamin E might decrease prostate cancer risk, and another study suggested that vitamin E might decrease colon cancer risk.
• 1 study (Kristal et al, Journal of the National Cancer Institute, doi: 10.1093/jnci/djt456, 2014) suggested that vitamin E alone might increase prostate cancer risk, but when vitamin E was combined with selenium there was no increased risk. I have discussed a likely explanation of those confusing results in a previous “Health Tips From the Professor” (https://www.chaneyhealth.com/healthtips/selenium-vitamin-e-increase-prostate-cancer-risk/).

That’s it. Six clinical studies show no effect of vitamins C & E on cancer risk, two studies suggest that vitamin E decreases cancer risk and one study suggests that vitamin E increases cancer risk. Yet all the “experts” are warning that antioxidant supplements might increase your cancer risk. It has become an urban nutrition myth.

You may remember that I said that the final characteristic of an urban nutrition myth is that when contrary information is published, it is ignored. In fact, an excellent study showing no effect of vitamins C and E on cancer risk has just been published – and it is being ignored because it doesn’t fit the “truth” that most experts have come to believe.

What Does the Latest Study Show?

The study in question (Wang et al, American Journal of Clinical Nutrition, 2014; doi: 10.3945/ajcn.114.085480) was a post-trial follow-up to the Physicians’ Health Study II. It followed 14,641 US male physicians (average age 64 at the beginning of the trial) for 10.3 years. The subjects were randomly assigned to receive 400 IU of vitamin E every other day, 500 mg of vitamin C daily, or their respective placebos.

The investigators in charge of the study recognized that cancer takes many years to develop and that the effects of supplementation might not be recognized until years later. Because of that, the subjects were followed for an additional 2.8 years after the close of the trial to allow additional time for cancers to develop.

The results were clear cut:

• Vitamin E supplementation had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation also had no effect on the incidence of prostate cancer or total cancers.
• Vitamin C supplementation decreased the incidence of colon cancer during the post-trial period by 46%, which was marginally significant.

The Bottom Line:

1) Can antioxidant supplements cause cancer? You can ignore the dire warnings that antioxidant supplements may increase your risk of cancer. The only case where this appears to be true is for high dose beta-carotene supplements in smokers. The weight of evidence for vitamins C and E suggests that they are unlikely to increase your risk of cancer.

2) As I have said previously if there is any risk of antioxidant supplements, it is most likely to arise from using high purity individual antioxidant supplements. I recommend vitamin E supplements containing the full spectrum of tocopherols and tocotrienols, carotenoid supplements containing all the naturally occurring carotenoids, and supplements that combine complementary antioxidant nutrients – vitamin E and selenium, for example.

3) That doesn’t mean that you should run out and stock up on antioxidant supplements in the hope that they will prevent cancer. The same clinical studies that showed no harm from vitamin C and E supplementation also showed no consistent benefit.

4) This is also consistent with my comments in previous “Health Tips from the Professor”. For example:

• It is very difficult to prove, and unreasonable to expect, that supplementation will have a measurable effect on risk of a particular disease like cancer for everyone. People who are healthy and have very low risk of cancer, may experience other benefits from supplementation but are unlikely to experience a measurable decrease in cancer risk.

• Supplementation is most likely to be advantageous in select populations, generally populations with increased need for a particular nutrient or at highest risk of disease. It is clinical studies looking at the effect of supplementation in these select populations that often show the greatest benefit of supplementation.

• Supplementation is just one component of a holistic approach for reducing disease risk. Diet, weight control, exercise, adequate rest and stress reduction all play a major role as well. You can’t weigh 250 pounds and eat all your meals at McDonalds and expect supplementation to save you from disease.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Supplements To Avoid

November 11, 2014 by Dr. Steve Chaney

What You Don’t Know Could Kill You

Author: Dr. Stephen Chaney

There are a few bad apples in every barrel, and the supplement industry is no different, especially when it comes to sports nutrition, weight loss products and supplements to avoid. In previous health tips from the professor I have exposed some of the more dangerous sports nutrition and weight loss products on the market at the time. For example, I have reported on the dangers of weight loss and sports nutrition products containing the amphetamine-like compounds DMAA and DEPA .

The DMAA story was a real scandal. Not only did sports nutrition products containing DMAA kill people, but the FDA actually had to raid the warehouses of a major nutrition retailer to force them to stop selling it.

You might ask why would supplement manufacturers even make products like that? The bottom line is that some companies are far more interested in their profit margin than they are in the safety of their customers. Amphetamine-like ingredients burn off calories and give athletes an artificial energy boost. Those results sell products.

The fact that those same ingedients also kill people is of little concern to unscrupulous manufactures. In fact, as soon as one amphetamine-like ingredient is banned, they just reformulate by adding another amphetamine-like ingredient to their product.

Sports Supplements To Avoid

The unscrupous manufacturers are at it again. A recent paper by a group of scientists in the United States and the Netherlands (Cohen et al., Drug Testing and Analysis, 2014: DOI 10.1002/dta.1735) reported that DMBA, another amphetamine-like ingredient that is a close analog of DMAA, was found in at least 12 products marketed to improve athletic performance, increase weight loss and enhance brain function.

DMBA (1,3-dimethylbutylamine) is a synthetic compound that has never been tested for safety in humans, something that the FDA is supposed to require for every new dietary ingredient added to a supplement. Because DMBA is chemically similar to DMAA (1,3-dimethylamylamine), the scientists conducting the study suspected that manufacturers may have started adding it to their products.

