Happy Mother’s Day!

Statins and Wilfred Brimley

Really don’t want to return to the topic of statins again, but my tosser entry about a wellness influencer from a week ago yielded an email that rhetorically asked-

Don’t you think diabetes is a pretty concerning side effect of statins?

That was in relation to statins being flagged as a contributor to insulin resistance via interference in the mevalonate pathway and possibly in altering the microbiome.

Sounds pretty scary.

In large-scale trials for high-intensity statins1, those in the statin group saw their HbA1c increase by an average of 0.08% over the control group.

So if their HbA1c was 6.0%, at the end of the trial their HbA1c rose to 6.08%. I’m simplifying because this was above and beyond the control group, and in the JUPITER trial the control group went from 5.7 to 5.8, and the statin group went from 5.7 to just under 5.9.

They didn’t suddenly have diabetes, but instead had a relatively small increase in their A1c, and if you have a metabolically unhealthy group — as those who need statins usually are — many will likely already be edging the arbitrary thresholds that we call pre-diabetes or diabetes proper. That ~0.08% increase can be a nudge effect on the group that sees more people hit that diagnostic threshold than among the control.

In the JUPITER trial, over the duration of the study 27% more statin users hit this arbitrary threshold than in the control group. Both groups were getting older and less healthy on the average with the passing of time, but the statin group had a tiny increase that was just enough to nudge them over that line in greater numbers.

The JUPITER trial actually ended early because the benefit of the statin was so overwhelming that it was considered unethical to require the control group to stay off statins, regardless of the minor insulin sensitivity benefit. And here’s the craziest part of all: The participants didn’t even have high LDL, but instead had high inflammation markers, and still statins were of enormous benefit!

The Things You Don’t Know

One strategy that wellness influencers use to push anti-science, anti-vax, pro-quackery positions is almost always to try to use medical science against itself. To take the enormously comprehensive, large-scale studies that were done on things like statins or vaccines and cherry-pick every side effect or downside, contrasting it usually with quackery that has marginal if any study whatsoever2 (or where, with something like high-fat keto guys, they always no true scotsman every study, all of which overwhelmingly refute their claims).

Because everything has multivariate effects on your body. Every single dietary choice you make alters your microbiome. Every spice you add to your dish has an enormous array of chemicals, many of which have little to no study at all.

Every vitamin or powder you consume, including that grifter longevity overpriced vitamin, has consequences that have never been studied. The vast majority of the things we consume basically just got grandfathered in.

Maybe they increase your insulin resistance. Maybe they supercharge some types of cancer. Maybe they interfere with a pathway that protects the brain, leading to dementia.

We just don’t know, and the truth is that the coverage area of study is absolutely minuscule, which is precisely why we keep having studies that refute prior studies, and guidance constantly sees change.

Does this mean to avoid everything? Of course not. But if someone fearmongers about something that has an enormous amount of research behind it, thoroughly detailing the highs and the lows, but then they segue to pitching some unstudied bullshit, understand that they are a grifter and they do not have your best interest at heart. They just want your attention and your dollars.

Footnotes

  1. Low-intensity statin usage saw far less of an effect on insulin resistance ↩

  2. The most illustrative example of this is how many of the same people who fearmonger about consensus medical science are first in line for crazy peptides cooked up in some black-market Hell’s Kitchen basement by some Facebook scammers. Peptides are a real thing, and revolutionary GLP-1 agonists are peptides, but it’s amazing scrolling Instagram and getting ads for all of these dodgy vendors mixing up random brews with zero oversight. And people are injecting this stuff. ↩

See Also