Statins And The Stream That Never Needed a Dam - What To Say To Your Doctor When They Recommend It To You.
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Let me paint a picture.
A tiny stream sometimes overflows after a storm. Sensible people would fix the stream, clear the debris, maybe reshape its bank. Instead, the authorities go a hundred miles upstream and build a giant dam across the main river. They do not just slow that one little stream, they choke every tributary. Towns go dry, crops die, communities suffer. That, in simple terms, is what we did with statins.
We were told cholesterol is the problem. Even if you accept that for a moment, which I don’t, statins do not tidy up a small stream. They throw a wall across the main river of human metabolism.
How many people are actually on these drugs?
In the US, depending on how you count, the numbers are huge. Somewhere in the region of 39 million Americans use a statin regularly. A federal analysis of medical use shows that any statin use over a two year period climbed from 37 million in 2012 to 2013 to 92 million in 2018 to 2019. The difference is definition, regular current users versus anyone who touched a statin in the window, but either way we are talking tens of millions of people.
Official data shows about 5 million people in England were dispensed a statin in 2023 to 2024, England is most of the UK by population, so UK wide use will be higher again.
Millions upon millions. A drug that powerful, given at that scale, deserves real scrutiny.
The part almost no one explains in clinic
Statins are HMG CoA reductase inhibitors. The long name is three, hydroxy, three, methylglutaryl CoA reductase. That enzyme turns acetyl CoA into mevalonate. Mevalonate is the gateway to a living forest of molecules. Block that gate and you do not only lower a lab number, you throttle many branches of cell biology.
Here are a few of the best known branches that mevalonate feeds, all cut back when you throw the statin dam across the river.
Cholesterol from squalene, used to build cell membranes, to repair tissue, and as the raw material for steroid hormones. Your brain is the most cholesterol rich organ in the body, holding around 20 to 25 percent of all your cholesterol, most of it in myelin, the insulation on your nerves.
Ubiquinone, coenzyme Q10, the little shuttle in the mitochondrial electron transport chain that helps turn food into energy. Statins reduce circulating CoQ10 in trials and meta analyses, which is a plausible link to fatigue and muscle complaints, even though supplement trials show mixed results on symptom relief.
Dolichol, the lipid carrier that assembles and ferries sugar trees for N linked glycosylation and related protein modifications. That is how cells finish and position many of their surface receptors. Starve dolichol and you can blunt growth factor signaling simply by under glycosylating the receptor, the cellular equivalent of mislabelled plumbing.
Isoprenoids, notably farnesyl pyrophosphate and geranylgeranyl pyrophosphate. These are the tags used for protein prenylation, a clip that lets small GTPases like RAS, RHO, and RAC sit in the membrane and relay signals for inflammation, bone turnover, angiogenesis, and more. Change prenylation and you change the way cells talk and move.
That is the main point. If you dam the river, you do not just lower one stream downstream, but all it’s tributaries. You dry out many farms and towns you never meant to touch.
The firefighter we blamed for the fire
Cholesterol shows up at sites of injury to patch and strengthen membranes while repair happens. Doctors found cholesterol at the scene and decided to arrest the firefighter. Then we slashed the hose that carries energy and signaling throughout the body. That is not medicine, it is madness.
Which steroid hormones come from cholesterol
Cholesterol is converted to pregnenolone by CYP11A1 in mitochondria. From pregnenolone you make progesterone. From there the family tree fans out.
Glucocorticoids, mainly cortisol, for stress responses and metabolism
Mineralocorticoids, mainly aldosterone, for salt and fluid balance
Androgens, DHEA, androstenedione, testosterone, and dihydrotestosterone
Estrogens, estradiol, estrone, estriol
And remember vitamin D is a cholesterol derived secosteroid made in skin with sunlight, then activated in liver and kidney
This is first year endocrinology, not a conspiracy.
Side effects
When you lower CoQ10, you risk hobbling mitochondria in tissues that work all day, every day, muscle and brain first. When you reduce dolichol, you change how receptors are built and presented. When you trim prenylation, you tug on dozens of cell switches at once, including those that control inflammation, bone resorption and formation, and blood vessel growth. The science shows each of these levers moving under statin exposure. That does not mean every person will feel it, but it explains why so many do.
Statins most often cause muscle related symptoms, aches, stiffness, cramps, weakness, and raised creatine kinase, rarely progressing to myopathy or rhabdomyolysis, they can raise liver enzymes and rarely trigger hepatitis, slightly increase the risk of new onset type 2 diabetes, and cause gastrointestinal upset, nausea, indigestion, diarrhoea or constipation, headaches, dizziness, sleep disturbance, and fatigue, skin rashes can occur, some people report cognitive issues, memory fog or confusion, that usually resolve when the drug is stopped, peripheral neuropathy and tendon problems are uncommon.
The questions I want every patient to ask their doctor
If a doctor says you need a statin, ask with calm confidence.
Why me, why now, what is my absolute risk, and how much does this pill change it for me
Where does a statin act in the pathway, what else does that pathway feed, and how will we monitor those other branches
What happens to coenzyme Q10 and mitochondrial energy, to cell membrane repair, and to steroid hormone synthesis when you block mevalonate
Which known side effects map to CoQ10 depletion, to altered receptor glycosylation, to disrupted prenylation
What is the upstream plan for insulin resistance, inflammation, minerals, thyroid, sleep, light, movement, food quality, and stress
Do you profit in any way from me taking a statin, for example speaking fees, incentives, or other benefits
Does your practice have to meet a target or quota for the percentage of patients on statins to qualify for bonus payments or other financial remuneration
Are you prescribing this because of a protocol you are required to follow to keep your licence, or because you believe this is best for me based on sound evidence and clear facts specific to my case
To be fair, a tool can be useful in a narrow situation. In the days and weeks after an acute coronary syndrome, starting a high intensity statin appears to calm vascular inflammation, lower C reactive protein, stabilize plaques, and reduce early recurrent ischemic events and longer term death or heart attack. Trials like MIRACL and PROVE IT showed fewer events when atorvastatin or intensive regimens were started soon after admission, which many cardiologists read as a mix of lipid lowering and pleiotropic, anti inflammatory effects. That is not a blank check for lifelong preventive use in people with low baseline risk, it is a time limited use, in a specific setting, with honest discussion of absolute benefit and harm. But a tool applied to an entire nation, many of whom are healthy and are taking it for “preventative” reasons without respect for the biology it touches is something else entirely.
The bottom line
Statins dam the main river. They lower a number, yes. They also cut flow to systems that keep you alive, thinking clearly, repairing damage, and making hormones. We put tens of millions of people on that dam and then act surprised when towns run dry and crops die out.
If you truly want to prevent heart attacks and strokes, go upstream. Fix the stream. Metabolic health, nourishment, sunlight, sleep, muscle, community, and honest medicine. Cholesterol is often the firefighter at the blaze. Stop blaming the hose.
Lots of love,
Doc Malik
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Thanks doc. I was prescribed statins last year. I never took them. I even had an appointment with lipid specialist and he tried to convince me but I quoted Dr Aseem Mulhotra. Lol..he didn't say much. But the Dr's are still trying to get me on them. I'll never take them. My cholesterol level was about 11...but my mum was same and she died at 79..still a good age, I'm much more healthier than my mum was..
Yasssssss. Thank you! My husband was put on statins about three weeks ago and last week he started having nosebleeds every single day. With blood clots. So now the doctor told him to stay off of them for a week to see if it gets better and then put them on different ones How about no statins? I warned him from the start. I begged him not to take them. I hope he will listen to this!