The scientists surveyed the listed ingredients on all supplements distributed in the United States for any ingredient name that might be a synonym for DMBA. They identified 14 supplements that fit that criteria and analyzed them for the presence of DMBA. 12 tested positive for DMBA.

The supplements they identified that contained DMBA were Contraband, Redline White Heat, Evol, MD2 Meltdown, Oxyphen XR AMP’D, OxyTHERM Pro, Oxyfit Extreme, Synetherm, AMPitropin, Decimate Amplified, AMPilean, and Frenzy – but they warned that there could be many more out there that they didn’t identify.

The authors of the study stressed that DMBA is a synthetic pharmaceutical ingredient, has the potential to cause the same health risks as DMAA, and has never been tested in humans. They stated: “Given the potential risks of untested pharmacologic stimulants, we strongly recommend that manufacturers immediately recall all DMBA in dietary supplements…The FDA and other regulatory bodies should, without delay, warn consumers about the presence of DMBA in [certain] dietary supplements.”

The Council for Responsible Nutrition, an industry group, sent a letter to the FDA on September 12th urging regulatory action…noting that it has a similar chemical structure to the banned ingredient [DMAA] and that none of those selling it have filed required “new dietary ingredient” paperwork with the FDA to substantiate its safety.” The FDA has yet to respond.

This story is all too familiar. The unscrupulous manufacturers won’t remove unsafe ingredients until they are forced to, and the FDA is far too slow to act. Often the FDA doesn’t act until the product actually kills people, as was the case for products containing DMAA.

Label Deception

If you are like me, you are probably outraged that manufacturers would even consider selling products like these. But the story only gets worse. None of the labels actually list DMBA as an ingredient. That’s probably because DMBA looks enough like DMAA that intelligent consumers might be scared off.

Instead, they list the ingredient as AMP citrate. They can do that because they are using AMP to stand for 4-amino-2-methylpentane. But that is not the common usage for AMP.

To any biochemist, and probably most high school biology students, AMP stands for 5’-adenosylmonophosphate – a normal and harmless cellular metabolite. Citrate is also a normal cellular metabolite.

In short, the manufacturers are purposely masquerading a synthetic and potentially dangerous stimulant under a pseudonym that looks like naturally occurring cellular metabolites. That is shameful!

Lack of Quality Control

But wait, it gets even worse. The scientists analyzed 14 products that had AMP citrate on the label and the amount of DMBA ranged from 0 to 120 mg. Apparently these manufacturers have no quality control process either. That is a huge concern because this ingredient has never been tested for safety in humans. We have no idea how much it takes to harm people!

The highest, and potentially most dangerous, levels of DMBA were found in:

• AMPilean, a fat burner from Lecheek Nutrition
• Frenzy, a pre-workout powder from Driven Sports
• MD2 Meltdown, a weight loss product from VPX Sports
• AMPitrophin, a brain enhancer sold by Lecheek Nutrition

What Can You Do?

Every time you read something like this, you might be tempted to avoid all sports nutrition and weight loss supplements. However, you should realize that unsafe products like these represent a very small part of the industry. You just need to be an informed consumer so that you are aware of supplements to avoid. For example:

Be skeptical of flamboyant claims. For example, some of the claims made by the products listed in this article are “The ultimate stimulant experience”, “Fat incinerator”, “Rapid energy surge”. When you see claims like that you should run the other direction.
Research your manufacturer. Only choose companies with a long track record of integrity and product quality.
Insist on published clinical studies showing that the product is both safe and effective.

The Bottom Line:

1) A recent report identified a number of sports nutrition and weight loss products containing the amphetamine-like ingredient DMBA. This is a synthetic compound that closely resembles DMAA, a stimulant that was recently banned by the FDA.

2) Because DMBA is potentially dangerous and has never been tested for safety in humans both the authors of this article and the Council for Responsible Nutrition have recommended that the FDA issue a recall of products containing this ingredient. To date the FDA has not acted.

3) You cannot identify products containing this dangerous ingredient by searching for DMBA on the label. That is because the manufacturers selling these products have chosen to use the harmless sounding pseudonym AMP citrate on their ingredient list rather than DMBA.

4) The amount of DMBA in products listing AMP citrate on their label ranged from 0 to 120 mg. That means you have no idea how much DMBA you are getting from the label. Even worse, because this ingredient has never been tested in humans we have no idea how much is safe.

5) Unscrupulous manufacturers who put untested and potentially dangerous ingredients in their supplements represent only a tiny fraction of the industry, but reports like this emphasize the importance of being an informed consumer. I recommend that you:

Use your common sense. Avoid supplements promising magic gains in energy, muscle mass or weight loss.
Research your manufacturer. Only choose companies with a long track record of integrity and product quality.
Insist on published clinical studies showing that the product is both safe and effective.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Should I Get a Flu Shot?

October 21, 2014 by Dr. Steve Chaney

The Truth About About Flu Shots That Nobody Else Is Telling You

Author: Dr. Stephen Chaney

It is flu season again, and the annual debate about whether everyone should get a flu shot is heating up. On the one hand we are told that the flu shot saves thousands of lives and everyone should be vaccinated. On the other hand we are being told that the flu shot is deadly and we should avoid it. As usual, the truth is somewhere in between.

When you examine the scientific literature it is clear that:

The risks of the flu shot have been greatly exaggerated.
The benefits of the flu shot have been greatly exaggerated.
The medical profession has not leveled with us about the real reason they recommend that everyone get a flu shot.

