John H. Keefe III, D.C.
CONDITION OF THE WEEK:Toddlers’ sleep problems tied to behavior issues later In a long-term study, toddlers who slept less than 10 hours a night or woke frequently at night tended to have more emotional and behavioral problems at age five. The risk was higher for internalizing problems, like being emotionally reactive, anxious or depressed, than for externalizing problems, like attention deficit or aggression. Chronic sleep problems can also cause shifts in stress hormones. Early sleep issues may be part of the reason for later emotional or behavioral problems, but many other factors, like child temperament and parental mental health, may be important as well. Kids respond great to chiropractic care sleep patterns usually improve when nervous system isn’t under pressure.
DIET: Coca-Cola and PepsiCo Agree to Remove Flame Retardant Chemical from Their ProductsBowing to public pressure, Coca-Cola and PepsiCo have both agreed to remove brominated vegetable oil (BVO) from all of their beverages in the near future. BVO, first patented as a flame retardant, contains bromine, which has been found accumulating in people’s bodies and in women’s breast milk. Bromine is a toxic endocrine disruptor that can damage your thyroid and lead to cancer, infertility, schizophrenia, and many other serious diseases. BVO is banned across Europe and Japan, but in the US is still permitted under “interim” status, pending safety studies—for the last 44 years. FDA says studying BVO is not a priority for them at this time because it’s “not a public health risk” and shares interim status with saccharin, mannitol, and acrylonitrile.
IN THE NEWS: AstraZeneca's diabetes drug Onglyza may increase death rate, FDA saysAstraZeneca Plc's diabetes drug Onglyza may be associated with an increased rate of death, according to a preliminary review of data by the U.S. Food and Drug Administration. It’s sad when a patient goes to a doctor with a health problem and the treatment ends up killing them. Most people think that a drug wouldn’t be on the market unless it is both “safe and effective”. But drug after drug has shown this is not the case. The problem is the FDA allows the drug company to do all of the testing. And drugs like this get by the process. “The overall trial results did not reveal a higher death risk, but a more detailed analysis examining only patients who took the drug suggests "a significantly increased risk of all-cause mortality," the review found. Over 2000 people a week every week 52 weeks a year for the past 50 years die from taking prescription drugs. Chiropractic and natural healthcare is both safe and effective.
FUNNY BONE:"It's April 15, tax day. The federal tax code is over 74,000 pages long. But stick with it because after page 72,000, it gets really good." – Conan O'Brien''Wikipedia is the first place I go when I'm looking for knowledge... or when I want to create some.'' —Stephen Colbert, ''I Am America''
Visit our web sites: keefeclinic.com&facebook.com/keefeclinic.com
The official way to measure stomach pH is to start with the stomach empty so only fluid remains in the stomach. Stomach fluid is removed through a tube that is inserted into the stomach through the esophagus (food pipe).
An easier way to approach this to get a “relative” stomach pH is to use pH paper to test your saliva. Normal saliva pH should be 6.4 as the pH of the stomach goes up and down the saliva will change in its pH as well.
You can demonstrate this on yourself by checking your pH and then consuming a meal and recheck your pH over the next hour. You should notice that your pH becomes alkaline right away as the acid in the stomach is being diluted by the food. In most cases it takes 30 minutes to an hour before your pH returns to the pre-meal state. If it takes longer for your pH to return to normal that suggest a weakness in the digestive process. Even though this test doesn’t give you an exact stomach pH it will give you a functional pH significant enough to tell you how your digestive process is doing.
To do proper pH testing on the body it’s important to have pH paper that is sensitive to subtle changes. The common pH paper that’s found in the drugstore is usually not sensitive enough to do proper body pH testing. Some papers only test every .5 in the pH scale you want to paper that tests every .2 in the pH scale. Your urine and saliva pH should be 6.4 under normal circumstances during the day. The exceptions to this is that your urine pH becomes concentrated overnight and tends to be more acid. And so if you want an accurate urine pH it’s best to check it sometime after your first morning void. Then the pH should be 6.4 any other time that you tested it unless you’re having an allergy reaction which would tend to make it more acidic.
Your saliva as we mentioned earlier will become more alkaline right after a meal. So the best time to check your saliva pH is either before you eat or more than an hour after you eat.
By checking your saliva pH every 30 minutes after a meal can reveal subtle problems with the digestive process. If it takes more than an hour for your saliva pH to return to its pre-meal state then that suggest a weak digestive system.
The problem in the digestive system causing your saliva pH to be off could be anywhere within the digestive track and so an evaluation is necessary to find the source of the problem. We recommend that if you start a meal at a pH 7 or higher that you take enzymes both before and after that meal. Most enzymes are best taken at the end of a meal unless their vegetable-based enzymes. The idea is that you want your digestive system to do as much as it can and then just supplement it to help improve a more thorough breakdown of your foods.
