Statins and Training

Medical Q&A [Moderated]
1

Hi Guys,
Thanks for what you do here. First post.

My wife recently started LP (ironically, at the admonishment of her endo to gain lean mass–though the endo did, obviously, not recommend an LP). She is:
47
5’ 2" 135 pounds.
Has Hashimotos, Type 2 Diabetes, and high cholesterol and some plaque build up. She is also Vitamin D Deficient. She is adopted, so has zero family history.

Hashimotos has been managed well. No meds for the Diabetes as she manages this via diet and exercise (she swims as she was a collegiate swimmer) and blood work is good (A1c, fasting blood sugars etc).

Recent Cholesterol work had her 209 total, HDL 50, LDL 154, trending up from previous readings, but significantly lower than years ago.

Since the cholesterol in starting to trend up her Endocrinologist has put her back on and then upped her statins. They were trying to get her off of them completely. And the endo has even stated that if she had a positive family history she would probably not even prescribe the statins as she hates them.

The LP was going well until 2 weeks ago.

Squat was at 135 for 5 sets of 3
Press was at 70 for 5 sets of 3
Deads were at 165 for 2 sets of 3

2 weeks ago, she started having severe muscle pain, severe joint/bone pain, and became incredibly fatigued. She says she feels like she has been beaten with a bag of rocks. The pain changes locations depending on the day, but it is similar in nature regardless of where it occurs. Of course, researching statins we are seeing significant warnings and relevance to what she is going through.

The endo had her stop taking the statins about a week ago and is running more bloodwork to look at muscle enzymes? She has upped her CoQ10 and she has started taking fish oil.

The questions we have at this point are: she should train? Do we need to worry about muscle damage? Should we cease lifting until these side affects stop and then just start the LP over?

My approach thus far has been to take weight off the bar and train around pain. But, given the side effects of statins and some of the horror stories around muscle trauma/damage, I am not sure that is what we should do.

Any thoughts or guidance is truly and greatly appreciated.

mark

2

Hey Mark, welcome.

So, a few follow up questions:

Was that lipid panel you listed measured while she was ON or OFF statins? Which one, and at what dose?

Has she ever had a cardiovascular event before (heart attack or stroke)? What is her current A1c?

How has she been feeling since stopping the medication?

Do you have the latest lab results yet?

Myalgias (i.e., aches) are fairly common. Myopathy (i.e., muscle damage) is far less common. True rhabdomyolysis is exceedingly rare.

3

Austin,
Thanks for the reply. I know the answer to some of these questions, but will wait until her and I review her records this evening, so I can give you a complete response.

On another note, you and I actually met a year and a half ago. I brought one of the teenage girls I was coaching down to your place in San Antonio for some coaching and to rule out FAI. I am the tattooed bearded guy from Georgetown (north of Austin). I don’t expect you to remember, but thought I would share…

4

Yep, I remember you man! I associated you with the username crookedfinger on the SS forums, so I immediately knew who you were from this post.

5

Sorry, total was 231, LDL 154, HDL 57. She was off statins for 3 months when these labs were run. After these results, her Endo prescribed 10 mg Pravastatin, and she has been taking this doseage for 2 months.

No, but she was born with a heart defect and had surgery at 30, she had an extra valve or ventricle.

Current A1C is 5.2

She stopped taking the most recent Pravastatin on Friday 3/16, so it’s only been 6 days and the muscle/joint pain and fatigue continue, but she says the severity has decreased by about 50%. It is less over large areas and more focused. Fatigue has lessened and the pain “ping pongs” from day to day (location wise)

No, no more lab results yet.

Thanks for your input and guidance on this! Glad you could recall my ugly mug. It’s always nice to put a face to the guy/girl on the other end of the keyboard.

6

Hm. With this information, I’m a bit more skeptical.

Pravastatin is one of the lower-potency statins (compared to something like atorvastatin or rosuvastatin), and 10 mg of it is the lowest possible dose you can prescribe it at. More “standard” dosing of pravastatin is usually at least 40 mg, which is still less potent than taking 40 mg of atorvastatin.

So I’d definitely be searching for other reasons for her symptoms before pinning it on the medicine.

Regardless, even if it is somehow related to the medicine, it’s estimated that over 90% of patients who for whatever reason don’t tolerate a given statin, do OK when re-challenged with a different one.

7

Just to add to the interest factor. She has been on/off statins for years. The Endo originally moved her to Pravastatin because she had been on Crestor and was experiencing simiar issues. The move to Pravastain years ago seemed to alleviate this historically.

When she first started experiencing these recurrent symptoms recently she actually did not even initially make the connection. I was convinced it was a recovery issue and we tried increasing her carb intake and reducing her swimming–both in frequency and intensity. Which did nothing. As she started researching her symptoms she was “reminded” that these are things she experienced years ago when on Crestor and Lipitor. The move to Pravastatin from those in the past seemed to alleviate these side affects.

I am convinced most of her health issues are genetic. Diet is pretty good (she needs to eat more protein, but she probably eats more than most women), no smoking, no drugs, moderate alcohol consumption. She is fairly active both at her job and via exercise. I never presured her to train and she actully after many, many years approached me because the endo wants her to increase lean mass and my wife knows she needs to strengthen her bones as she heads into the menopausal years.

So, I guess the questions are:

  1. should she cease training until we get this sorted out or should we keep going?
  2. Given her other health factors, do statins seem like they should be continued?

Thanks again Austin. I truly appreciate your time on this.

8

I suspect she’s OK to continue training, though I cannot make a final recommendation through this medium without being aware of her recent lab results, for obvious reasons.

The general recommendation is for patients with type II diabetes to be treated with a statin medication, as they are at higher cardiovascular risk (and Hashimoto’s also increases cardiovascular risk as well, FWIW)

With that said, her A1c represents exceptionally good diabetes control. Her lipid panel shows mild only hyperlipidemia; she may be able to make some dietary adjustments to improve these numbers (the goal should be a non-HDL-C [i.e., total cholesterol minus HDL-C] below 130), and if the conclusion ends up being that she is indeed truly statin intolerant and in need of medication, there are other non-statin options available if necessary.

9

Good stuff…thanks again Austin!

For what it’s worth, I asked her this morning (before I saw your response) if she was planning on training today. She looked at me and was like “of course.” I’ll just keep working around her pain/fatigue and we’ll see what the other lab results bring.

We may be in contact for a consult, just to get another pair of qualified eyes on her labs. Her Endo is fairly good and we have been impressed by her recommendations and approach, but she has no background with strength training.

Sincere thanks again for all you do here.