Flu Shot Side Effects

The greatest fear of vaccination and therefor flu shot side effects for children has been the claim that the flu vaccine causes autism. It is easy to understand how the hypothesis arose that vaccinations and autism might be linked, because the first symptoms of autism usually appear around the time that children are completing their initial series of vaccinations.

However, clinical research has not substantiated that any causal relationship between vaccinations and autism. It isn’t that scientist haven’t looked. A number of clinical studies have looked for a link between vaccinations and autism and have failed to find any. The age of onset and prevalence of autism are virtually identical in vaccinated and unvaccinated children.

However, most vaccines still contain mercury, and mercury is a neurotoxin. So if you are getting your child vaccinated, I recommend that you insist on getting a mercury free vaccine. You may want to inquire about the preservatives and additives in the flu vaccine as well, because some of them are also toxic.

Beyond that the biggest concerns are severe allergic reactions and an autoimmune response called Guillian-Barré syndrome which causes symptoms ranging from muscle weakness and fatigue to partial paralysis. These side effects are real and they are serious, but they are also quite rare. They affect somewhere between 1 in a million to 1 in 100,000 children, depending on the vaccine.

In short, flu shot side effects risks are real, but they have been greatly exaggerated by some in the media.

Let’s Talk Science

It turns out that the benefits of the flu shot have been greatly exaggerated by health professionals and the media as well. However, to properly understand why the messages you hear are a bit misleading you need to understand some scientific jargon, namely the difference between relative risk and absolute risk.

Relative risk describes the effect of an intervention for people with a certain condition. In this case, relative risk would be the effect of the flu shot (intervention) for people who have been infected with the flu virus (condition). Relative risk is often used in media reports because it magnifies the effect of the intervention. In short, it makes the intervention look really good.

Absolute risk describes the effect of an intervention on the probability that you will develop a certain condition. In this case absolute risk would be the effect of the flu shot on you actually getting the flu. Since this takes into account your probability of being infected by the flu virus as well as the relative risk reduction once you have become infected, it is a much smaller number. Absolute risk is a much better measure of the actual benefit you can expect to receive.

Is The Flu Shot Effective?

There is always year to year variation in the severity of the flu and the effectiveness of flu vaccines. In addition, many other viruses that cause flu-like symptoms and are completely unaffected by the flu vaccine.

For example, both enterovirus D68 and the Ebola virus are in the headlines – enterovirus D68 because it has hospitalized so many kids this fall and Ebola virus because it is so deadly. Unfortunately, the flu vaccine has no efficacy against either of those viruses.

In addition, there is also significant variation in both the efficacy and evidence for efficacy in different population groups that is generally not acknowledged during the annual campaigns recommending that everyone should get a flu shot. To better understand that we need to look at the efficacy of the flu shot in each population group individually.

Is The Flu Shot Effective in Children Age 6 Months To 2 Years?

In 2010, the US Advisory Committee on Immunization Practices began recommending flu vaccination for all healthy children older than 6 months. However, in 2012 the Cochrane Collaboration conducted a systematic review of all published clinical studies and concluded that for children in that age group currently licensed flu vaccines “are not significantly more effective than placebo”. [To fully understand the significance of that statement you need to know that the Cochrane Collaboration is an independent, non-profit organization that promotes evidence-based medicine. In fact, in the medical community Cochrane Collaboration systematic reviews are considered to be the gold standard for evidence based medicine.]

Summary: This is one of the groups at greatest risk for developing severe complications to the flu, so it is disappointing that the flu vaccine is not more effective for this group. I will talk about the best way to protect this group below.

Is The Flu Shot Safe & Effective in Healthy Children Age 2 To 7 Years?

This is the age group for which immunization makes the greatest sense, and the nasal spray gives the best results for this group. According to the 2012 Cochrane Collaboration review the flu shot reduces the relative risk of the flu by 48% and the nasal spray with attenuated live virus reduces the relative risk by 83%.

Since around 16% of unvaccinated children catch the flu in an average year this translates to an absolute risk reduction of 3.6% for the flu shot and 17% for the nasal spray. That is a smaller number, but still significant. This, of course, varies from year to year dependent on how well the vaccine matches the strains of virus that are actually circulating through the population.

Summary: The science behind vaccination for this group has shifted significantly in the past few years. The evidence for the efficacy of the flu shot in this age group has increased while the evidence for harm has deceased. The fear of the flu shot causing autism has been largely disproven by recent clinical studies. That leaves severe allergic reactions and the Guillian-Barré syndrome as the major complications of the flu vaccination.

Proponents of the flu vaccinations have estimated that if all children in this age range were vaccinated, around 200 would develop severe complications to the flu shot, and if all children in this age range were unvaccinated 20,000 would develop severe complications from the flu. I have not been able to independently substantiate those statistics. We also need to keep in mind that in those rare years, such as during the 1976 swine flu epidemic, when approximately 1 in 100,000 vaccinated children developed Guillian-Barré syndrome the incidence of severe complications to the flu shot could have reached the 2-3,000 range if the vaccination program had not been terminated early.

I realize that this is an emotional issue for parents, and there is no perfect answer. However, at present the weight of evidence is slightly in favor of vaccination for this age group.

Is The Flu Shot Effective in Healthy Children Age 8 To 18 Years?

According to a recent meta-analysis of all available clinical studies (Oosterholm et al, The Lancet Infectious Diseases, 12: 36-44, 2012), we simply don’t know whether the flu vaccine will be effective in this age group because no reliable studies have been conducted.