Undigested food is an irritant to your colon. This is why chronic use of antacids are so dangerous not only because they put undigested food which is an irritant to the lining of the colon but they also allow microorganisms that would normally be killed in the upper digestive track. HCl helps purify your food as well as breaking it down. So chronic use of antacids would deprive you of essential nutrients from the foods that you eat. And since minerals are metal they will be the first of the nutrients that you will start noticing deficiencies from. But other elements like B-12 are classically found low in people who use antacids chronically.
“The FDA report cautions against high doses
or prolonged use of PPIs, because they’ve been
shown to increase the risk of infection, bone fractures and dementia.”
But the danger doesn’t stop there. All acid stopping drugs (not just PPIs) inhibit nutrient absorption, promote bacterial overgrowth,reduce resistance to infection and increase the risk of cancer and other serious diseases.”
Your body pH, which is tested through the urine, can also be a factor affecting your digestive pH. It’s not uncommon to find both of these pHs to be extremely different and at opposite extremes. If your urine pH, body pH, becomes way too acid there can be a negative feedback loop that suppresses your stomach’s production of even more acid. So an attempt to correct your digestive pH you might have to utilize techniques to improve your body pH. Since most of our chronic diseases develop in an inflammatory chemistry having an acid urine can be a indicator of inflammatory chemistry.
Utilizing alkaline water or alkalizing foods can have a healing effect on an inflammatory chemistry. You can ask for a pH food list to help correct your body pH if it is too acid or to alkaline. If your urine is too acid then you need to eat more alkalizing foods which are listed on the handout.
Alzheimer's disease was officially recognized a hundred years ago, but there's still no effective medical approach for it. Alzheimer's can be a devastating disease that can make a person disappear a little bit at a time. Eventually the person that you knew is no longer there which can be a hopeless experience. There is new understanding about this condition that has led to new approaches to help arrest and even reverse it. Most of you have heard of beta amyloid plaque which many thought was the cause of this disease. This plaque has been found on MRIs and used to be a way of judging the outcome of this disease. A drug was discovered that can reduce this beta amyloid plaque and was rushed into testing. The surprising results were that it accelerated the disease. The trials were quickly abandoned and a new understanding emerged of what was actually going on in the condition.
It has since been discovered this plaque is actually the body's defense against damage to the brain. Beta amyloid plaque is now understood as being in antimicrobial peptide. In other words is part of the body's immune system against damage. Recent studies have shown that while the adaptive immune system has limited access to the brain, the central nervous system can still mount a robust response to invading pathogens, antimicrobial peptides and the innate immune system. Vitamin D has been found to be one of the protective nutrients in controlling the damage to the brain. Even though vitamin D is not a cure-all for Alzheimer's, studies have shown it to benefit not only Alzheimer's but Parkinson's disease.
Studies have also found that the herpes simplex virus (the cold sore virus) is one of the different organisms that can initiate damage to the brain. This particular virus has been found in 90% of adults even though they don't show outbreaks of cold sores. But there are usually other factors besides this virus alone that sets up the process of damage within the brain. Chlamydia (chlamydophila penedumoniae) is also another microorganism found in the brain.
Microglia are a type of glial cell that are the resident macrophages (cells that consume microorganisms) of the brain and spinal cord, and thus act as the first and main form of active immune defense. These cells are found around the damaged area of the brain in Alzheimer's. These cells are activated in inflammatory chemistry and can be triggered by viruses, excitatory proteins, a lack of vitamin D and obesity.
Studies show that obesity is a contributing factor to brain disease due to the inflammatory chemistry that is overdeveloped. So part of the process of preventing neurodegenerative disease is controlling inflammation and oxidation stress.
In a UCLA study, patients made dramatic lifestyle changes. They avoided simple carbs, gluten and processed foods. They increased their fish intake, took yoga and meditated. They were instructed to take melatonin, get adequate sleep, incorporate vitamin B-12, vitamin D-3 and fish oil. Within six months, nine of the 10 memory-loss patients saw a noticeable improvement in memory. One patient, who was in the late stages of Alzheimer's, did not show improvement.
Inflammation and tissue toxins are obvious contributors to Alzheimer's. The dietary recommendations and the nutritional support recommended tend to be directed towards reducing inflammation.
Following your body type diet is crucial in controlling inflammation. Also the latest research on sleep indicates this is how your brain detoxifies itself.
Spending time in meditation or prayer can have a calming affect on your nervous system. Chiropractic adjustments are a very effective way to reduce stress to the nervous system and maintain proper nerve function as well as organ and glandular function. Also regular chiropractic adjustments enhance immune function which can be important with Alzheimer's. Exercise is a way of controlling cortisol which is a stress and inflammation producing hormone from the adrenal glands.
Some of the nutrients that can be helpful for Alzheimer's and focus on the Nrf2 antioxidant response pathway : vitamin D, coconut oil (MCT Oil), CoQ10, Alpha lipoic acid, phosphatidylserine, acetyl l-carnitine, l-lysine (for the herpes virus), curcumin, caloric restriction (improves mitochondria function), pterostilbene (from resveratrol) , sulforaphane (from broccoli, Brussels sprouts or cabbages) , green tea extract, garlic, DHA, glutathione, SOD (superoxide dismutase), nutrients for detoxification, exercise (20 minutes per day), sunshine, and a anti-inflammatory diet.
Vega testing is an excellent way to determine which of these products your body might need. Nobody needs all of these. Also non-GMO foods and organic foods would be smart if you're dealing with advanced memory issues. The use of Stevia over artificial sweeteners would be recommended and artificial food coloring and other food additives could be an issue. Eat foods in their natural state.
Statin cholesterol-lowering drugs, antidepressants, beta blockers, diuretics, tamoxifen, methotrexate, anti-inflammatories, oral contraceptives, antibiotics, nighttime pain relievers, antihistamines, and other sleep aids, such as: Excedrin PM, Tylenol PM, Nytol, Sominex, Unisom, Benadryl, Dramamine and vaccines.
John H. Keefe III, D.C.
IN THE NEWS: Rhodiola shows antidepressant benefits in new study Rhodiola rosea, an herb deriving from Siberia and China, has shown benefits as an antidepressant agent in a recent study. Published in the March 15 edition of the journal Phytomedicine, Rhodiola was tested among 57 subjects suffering from mild to moderate depression over 12 weeks, against the antidepressant drug sertraline. Results of the study were measured using standard scoring tests. The results showed that Rhodiola offers antidepressant benefits, though sertraline proved more effective. But the researchers who conducted the study found Rhodiola imparts fewer negative effects than sertraline, making it a safer choice. NOTE: TREATING DEPRESSION NEEDS TO BE A HOLISTIC APPROACH, PICKING ONE HERB OR NUTRIENT THAT YOU READ ABOUT MIGHT NOT ADDRESS THE UNDERLYING CAUSE. ASK US ABOUT AN EFFECTIVE PROTOCOL.
CONDITION OF THE WEEK: HEALTH have you ever thought of the difference between healthcare and disease care? Most people haven’t. Let’s take headaches for an example, the average medical approach for headaches are some type of painkiller. Do you think you have the headaches because you’re low in painkillers? In natural healthcare we would consider nerve pressure in the neck, toxicity, dehydration just to name a few. In natural healthcare we have to find the source of the problem because we don’t use toxic drugs to cover up the symptoms. How many drugs do you think you would have to take every day to be healthy? Even if you’re an insulin-dependent diabetic the insulin doesn’t restore you to normal health. You will have health challenges the rest of your life. Health is a natural expression of the body’s genetic potentials through the nervous system. Keep your spine in proper alignment, eat foods consistent with your body type, drink plenty of water, stay active and spend time relaxing (prayer or meditation).
FUNNY BONE: A new report says that dogs can sniff out prostate cancer with almost 98 percent accuracy. The report also finds that cats can sniff it out with 100 percent accuracy but they prefer to watch you die. Conan O'Brien
Visit our web site: keefeclinic.com&facebook.com/keefeclinic
John H. Keefe III, D.C.
DIET: Foods that trigger headaches For many headache and migraine sufferers, certain foods can act as triggers. Tyramine (is a naturally occurring monoamine compound and trace amine derived from the amino acid tyrosine.) can cause your blood pressure to rise, which can trigger headaches in some people. If you experience this reaction, you may want to avoid other trigger foods, such as: Smoked or cured meats, Aged cheeses, Citrus fruits, Sauerkraut, Soy sauce, Red wine, And certain beers.Research shows that tyramine in grapes can have a negative effect on certain antidepressants called MAOIs.
IN THE NEWS: Could Wearable Computers Be as Harmful as Cigarettes? Wireless phones and other gadgets have the potential to cause all sorts of health problems, from headaches to brain tumors. Wearable technology devices are reasonably safe, provided they do not have a 3G connection built in. Children are especially vulnerable to cell phone radiation because their brain tissues are more absorbent, their skulls are thinner, and their relative size is smaller.The findings show that 3G phones may cause more harm than earlier versions, raising the risk of brain cancer four-fold. It also appears to have shorter latency period—just five to 10 years, compared to about 25 years for earlier mobile phone versions.
CONDITION OF THE WEEK:SPORTS INJURIES most sports injuries respond very well to chiropractic care. In most cases the injury can be resolved without drugs or surgery and the patient can be returned to sports activity in a stronger physical condition. Some sports injuries are due to the fact the bodies out of alignment in the first place. When you put your body under increased pressure due to alignment issues then you’re more prone to an injury. Chiropractic studies show that athletes that receive regular chiropractic care sustain fewer injuries and recover faster from the injuries they do receive. Be it a kid in school sporting activities or the weekend warrior trying to get ready for the marathon, chiropractic can help you reach your best performance.