Even worse than that, we may never know whether the flu shot offers any protection for this age group because of a Catch 22 situation in modern clinical research. Once a particular treatment becomes “the standard of care” it is considered unethical to withhold that treatment in a clinical trial. Since the CDC is now recommending the flu shot for everyone over age 2, it would be considered unethical to conduct a clinical trial in which half the population received flu shots and half did not.

Summary: I suspect that the flu shot may offer some protection in this age group, but there is no convincing clinical evidence to support that belief at present and for the foreseeable future.

Is The Flu Shot Effective in Healthy Adults Age 18 To 65 Years?

Here the answer is yes. According to a 2012 meta-analysis of 31 published clinical studies (Oosterholm et al, The Lancet Infectious Diseases) the flu shot gives an impressive 75% reduction in the relative risk of catching the flu. However, in an average year only 4% of this population will catch the flu if unvaccinated, so the absolute risk reduction is a modest 3%.

This is also the group that has the least to fear from the flu. Only about 1 in 100 people in this age range develop severe complications as a result of getting the flu, and these are usually the people with severe diseases and/or compromised immune systems. For most healthy adults in this age range, the flu is merely a one or two day inconvenience.

Summary: For healthy adults in this age range the flu vaccine offers only a modest decrease in the absolute risk of catching the flu, and this group has a relatively low risk of developing severe complications from the flu. If the self interest of this group were the only consideration, it is hard to understand the insistence of the medical community that everyone in this age range get a flu shot. It would appear to be a matter of personal choice.

Is The Flu Shot Effective in Seniors Age 65 And Older?

Flu shot proponents will tell you that flu shots cut the risk of death in this group by 50% based on a meta-analysis published in 2002 (Vu et al, Vaccine, 20: 1831-1836, 2002).

However, more recent research has come to the opposite conclusion. A recent meta-analysis (Oosterholm et al, The Lancet Infectious Diseases, 12: 36-44, 2012) concluded “Evidence for protection in adults aged 65 years or older is lacking”. The 2010 Cochrane Collaboration systematic review concluded “Due to the poor quality of available evidence, any conclusions regarding the affects of influenza vaccines for people aged 65 years or older cannot be drawn.”

The lack of protection of the flu virus in seniors is most likely due to the fact that, in many cases, their immune systems have weakened with age.

Summary: This is another group where you would most like to see protection by the flu shot, because this group is likely to suffer severe complications and death from the flu, so it is disappointing that the flu vaccine is not more effective for this group.

Who Has Most To Fear From The Flu?

When you hear that the flu shot significantly reduces the risk of severe complications and death from the flu, you should know that the risks are not spread evenly over the population. The very young are at risk because their immune systems haven’t fully developed. The very old are at risk because their immune systems have weakened with age and they may already be in precarious health because of other diseases. And, of course, anyone at any age who is in precarious health because of disease or who has a compromised immune system is at risk as well.

Why Do Health Professionals Recommend That Everyone Get A Flu Shot?

If you are a healthy adult in the 18-65 age range, your risk of severe complications and death is from the flu is very low. It is not zero, but it is low. So why are health professionals so insistent that you need to get a flu shot?

The reason is straight forward, but it is not the reason that they are giving you. It is a public health measure, pure and simple.

The very young, the very old, the sick and the infirm are the ones most likely to develop severe complications and die from a flu infection. However, the flu shot doesn’t offer them much protection because their immune systems are often compromised. The best way to protect those groups is to immunize everyone else. If the flu virus can’t gain a foothold in the rest of the population, those at greatest risk will never be exposed to the flu.

So the constant warnings that you need to get a flu shot is less about protecting you than it is about protecting those whom you might infect. Now you know the truth. If you decide to get a flu shot it will be for the right reason, not the reason you are being given by the medical profession.

In a similar vein, many health departments are warning about hospitalizations and deaths from enterovirus D68 infections and urging people to get flu shots. They are not telling people that the flu shot has no efficacy against enterovirus D68.

I understand the concept that the rare combination of the regular flu and enterovirus D68 infection in the same patient would be particularly deadly. But, I also believe in truth in advertising. The medical profession needs to level with people about why they are recommending flu shots, not use scare tactics that make promises the flu shot can’t deliver.

Should I Get A Flu Shot?

As you can see, your decision about whether or not the flu shot is the right thing for you is not an easy one. Both the benefits and risks of the flu shot have been greatly exaggerated in the media. I have tried not to be an advocate either for or against flu vaccinations. I have evaluated the scientific literature and tried to give you the unvarnished truth. It is now up to you to make an educated decision – one that is right for you.

My personal decision about the flu shot is influenced by my father’s example. He dutifully got his flu shot every year, and every year he came down with the flu shortly after getting the flu shot. I’ve seen the same phenomenon with several of my friends who work at area hospitals and are required to get an annual flu shot. I know that the experts claim you can’t get the flu from the flu shot. I don’t know about that. I only know what I have observed.

In addition, I do not have young children or elderly parents at home who might be compromised if I were to develop even a mild case of the flu. So I chose to follow the kind of lifestyle that keeps my immune system strong rather than relying on a flu shot to protect me from the flu. That immune-healthy lifestyle, of course, will be a topic for a future “Health Tips From the Professor”.