Visit our web sites: keefeclinic.com&facebook.com/keefeclinic
The Diet-Heart Myth: Statins Don’t Save Lives when you look at the true stats
In this article, I will debunk the myth that statin drugs save lives in healthy people without heart disease, and discuss some of the little known side effects and risks associated with these drugs.
Myth: Statins save lives in healthy people without heart disease
Statins have been hailed by many in the conventional medical establishment as wonder drugs, with some physicians going as far as suggesting they should be added to the water supply. (The doctor that made that particular suggestion is named John Reckless – I kid you not.) But are statins really the wonder drugs they’ve been made out to be?
Are statins really the wonder drugs they’ve been made out to be?
Before we dive into the statistics on statins, I need to briefly explain the difference between relative and absolute risk reduction. Researchers and pharmaceutical companies often use relative risk statistics to report the results of drug studies. For example, they might say “in this trial, statins reduced the risk of a heart attack by 30%”. But what they may not tell you is that the actual risk of having a heart attack went from 0.5% to 0.35%. In other words, before you took the drug you had a 1 in 200 chance of having a heart attack; after taking the drug you have a 1 in 285 chance of having a heart attack. That’s not nearly as impressive as using the 30% relative risk number, but it provides a more accurate picture of what the actual, or “absolute” risk reduction is.
With that in mind, let’s take a closer look at the efficacy of statins in two broad groups of people: those with pre-existing heart disease, and those without pre-existing heart disease. In the medical literature, these groups are referred to as “secondary prevention” and “primary prevention”, respectively.
Secondary prevention (those with pre-existing heart disease)
Absolute risk reductions range from 0.8% in MIRACL on the low end to 9% in 4S on the high end, with an average of 3%.
An analysis by Dr. David Newman in 2010 which drew on large meta-analyses of statins found that among those with pre-existing heart disease that took statins for 5 years (1):
Primary prevention (those without pre-existing heart disease)
Statins do reduce the risk of cardiovascular events in people without pre-existing heart disease. However, this effect is more modest than most people assume. Dr. Newman also analyzed the effect of statins given to people with no known heart disease for 5 years (5):
These statistics present a more sobering view on the efficacy of statins in people without pre-existing heart disease. They suggest that you’d need to treat 60 people for 5 years to prevent a single heart attack, or 268 people for 5 years to prevent a single stroke. These somewhat unimpressive benefits must also be weighed against the downsides of therapy, such as side effects and cost. During that hypothetical 5 year period, 1 in 67 patients would have developed diabetes and 1 in 10 patients would have developed muscle damage (which can be permanent in some cases, as we’ll see later in this section).
In addition, while statins do moderately reduce cardiovascular events such as heart attack in people without heart disease, they’ve never been shown to extend lifespan in this population. This is true even when the risk of heart disease is high. In a large meta-analysis of 11 randomized controlled trials by Kausik Ray, MD and colleagues published in the Archives of Internal Medicine, statins were not associated with a significant reduction in the risk of death from all causes. (6)
This trial included 65,000 people without pre-existing heart disease but with intermediate to high risk of heart disease. It was important because it was the first review that only included participants without known heart disease. Previous studies suggesting that statins are effective in reducing death in people without pre-existing heart disease included some people that did have heart disease, which would have skewed the results.
The lack of significant effect on mortality is even more interesting in light of the fact that LDL cholesterol levels did decrease significantly in the statin group; the average LDL level in those taking placebo was 134 mg/dL and the average in the statin-treated patients was 94 mg/dL—roughly 30% lower. Yet in spite of this marked reduction in LDL cholesterol in the statin group, there was no difference in lifespan between the two groups. This is yet another line of evidence suggesting that the amount of cholesterol in LDL particles is not the driving factor in heart disease.
A meta-analysis of statin trials in people without heart disease by the prestigious Cochrane Collaboration came to a similar conclusion. (7) They also observed that all but one of the clinical trials providing evidence on this issue were sponsored by the pharmaceutical industry. This is significant because research clearly indicates that industry-sponsored trials are more likely than non-industry-sponsored trials to report favorable results for drugs because of biased reporting, biased interpretation, or both. (8)
Adverse effects of statins
If statins were harmless and free, then it wouldn’t matter how many people need to be treated to prevent a heart attack or extend someone’s lifespan. But statins are not free, nor are they harmless. Statin use has been associated with a wide range of side effects, including myopathy (muscle pain), liver damage, cataracts, kidney failure, cognitive impairment, impotence and diabetes.
Unfortunately, studies show that physicians are more likely to deny than affirm the possibility of statin side effects, even for symptoms with strong evidence in the scientific literature. (9) Assuming that physicians would likely not report the adverse reaction in these circumstances, it’s probable that the incidence of statin side effects is much higher than the reported rates.
One of the most troubling side effects of statins that has only recently become apparent is their potential to increase the risk of diabetes, especially in women. A study by Dr. Naveed Sattar and colleagues published in The Lancet in 2010 examined 13 randomized clinical trials involving over 90,000 patients taking statins. They found that statin use was associated with a 9% increased risk in developing diabetes. Note that this is a relative risk, so the absolute risk of developing diabetes while taking a statin is very low. That said, observational data from the Women’s Health Initiative found a 48% increased risk of diabetes in healthy women taking statins after adjusting for other risk factors. (10)
Statin Myopathy: A Common Cause of Chronic Pain
By James J. Lehman, DC
Statin myopathy is a common dilemma that causes persistent myalgia(1) and chronic pain. Chiropractic physicians should be prepared to evaluate patients with these conditions. This article describes statin myopathy and its differential diagnosis.
While primary care physicians and chiropractic physicians treat more than 90 percent of chronic pain patients in the United States,(2) the treatment approaches vary considerably. Primary care providers, such as allopathic and osteopathic physicians, advanced practice registered nurses and physician assistants often focus on pharmacological therapeutics, including the use of opioids. Chiropractic physicians focus on nonpharmacological therapeutics to relieve pain due to neuromusculoskeletal conditions, which as of January 2015 are included in the standard of care promulgated by the Joint Commission.(3) As a member of the medical staff for a federally qualified health center, credentialed as a patient-centered medical home, I appreciate the Joint Commission’s new standards. There is a need to revolutionize the treatment of chronic pain in America,(4) and nonpharmacological therapeutics, including chiropractic and acupuncture interventions, are reasonable solutions.
The Community Health Center Inc. of Middletown, Conn. has integrated chiropractic services into nine primary care sites. Chiropractic specialists and chiropractic residents (e.g., nonsurgical orthopedics and neuromusculoskeletal medicine) evaluate and manage chronic pain patients as members of the primary care team. As one of the chiropractic specialists, I have encountered chronic pain patients who do not respond favorably to pharmacological care offered by primary care providers or the nonpharmacological chiropractic treatment. Often these non-responsive patients are taking statins to prevent heart attacks and death.(5) So now I consider statin myopathy as a possible cause of chronic pain. Since my training and scope of practice do not include pharmacological therapeutics, I do not alter the patient’s medications, but as an evidence-based and patient-centered provider, I have a responsibility to the patient and the primary care provider to communicate my diagnosis. Because I’m a member of the medical staff with full access to the electronic health care record, I am able to efficiently communicate my concerns to the prescribing primary care provider.
Since the majority of chiropractic physicians practice as solo practitioners or as associates in chiropractic practices,(6) they face a conundrum when a chronic pain patient presents with the symptoms of statin myopathy. It is common for prescribing physicians to deny drug toxicity and the symptoms of statin myopathy.(7) Although a doctor of chiropractic (DC) is capable of performing focused history and neuromusculoskeletal examination, which is essential when evaluating muscle complaints that may be induced by statins, the diagnosis is complicated for the chiropractic physician because the process usually involves a change in the statin prescription or a “statin holiday,” which is not within the chiropractic scope of practice. However, a DC does have the ability to contact the patient’s medical provider to discuss the statin and work with that provider on behalf of the patient.
Statin Therapy Guidelines
The Centers for Disease Control and Prevention estimated in 2010 that 32 million Americans take statin medications. 50 percent of men between 65 and 75 years of age and 39 percent of women ages 75 and older were taking statins from 2005 to 2008. One in four Americans over 45 years of age take statin medications.(8) New guidelines, formulated by the American Heart Association and the American College of Cardiology, would increase the use of statins for the older population to 87 percent of men ages 60 to 75 and 54 percent of women in that age range.(9)
The new guidelines recommend statin therapy for the following groups:(10)
• People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.
• People with a history of a cardiovascular event (e.g., heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
• People 21 and older who have a very high level of bad cholesterol (i.e., 190 mg/dL or higher).
• People with Type 1 or Type 2 diabetes who are 40 to 75 years old.
Incidence of Statin Myopathy
For several reasons, controlled clinical trials underestimate the actual percentage of patients who suffer statin myopathy and suggest that muscle problems are rare.(11) Observational studies in nonselected outpatients show a higher frequency of muscle complaints in the statin groups than in the control groups. Statin myopathy frequency has been reported at 9 to 20 percent with these studies. By some estimates, statin myopathy affects 7 million of the 33 million people taking statins in the United States, or 25 percent of the cases.(12)
In spite of the following warning offered by Consumer Reports regarding the use of statin medications, it appears that prescribing physicians usually reject any possible connection of statins and symptoms supported by evidence in the literature.
If you are taking a statin and have muscle aches, pain or weakness, call your doctor right away. This could be a sign of a dangerous breakdown in the muscle tissue.