The Bottom Line:

Both the effectiveness and risks of the flu shot have been greatly exaggerated.
The flu shot has no proven effectiveness in children ages 6 months to 2 years, children aged 8-18 years and seniors 65 years and older.
In children, aged 2 to 7, nasal sprays with partially inactive flu virus give a 17% decrease in absolute risk of catching the flu. Side effects of the flu vaccine in this population group are severe allergic reactions and an autoimmune response called Guillian-Barré syndrome. Both severe complications from the flu virus and side effects of the flu vaccine are very rare, but complications from the flu virus are several fold more common than side effects from the vaccine.
Fears that the flu vaccine could trigger autism have not been validated by clinical studies. However, mercury is a neurotoxin so I recommend that you insist on mercury-free vaccines for your children. You may also wish to inquire about other preservatives and additives in the vaccine, because some of them are toxic.
In healthy adults, aged 18 to 65, flu shots give a 3% decrease in absolute risk of catching the flu. This is also the population group with the lowest risk of severe complications from the flu. For most adults in this age group the flu is nothing more than a one or two day inconvenience.
The groups most likely to develop severe complications and die from flu infections are the very young, the very old, and the sick. They are also the groups least likely to benefit from the flu shot because their immune systems are weak.
If you are a healthy adult in the 18 to 65 age group, the constant warnings that you need to get a flu shot is less about protecting you than it is about protecting those whom you might infect if you catch the flu. It is a public health measure to protect the very young, the very old, and the sick. Now you know the truth. If you decide to get a flu shot it will be for the right reason, not the reason you have been given by the health profession.
In addition, the flu shot has no efficacy against either enterovirus D68 or Ebola virus. Although both of these viruses are real concerns, neither is a justification for recommending that people get flu shots.
As for me, I am influenced by the example of my father who got the flu from the flu shot every year. I chose to follow the kind of lifestyle that keeps my immune system strong rather than relying on a flu shot to protect me from the flu. That, of course, will be a topic for a future “Health Tips From the Professor”.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does An Apple A Day Keep Statins Away?

February 4, 2014 by Dr. Steve Chaney

The Latest On Diet And Heart Health

Author: Dr. Stephen Chaney

In a previous “Health Tips From the Professor” I talked about how difficult it has been to prove that statins significantly reduce the risk of heart attack or cardiovascular deaths in a low risk population group. Now let’s look at the other side of the coin – lifestyle change –and ask how effective lifestyle change is at reducing the risk of cardiovascular disease.

You’ve all heard the saying “An apple a day keeps the doctor away”. It dates back to Victorian England. It was the public health message of the day – much simpler and more concise than our current food guide plate.

A prominent British doctor and his research team recently decided to see how accurate that saying really was. But they took their study one step further. They compared the effectiveness of an apple a day versus a statin a day at reducing the risk of cardiovascular deaths (Briggs et al, British Medical Journal, 3013;347:f7267 doi: 10.1136/bmj.f7267).

The results of that comparison may surprise you.

Does An Apple A Day Keep Statins Away?

They used the data from the Cholesterol Treatment Trialist meta-analysis to estimate the effectiveness of statin drugs at reducing cardiovascular deaths. They used the data from the PRIME comparative risk assessment model to estimate the effectiveness of apple a day at reducing cardiovascular deaths.

They asked what would happen if each of them were the primary intervention for the entire British population over 50 who were not currently taking statin drugs (17.6 million people).

They assumed a 70% compliance rate for both interventions. In simple terms that means they assumed that 70% of the population would actually do what their doctors told them. (Patients must be more compliant in England than in the US).

The results were interesting. They estimated that:

Giving a statin drug each day to 17.6 million people would reduce the number of cardiovascular deaths by 9,400.

Giving an apple each day to the same 17.6 million people would reduce the number of cardiovascular deaths by 8,500 (not significantly different).

But when they looked at side effects and cost the two interventions were significantly different.

Giving a statin drug each day to 17.6 million people would also cause some significant side effects. The authors estimated that it would lead to:

1,200 excess cases of severe muscle pain and weakness
200 excess cases of rhabdomyolysis (muscle breakdown, which can lead to irreversible kidney failure)
12,300 excess cases of diabetes

On the other hand, there are no known side effects to an apple a day.

The statin intervention would cost an estimated $295 million. In the case of apples, you would presumably be substituting a more healthy food for a less healthy food so there would be little or no net cost.

And the 70% compliance rate is probably wildly optimistic. Some experts have estimated that up to 50% of patients discontinue their statin medications within the first year because of side effects or cost.

Is There A Scientific Basis For Those Estimates?

Of course, we all know that the “apple a day…” saying was never meant to be taken literally. It was just a simple way of saying that a good diet will reduce the risk of disease.

It turns out that there was another major study on the effect of dietary fiber on reducing the risk of cardiovascular disease in the very same issue (Threapleton et al, British Medical Journal, 2013;347:f6879 doi: 10.1136/bmj.f6879). It was a meta-analysis that combined the data from 22 previously published studies.

This study showed:

For every 7 g/day increase in dietary fiber the risk of both heart attacks and cardiovascular disease decreases by 9% (7 grams of dietary fiber could come from one serving of whole grains plus one serving of beans or lentils or from two servings of fruits or vegetables).

For every 4g/day of fruit fiber (equivalent to one apple) the risk of heart attacks decreases by 8% and the risk of cardiovascular disease decreases by 4%.

The numbers are similar for every 4 g/day of vegetable fiber.

Another recent study showed that consumption of 75 g/day of dried apple (equivalent to two apples a day) lowered total cholesterol by 13% and LDL-cholesterol by 24% in post-menopausal women (Chai et al, J. Acad Nutr Diet, 112: 1158-1168, 2012). That’s comparable to the cholesterol reduction achieved with statin drugs.