A patient-targeted survey, addressing how physicians responded when patients presented with possible adverse drug reactions (ADRs) to statin medications, demonstrated that physicians usually do not acknowledge patients’ complaints including muscle pain. 87 percent of patients reportedly spoke to their physician about the possible connection between statin use and their symptom. Patients reported that they and not the doctor most commonly initiated the discussion regarding the possible connection of drug to symptom (98% vs 2% cognition survey, 96% vs 4% neuropathy survey, 86% vs 14% muscle survey; p < 10−8 for each). Physicians were reportedly more likely to deny than affirm the possibility of a connection. Rejection of a possible connection was reported to occur even for symptoms with strong literature support for a drug connection, and even in patients for whom the symptom met presumptive literature-based criteria for probable or definite drug-adverse effect causality. Assuming that physicians would not likely report ADRs in these instances, these patient-submitted ADR reports suggest that targeting patients may boost the yield of ADR reporting systems.(13)
Consumer Reports Best Buy Drugs lists a significant variation in costs for statin medications. In 2007, a generic statin costs as little as $12 per month or less, with brand-name statin costs escalating to more than $500 per month.(14) Normally, these medications are prescribed for long-term use, and cost is relevant for patients. Of interest is that up to 60 percent of patients discontinue use of statins within two years of the initial prescription.(15)
A panel of four physicians, including three cardiologists and one neuroscientist, claims that statins are effective but under prescribed because of muscle toxicity concerns by physicians. The panel offers the following key points regarding statin myopathy:(16)
• There is little consensus on the definition of stat in-induced myopathy, and it is underdiagnosed.
• Abnormal pharmacokinetic activity contributes to toxicity, but some patients may be predisposed by underlying metabolic muscle disorders.
• A focused history and neuromusculoskeletal examination are important in the evaluation of muscle complaints that may be induced by statins.
• In patients with possible statin-induced myopathy, assessing the risks and benefits of statin therapy is essential.
• For patients who cannot tolerate statin therapy, alternatives include a “statin holiday” followed by a rechallenge with a different statin, intermittent rosuvastatin (Crestor) or resin therapy. Sometimes the best alternative is a compromise between the goal level for low-density-lipoprotein cholesterol and the level achievable with alternative therapy.
In 1997, Lennemas and Fager described the pharmacodynamics and pharmacokinetics of the HMG-CoA reductase inhibitors and pointed out the similarities and differences. They explained the crucial role of hypercholesterolemia and the subsequent development of coronary heart disease and atherosclerosis and its risks of progression with increasing levels of total serum cholesterol or low-density lipoprotein (LDL) cholesterol.
The statins are reversible inhibitors of the microsomal enzyme HMG-CoA reductase, which converts HMG-CoA to mevalonate. This is an early rate-limiting step in cholesterol biosynthesis. Inhibition of HMG-CoA reductase by statins decreases intracellular cholesterol biosynthesis, which then leads to transcriptionally upregulated production of microsomal HMG-CoA reductase and cell surface LDL receptors.(17)
The FDA added a safety warning about associated cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment and confusion) and the numerous interactions with cardiovascular and other drugs that may increase the toxicity of statins.(18) there are also increased risks of raised blood sugar levels and the development of Type 2 diabetes. Some drugs interact with statins in a way that increases the risk of muscle injury (myopathy), characterized by unexplained muscle weakness and/or pain.
Statin-Associated Muscle-Related Adverse Effects
In one case series involving 354 patients (age range 34-86 years) who self-reported muscle-related problems associated with statin therapy, 93 percent of the patients reported muscle pain, 88 percent fatigue and 85 percent weakness.(19) Patients with persistent muscle pain due to statin myopathy present with symptoms of muscle weakness, soreness, tenderness, stiffness, cramping or aching, either at rest or with exercise.(20) It is common for women taking statins to experience exertional fatigue and loss of energy.(21) In my experience, many patients suffering with chronic pain present with similar nonspecific muscle symptoms. Warren Hammer, DC, claims his patients complain of nonspecific muscle pain, tenderness, weakness, joint pains, peripheral neuropathy, tendinopathy and lupus-like symptoms that may be caused by the use of cholesterol-lowering drugs (statins).(22)
It is essential that specific definitions differentiate the types of statin myopathy. While myositis and rhabdomyolysis must be recognized and treated immediately, physicians have a tendency to deny a possible drug connection when a patient presents with myalgia or neuropathy.(23) The specific definitions developed by experts in the fields of cardiology, statin myopathy and drug toxicity attempt to clarify three different statin-associated musclerelated adverse effects: myalgia, myositis and rhabdomyolysis.(24)
A case report described two chiropractic patients presenting with chief concerns of neuromusculoskeletal pain complaints while taking statins. The first patient sought relief of pain in the neck, both legs and knees. The other patient presented with a chief concern of lower thoracic paraspinal pain. Both of these patients responded favorably with a statin holiday and a change in statin medications respectively.(25) The chiropractic physician did not advise the patients to discontinue their medications but referred them to their prescribing physicians.
Statin myopathy patients may present for chiropractic care complaining of chronic neuromusculoskeletal pains affecting the spine and/or extremities. Often there is no history of recent trauma. Provocative maneuvers may or may not reproduce the pains of chief concern. Conservative chiropractic treatments may provide only temporary relief or no relief of the persistent muscle or nerve pain. I suggest that whenever a patient presents with persistent muscle pain and a history of statin medications, you consider statin myopathy as a cause of the chronic pain.
Patients suffering with musculoskeletal pain frequently present to chiropractic clinicians for evaluation and management.(27) The rising use of statins indicates that an increasing number of patients suffering with muscle pain, neurological symptoms and chronic pain due to statin toxicity will present to primary care providers and chiropractic clinicians. Hence, chiropractic physicians might be better prepared to evaluate patients with statin myopathy if the chiropractic colleges teach that to chiropractic students and graduates.
Chiropractic students, as part of their training, are taught to perform a differential diagnosis in order to determine the cause of the patient’s neuromusculoskeletal pain symptoms. The students determine the pain generator and its cause through the process of differential diagnosis, involving a focused history and physical examination. It is necessary to discuss the pharmacology and pharmacokinetics of statins. The need to communicate directly with the prescribing provider and the patient is stressed to the students. I suggest that evidence-based and patient-centered care mandates that when the neuromusculoskeletal complaints are due to statin myopathy, the attending chiropractic physician should advise the patient and the prescribing provider of these clinical concerns.
I suggest that the majority of chiropractic clinicians may not recognize this drug-induced muscle pain. It would be enlightening to receive feedback from chiropractic clinicians. So, I pose the following question collectively to the readers of this manuscript: “Would you recognize a patient with statin myopathy if he or she walked into your office?” Please respond to my email: firstname.lastname@example.org.
1. Fernandez G, Spatz ES, Jablecki C, and Phillips PS. Statin myopathy: a common dilemma not reflected in clinical trials. Cleveland Clinic Journal of Medicine, Vol 78, Number 6. June 2011.
2. Blondell RD and Ashrafioun L. Treating Opioid Dependency and Coexistent Chronic Nonmalignant Pain.Am Fam Physician. 2008 Nov 15;78(10):1132-1133.
3. Revisions to pain management standard effective January 1, 2015. Standard PC.01.02.07: The [organization] assesses and manages the [patient’s] pain. Joint Commission Online. Nov. 12, 2014. Available from: www.jointcommission.org/assets/1/23/jconline_November_12_14.pdf. [See Jan/Feb ACA News, Page 8]
4. The Mayday Fund. A Call To Revolutionize Chronic Pain Care in America: An Opportunity for Health Care Reform.
5. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366:1267–1278.
6. For the Good of the Patient: The Integrative Chiropractor. ACA News. Available from:www.acatoday.org/content_css.cfm?CID=3298.
7. Golomb BA, McGraw JJ, Evans, MA Dimsdale, JE 2007. “Physician Response to Patient Reports of Drug Adverse Effects: Implications for Patient-Targeted Adverse Effect Surveillance.” Drug Safety; 30(8): 669-675.
8. Wehrwein P. Statin use is up, cholesterol levels are down: Are Americans’ hearts benefiting? Harvard Health Blog. Available from: www.health.harvard.edu/blog/statin-use-is-upcholesterol-levels-are-down-are-americans-hearts-benefiting-201104151518.
9. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. J Am Coll Cardiol. Volume 63, Issue 25, Practice Guideline July 2014.
10. Doctor discussion is key for cholesterol treatment. American Heart Association. Blog.heart.org. Available from: http://blog.heart.org/doctor-discussion-is-key-for-cholesterol-treatment.
11. Ganga HV, Slim HB and Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Am Heart J. 2014 Jul;168(1):6-15. doi: 10.1016/j.ahj.2014.03.019. Epub 2014 Apr 12.
12. Vladutiu GD. Genetic predisposition to statin myopathy. Curr Opin Rheumatol. 2008;20-648-655.
13. Golomb BA, McGraw JJ, Evans, MA Dimsdale, JE 2007. “Physician Response to Patient Reports of Drug Adverse Effects: Implications for Patient-Targeted Adverse Effect Surveillance.” Drug Safety; 30(8): 669-675.
14. Choosing a Statin to Lower Cholesterol. Consumer Reports Health Best Buy Drugs.
15. Jackevicius CA, Mamdani M, Tu JV. Adherence of Statin Therapy in Elderly Patients with and without acute coronary syndromes. JAMA 2002;288:462-467.
16. Fernandez G, Spatz ES, Jablecki C, and Phillips PS. Statin myopathy: a common dilemma not reflected in clinical trials. Cleveland Clin J Med, Vol 78, Number 6. June 2011.
17. Lennemas H, Fager G. Pharmacodynamics and pharmacokinetics of the HMG-CoA reductase inhibitors. Similarities and differences. Clin Pharmacokinet. 1997 May;32(5). 403-425.