The Bottom Line

If you have not previously had a heart attack and are at relatively low risk, something as simple as adding an apple a day (in place of less healthy foods) may just as effective as statin drugs at reducing your risk of cardiovascular death without the side effects and cost of the drugs.

This is not really new information. For years both the American Heart Association and the National Institutes of Health have recommended that Therapeutic Lifestyle Changes (weight loss, healthy diet and exercise) should be tried BEFORE drug treatment to reduce the risk of heart disease.

So if you want to avoid statins, tell your doctor that you are willing to make the needed lifestyle changes to reduce your risk of heart disease and stick with it. Lifestyle changes are hard, but clinical studies clearly show they can often be just as effective as drug therapy, without the cost and side effects.

Don’t misunderstand me. I’m not advocating avoiding statin drugs if they are absolutely necessary. If you have had a heart attack or are at high risk of heart disease, it is clear that statins can save lives. Even here I would recommend talking with your physician about incorporating therapeutic lifestyle change into your regimen. It may allow them to minimize the dose, and therefore the side effects, of the statin drugs.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Diet Pills Safe?

January 7, 2014 by Dr. Steve Chaney

Another Diet Pill Bites the Dust

Author: Dr. Stephen Chaney

The New Year is upon us, and everyone is looking for an easy way to lose weight.

Let’s face it. Losing weight is difficult. You have to give up your favorite foods. You’re often hungry and cranky. You have to change your lifestyle. And did I mention that you might need to put on your running shoes and go for a run or, heaven forbid, actually go to the gym.

It’s so much easier to take one of those diet pills. You know the ones I’m talking about. They promise to give you energy – burn the fat – suppress your appetite. All you need to do is take one of those little pills every day and, voila, you’re ready to try on that bikini.

It all sounds great. But are those diet pills really safe? A few weeks ago I shared with you that the experts have warned against the use of fat burning sports supplements. They consider them unsafe. Now it’s time to turn our attention to the fat burning diet pills.

Are Diet Pills Safe?

Lots of diet pills have come and gone over the years. Some have just faded away because they didn’t work. They didn’t live up to their claims. Others have been withdrawn from the market by regulatory agencies because they were dangerous or actually killed people- Ma huang and Fen-Phen come to mind, but there have been many others.

And now it looks like yet another diet pill, one called Dexaprine, may have the same fate.

The ads make it sound like a wonder pill.

“With one little change…you could feel energy all day long”

“With one little change…you can suppress your insatiable appetite”

“You can try another unsuccessful diet without it, but when you’re ready…the ultimate fat burner will be waiting for you with open arms.”

The Dark Side

And yet, like most diet pills, it also has a dark side. Side effects include insomnia, sweating, heart palpitations and high blood pressure. As if that weren’t bad enough, the supplement manufacturer that makes Dexaprine conducts no clinical studies on their products, so they have no idea whether their product is safe or not.

And, it appears that it may not be safe. Dutch authorities banned Dexaprine in August after reports of 11 adverse reactions associated with Dexaprine use in Holland since March of this year, including hospitalizations and severe heart problems. British authorizes followed suit the next day and issued a warning against use of “fat burner” supplements in general. It’s probably just a matter of time before other governments step in and ban Dexaprine as well.

And, it’s not just Dexaprine. New diet pills hit the market almost every day. And, they all have those same “magical” claims.

The Only Safe Drug Is A New Drug

It reminds me of the wise advice that a physician colleague of mine gave to the medical students near the start of their first year. He told them “The only safe drug is a new drug”. He went on to say that he didn’t mean that new drugs were safer than the older drugs. It’s just that we don’t know all of their bad side effects until they’ve been on the market for a few years.

Diets pills are no different. They burst on the market full of promise. But, once they’ve been on the market for a year or two, reports of their bad side effects start to appear. We start to learn just how dangerous they are. And, one by one, they all bite the dust.

The Bottom Line

1) There is no “Tooth Fairy”. There is no “Easter Bunny”. And, there is no magical pill that will SAFELY melt the pounds away. You simply don’t want to risk the diet pill solution – no matter how easy it sounds. No magical, “quick fix” diet solution is worth risking permanent heart damage – or worse.

2) If you are fortunate to lose weight safely using one of those diet pills, you won’t have learned anything. You won’t have changed anything. The weight will come right back on.

3) Permanent weight loss requires a permanent change to your lifestyle. Some of those changes will be difficult at first, but once those lifestyle changes become habits – once they become part of who you are, they will become easy.

You can achieve both the weight and the health you want!

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Cholesterol Lowering Drugs Right For You?

January 11, 2023November 19, 2013 by Dr. Steve Chaney

Do Statins Really Work?

Author: Dr. Stephen Chaney

Statins – those ubiquitous drugs used to lower cholesterol levels – are big business!

Over 20 million Americans are currently being treated with statin drugs at a cost that runs into billions of dollars every year. And cardiologists have just recommended that another 20 million Americans consider using cholesterol lowering drugs. 44% of the men and 22% of the women in this country are now being told that they should be using statin drugs.

Some of my cardiologist friends are so convinced that statin drugs prevent death from heart attacks that they have said, only half-joking, that we should just add statins to the water supply.

Are Cholesterol-Lowering Drugs Right For You?

Is the faith of doctors in the power of statin drugs to prevent death from heart disease justified? To answer that question in full we need to look at people who have already survived a heart attack and people who have never had a heart attack separately.

If you’ve already had a heart attack the evidence is clear cut.

If you have had a heart attack, there is good evidence that statins will reduce your risk of dying from a second heart attack.

In the technical jargon of the scientific world that is referred to as secondary prevention.

But what about those millions of Americans who are being prescribed statin drugs who have never had a heart attack? This is something we scientists refer to as primary prevention.

What Do The Studies Actually Say About Statins And Primary Prevention?

Here the evidence is not clear at all. Two major reports have cast doubt on the assumption that statins actually do prevent heart attacks in people who have not already had a first heart attack.

In the first study, Dr. Kausik Ray and colleagues from Cambridge University in England performed a meta-analyis of 11 clinical studies involving over 65,000 participants (Ray et al, Arch. Int. Med., 170: 1024-1031, 2010). They focused on those participants in the studies who had not previously had a heart attack (primary prevention).

They found that the use of statins over an average of 3.7 years had no statistically significant effect on mortality. In short, statins had no effect on the risk of dying from heart disease or any other cause.

Dr. Sreenivasa Sechasai, one of the doctors involved in the study, said “We didn’t find a significant reduction in death despite having such a huge sample size. This is the totality of evidence in primary prevention. So if we can’t show a reduction with this data, it is unlikely to be there.”

The second study was a Cochrane Systemic Review of statins published January 19th, 2011. It stated that there was not enough scientific evidence to recommend the use of statins in people with no previous history of heart disease with some caveats (see below).

To help you understand the significance of that conclusion, let me give you a bit of background:

First you need to understand that the Cochrane Collaboration is an independent, non-profit organization that carefully reviews the scientific evidence behind medical treatments and proposed medical treatments.

Cochrane Reviews are considered the “Holy Grail” of evidence-based medicine (ie. medicine based on the best scientific evidence rather than what the pharmaceutical companies would have you believe).

So when a Cochrane Review concludes that there isn’t enough evidence to recommend use of statins in patients with no prior history of heart disease that is pretty big news in the medical world.

How Should These Studies Be Interpreted?

Please don’t misinterpret what I am saying. The Cochrane Review said that statin drugs are overprescribed, but it did not say that everyone who has not had a heart attack will not benefit from statins. It said that there are a number of risk factors that need to be considered in evaluating individual patients for statin use.

Simply put, that means that it is not as simple as saying that everyone with no previous history of heart disease should not be on statin drugs.

If you are currently taking statin drugs and you have no previous history of heart disease, you may want to discuss with your physician whether the Cochrane Review of statin drugs changes their opinion of whether se of those drugs is still warranted for you.

But the bottom line is that only your physician is trained to take into account all of the factors that increase your risk of heart disease and the best therapeutic approach for reducing your risk of heart attack.

There Is A Double Standard In The Medical Community

More importantly, these studies highlight the difficulty in showing that anything works when you start out with a healthy group of adults with no prior evidence of disease (primary prevention).

And, the way that doctors have responded to primary prevention studies shows that there is a double standard in how primary prevention trials are interpreted in the medical community. For example:

There is no good evidence that statins prevent fatal heart attacks in healthy people.

However, because statins do work in high risk patients, most doctors recommend their use by millions of Americans who have never had a heart attack.

There is also no good evidence that nutrients like vitamin E and omega-3 fatty acids prevent fatal heart attacks in healthy people.

However, there is evidence that both vitamin E and omega-3 fatty acids prevent heart attacks in high risk patients, yet most doctors will tell you they are a waste of money.

It is food for thought.

The Bottom Line

1) Statin drugs clearly save lives when used by people who have already had a heart attack.

2) On the other hand, there is no proof that statin drugs prevent heart attacks in people who have not previously had a heart attack

3) Statin drugs do have side effects. Increased risk of diabetes, liver damage, muscle damage and kidney failure are the best documented, although memory loss has also been reported.

4) I am not recommending that you stop using statin drugs without consulting your doctor. I am suggesting that you discuss the benefits and risks of statin drug use with your doctor.

5) Perhaps the most important poin tto come out of these studies is that it almost impossible to prove the benefit of any intervention in a primary prevention trial. If you can’t prove that statins work in healthy people, it is not surprising that it is difficult to prove that other interventions work.

6) Finally, the way that these studies have been interpreted shows that there is a clear double standard in how the medical community evaluates primary intervention trials.

Statin drugs don’t show any benefit in a primary prevention setting, yet most doctors still recommend them.

Vitamin E and omega-3 fatty acids don’t show any benefit in a primary prevention setting, and most doctors recommend against them.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Statins Decrease Or Increase The Risk Of Parkinson’s Disease?

October 17, 2013October 1, 2013 by Dr. Steve Chaney

The Fine Print Behind The Misleading Headline

Author: Dr. Stephen Chaney

I hadn’t paid much attention to the headlines saying “Statin Use May Decrease Parkinson’s Risk” until the other day when I happened to glance a couple of lines below the headline and spotted a statement saying “Study Shows That Discontinuation of Statin Therapy Increases Risk of Parkinson’s”.

I immediately said to myself “That’s bizarre. There is a total disconnect between the headlines and the study.” If you really wanted to determine whether statin use reduced the risk of Parkinson’s, you would compare the incidence of Parkinson’s disease in a group of statin users and a matched group who did not use statins.

It turns out those studies have been done, and they were inconclusive – some studies showed a slight increase in Parkinson’s in statin users, some showed a slight decrease, and most showed no correlation between statin use and Parkinson’s.