18. United States Food and Drug Administration FDA drug safety communication: important safety label changes to cholesterol- lowering statin drugs. Silver Spring (MD): The Food and Drug Administration; 2012. Available from: www.fda.gov/Drugs/DrugSafety/ucm293101.htm.
19. Cham S, Evans MA, Denenberg JO, Golumb BA. Statinassociated muscle-related adverse effects: a case series of 354 patients. Pharmacotherapy. 2010 Jun;30(6):541-53. doi: 10.1592/phco.30.6.541.
20. Linares LA, Golomb BA, Jaojoco JA, Sikand H, Phillips PS. The modern spectrum of rhabdomyolysis: drug toxicity revealed by creatine kinase screening. Curr Drug Saf. 2009 Sep;4(3):181-7. Epub 2009 Sep 1.
21. Golomb BA, Evans MA, Dimsdale JE, White HL. Effects of Statins on Energy and Fatigue With Exertion: Results From a Randomized Controlled Trial. Arch Intern Med/Vol 172 (NO. 15), Aug 13/27, 2012: 1180-1182
22. Hammer W. That Persistent Muscle Pain May Be Drug- Induced. Dynamic Chiropractic – Feb. 24, 2003, Vol. 21, Issue 05.
23. Golomb BA, McGraw JJ, Evans, MA Dimsdale, JE 2007. “Physician Response to Patient Reports of Drug Adverse Effects: Implications for Patient-Targeted Adverse Effect Surveillance.” Drug Safety; 30(8): 669-675.
24. Linares LA, Golomb BA, Jaojoco JA, Sikand H, Phillips PS. The modern spectrum of rhabdomyolysis: drug toxicity revealed by creatine kinase screening. Curr Drug Saf. 2009 Sep;4(3):181-7. Epub 2009 Sep 1.
25. Rodine RJ, Tibbles AC, Kim PSY, Alikhan N. Statin induced myopathy presenting as mechanical musculoskeletal pain observed in two chiropractic patients. J Can Chiropr Assoc. Mar 2010; 54(1): 43–51.
26. Cholesterol Lowering Drugs. Cleveland Clinic. Available from:http://my.clevelandclinic.org/health/diseases_conditions/hic_Cholesterol/hic_About_Cholesterol-Lowering_Drugs.
27. Chiropractic: An Introduction. National Center for Complementary and Integative Health (NCCIH).http://nccam.nih.gov/health/chiropractic/introduction.htm.
28. Kumar A and Cannon CP. Acute Coronary Syndromes: Diagnosis and Management, Part I. Mayo Clin Proc. Oct 2009; 84(10): 917–938.
29. Linares LA, Golomb BA, Jaojoco JA, Sikand H, Phillips PS. The modern spectrum of rhabdomyolysis: drug toxicity revealed by creatine kinase screening. Curr Drug Saf. 2009 Sep;4(3):181-7. Epub 2009 Sep 1.
Dr. James J. Lehman is an associate professor of clinical sciences and director of health sciences postgraduate education at the University of Bridgeport. He is a board-certified chiropractic orthopedist and neuromusculoskeletal medicine specialist at the Community Health Center Inc., in Waterbury, Conn., a federally qualified health center and a patientcentered medical home. Dr. Lehman teaches non-surgical orthopedics, neurosciences, neuromusculoskeletal medicine, evidence-based practice and health care reform classes for the University of Bridgeport. He also serves as the team chiropractor for the Bridgeport Bluefish pro baseball team and mentors fourth-year chiropractic clerks and chiropractic residents in orthopedics/ neuromusculoskeletal medicine. He can be contacted at email@example.com.
John H. Keefe III, D.C.
CHIROPRACTIC: NEUROLOGICAL BASES OF HEALTH chiropractic care offers improved regulatory function of the organs, glands and muscles of the body. The nervous system regulates and controls every organ part and system of the body and relates an individual to his or her environment through the five senses. The nervous system regulates the control of function and healing, and when there’s no interference along the channels of communication with the body then your body can function at 100%. As the adjustments remove nerve pressure then there’s an improvement of function throughout the body. The five laws of health include diet, rest and relaxation, exercise, positive mental and spiritual attitude and last a healthy nervous system. As a chiropractic physician we encourage you to engage in each of these laws to maximize your health potentials. Your family and friends will benefit from chiropractic care, tell others.
FUNNY BONES: Reaching the end of a job interview, the Human Resources Officer asks a young engineer fresh out of the Massachusetts Institute of Technology, "And what starting salary are you looking for?" The engineer replies, "In the region of $125,000 a year, depending on the benefits package." The interviewer inquires, "Well, what would you say to a package of five weeks vacation, 14 paid holidays, full medical and dental, company matching retirement fund to 50% of salary, and a company car leased every two years, say, a red Corvette?" The engineer sits up straight and says, "Wow! Are you kidding?" The interviewer replies, "Yeah, but you started it."
Visit our web site: keefeclinic.com-ebook/keefeclinic.com