In that context, this study could equally well have been interpreted as suggesting that statin use increased the risk of Parkinson’s, but somehow none of the headlines mentioned that possibility.

Are Both Possibilities Plausible?

Let’s look at each possibility in detail. The reasoning is complex, but let me try to walk you through it.

Could Statins Decrease The Risk Of Parkinson’s

Parkinson’s is caused by the progressive degeneration of the brain neurons that produce a chemical messenger called dopamine that controls muscle movement. However, the causes of nerve degeneration in Parkinson’s patients are largely unknown.

Genetics may play a small role. Environmental toxins may play a role. But most experts feel that Parkinson’s patients produce an excess of free radicals, and it is the oxidative damage caused by those free radicals that results in the loss of the ability of neurons to produce dopamine.

But even that is not the whole answer. The brain is normally able to use coenzyme Q10, which is very abundant in brain, and other antioxidants to destroy free radicals before they damage brain neurons. Somehow in Parkinson’s patients free radical production and antioxidant production have gotten out of balance.

Advocates of the theory that statins may decrease the risk of Parkinson’s, point out that statins decrease oxidative damage. So if a person was predisposed to developing Parkinson’s and oxidative damage is a major cause of Parkinson’s, it is theoretically possible that statins could slow the progression to Parkinson’s while they were taking the drug. Of course, once they stopped taking the drug the oxidative damage to dopamine-producing neurons would resume and Parkinson’s would eventually develop.

In this model- Let’s call it Model A:

1) Oxidative damage of dopamine-producing neurons was caused by some unspecified external agent.

2) Statins protected the neurons from oxidative damage while they were being used.

3) Once the statin drugs were discontinued oxidative damage resumed and the risk of developing Parkinson’s increased.

This is the model favored by the authors and repeated in all of the headlines you saw.

Could Statins Increase The Risk Of Parkinson’s?

Statins also interfere with the synthesis of cholesterol and coenzyme Q10, and these are both absolutely essential for brain function. Let’s start with cholesterol:

20% of the body’s membrane cholesterol is found in the myelin sheath that coats the brain’s neurons (You can think of the myelin sheath as analogous to the plastic coating that insulates an electrical wire).

Cholesterol can’t cross the blood-brain barrier, which means that the brain cannot utilize cholesterol from the bloodstream . It has to make its own cholesterol.

As for coenzyme Q10:

It is not only a powerful antioxidant. It is also absolutely essential for cellular energy production.

The brain has tremendous energy requirements. The brain accounts for 20% of the energy utilization of our body. Neurons burn 2 times more energy than other cells in our body.

For both of these reasons, many experts have cautioned that statin drugs have the potential to cause neurodegenerative diseases such as Parkinson’s. In this model – Lets call it model B:

1) The statin drugs themselves are damaging the dopamine-producing neurons by inhibiting cholesterol and coenzyme Q10 synthesis in the brain.

2) The antioxidant effects of the statin drugs were masking the damage caused by the statins while the drugs were being used.

3) Once the statin drugs were discontinued the underlying damage was unmasked and the patients quickly developed Parkinson’s.

What Did The Study Actually Show?

The study (Lee et al, Neurology, 81: 410-416, 2013) looked at 43,810 statin users on the island of Taiwan. The Taiwanese Health System keeps extensive records of prescription use and health conditions of everyone on the island. It also requires that statin use be discontinued as soon as the patient reach their target of < 100 mg/dL LDL cholesterol, so they had the perfect population base to study what happens when you discontinue statin therapy.

The results were:

The patients who discontinued statin therapy were 42% less likely to develop Parkinson’s that those who continued on statin therapy. That result is consistent with both models A & B.

The increased risk of developing Parkinson’s when the drug was discontinued was only seen for the statin drugs like simvastatin and atorvastatin that are able to cross the blood brain barrier. That result is actually a bit more consistent with model B (Remember that the brain has to be able to make its own cholesterol and statins block cholesterol production).

When the study compared people using statin drugs to those not using statin drugs there was no significant difference in the prevalence of Parkinson’s – even for those statin drugs that cross the blood brain barrier. That means that merely being on a statin drug did not influence the risk of developing Parkinson’s. It was only when patients were on statin drugs for a period of time and were subsequently taken off statins that the risk of developing Parkinson’s was affected – and the effect was to increase risk! In the context of the first two findings, that result is also a bit more consistent with model B.

The Bottom Line:

If I were writing one of those medical blogs, I would have probably have gone with the party line and told you that statins decrease your risk of developing Parkinson’s. And if I were one of those health bloggers who never let the facts get in the way of a good story, I’d probably be scaring you with headlines saying that statins increase your risk of Parkinson’s.

But, I’m a scientist. I actually read the article, and I tell it to you like it is. Here’s your bottom line.

1) Ignore the headlines. The study they are talking about can’t distinguish between statins increasing or decreasing the risk of Parkinson’s. Don’t let anyone tell you that reducing the risk of Parkinson’s is a side benefit of statin therapy. That simply has not been proven.

2) The study does clearly show that discontinuing the statin drugs simvastatin and atorvastatin is associated with increased risk of developing Parkinson’s. That’s a big red flag for me, because 53% of patients discontinue statin therapy because of side effects, cost or other reasons.

3) However, statin drugs do save lives, especially for people who have already had a heart attack, so talk with your doctor about the benefits and risks of statin drugs, and which statin drugs are best for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.