I formerly was walking two miles a day; now I can barely walk a half-mile, and that is with stops. I have tried niacin and red yeast rice. I am currently taking omega-3 and flaxseed-oil capsules.

I am 5 feet, 2 inches and weigh 168 pounds. I am careful about my diet. I feel good and energetic when not taking a statin; however, I’m lethargic when taking the drug. I’m afraid to quit but am truly miserable, so which is the lesser evil? I truly do not know what to do.

DEAR READER: Statin drugs work well, but for some people, the price is high. This poses the question of whether the benefits outweigh the risks. No one wants to suffer a heart attack or stroke, nor do they want unpleasant side effects such as those you have experienced. The answer should be a decision between a patient and his or her physician. That said, there might be alternatives. First, however, let’s hit some possibilities.

You can lower the dose of your medication. This may reduce or eliminate the leg cramps and fatigue but may also reduce the effectiveness of the statin. You can change to another label; however, this might not be successful. You have already cut back on your exercise routine, so I can’t endorse a further reduction. While some researchers question its effectiveness, you might consider ezetimibe, a prescription cholesterol-absorption inhibitor, or you might try an over-the-counter with natural plant stanols and sterols. You don’t indicate if the niacin was at all effective. Did you give it a try for a satisfactory length of time?

If you smoke, discontinue the habit. Eliminate fried foods, the skin on chicken and the fat on steak. Broil meats, and be sure to cut off any excess fat prior to cooking. Continue to exercise and modify your diet. Eat more fruits, vegetables, whole grains, fish and chicken. Limit the amount of cheese and eggs you consume, and switch to fat-free milk.

Ask your physician if he or she would consider an appropriate length of time so you can initiate a new diet and exercise plan. Perhaps a referral to a nutritionist and the physical-therapy department of your local hospital will be appropriate. Consider an OTC that doesn’t contain a statin component.

Ask your physician or specialist for advice on treating your leg cramps. If an underlying cause, such as iron deficiency or peripheral neuropathy, enters the equation, obtain appropriate treatment. Then consider ibuprofen, meditation, yoga and warm or cold packs. Avoid caffeine and alcohol. Place a bar of soap under your bed sheet to alleviate cramping. Exercise, but don’t overdo it, because fatigue will make your symptoms worse.

To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

During the day, I occasionally feel the same discomfort but not to the same degree, and it’s not as bothersome. Do you have any ideas on what it could be or how I can work toward making it go away?

I’m 51 years old, slender and in good health. I do not smoke or drink, am not diabetic, and I don’t have high blood pressure. My cholesterol levels are a little higher than they should be, so I have been taking red yeast rice. Also, I’ve developed a bit of a rash on the inside of both my knees. I hope you have some ideas because my doctor doesn’t. I’ve been researching circulatory problems, but nothing there rings a bell.

DEAR READER: Your initial pain certainly could have resulted from using the glute machine. The use of any new and different piece of equipment may result in unexpected stress and strain on bones and their connective tissues.

The outer edge of the tibia, the large prominent bone in the front of the lower leg, causes the pain of shin splints. And frequent starts and stops from sports such as tennis or basketball, from training too quickly and/or to excess, are what cause shin splints. The pain may be continuous. Relief is often found through rest, ice or hot packs, over-the-counter salves with cayenne pepper or eucalyptus formulas, physical therapy and massage.

If the pain is in the calf area, it’s possible your red yeast rice could play a role. This product contains lovastatin (with statin being the key part of the word). About 10 years ago, the Food and Drug Administration came down hard on several manufacturers and has since monitored the market closely. Any red-yeast-rice product found to contain more than “trace” amounts of lovastatin is considered an “unapproved drug” and may be banned. Studies have shown the product does work for some people (despite low statin levels, suggesting something else might be at work), but it may still cause the problems statins cause. Given its unregulated manufacture, there is no way for consumers to know exactly what dosage they are using.

Side effects include muscle pain or damage and kidney problems, and it isn’t recommended for people with liver disease. I don’t think your problem is vascular in nature. I suggest you buy a hypoallergenic pillow for your knees.

Discontinue the red yeast rice to determine whether the pain subsides, use ice or hot packs, exercise in moderation, and attempt to control your cholesterol levels through proper diet. If these recommendations fail to provide relief, request a second opinion.

To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Now I have been told I have biliary cirrhosis. My doctor told me it was likely due to the statins.

DEAR READER:
Statins are well known for the side effect of liver damage. That is why doctors should check cholesterol and liver enzyme levels at least once a year on individuals taking these powerful medications. However, I can find nothing indicating that statins lead to biliary cirrhosis. This is not to say it is not caused by the medication, but there is a chance your biliary cirrhosis is completely unrelated.

Primary biliary cirrhosis is a condition in which the bile ducts of the liver become irritated and swollen. This in turn can block the flow of bile leading to liver damage. It is more common in middle-aged women and may be associated with autoimmune disorders such as arthritis, hypothyroidism and others.

Symptoms generally come on gradually and can include fatigue, itching, jaundice, abdominal pain and much more.

Treatment aims to relieve symptoms. Fat-soluble vitamins (A, K, D) and calcium may need to be supplemented. Medication may be needed to reduce itching and assist in the removal of bile from the bloodstream. Without treatment, most patients will require a liver transplant after about seven years.

Now to statins. Most cholesterol-lowering medications contain statins. These can cause an increase in liver enzymes. Mild elevations generally don’t call for treatment or cessation of the drug. More severe increases, however, often require stopping the medication. Enzymes usually return to normal with no permanent damage.

For those with drastically elevated enzymes that are ignored, permanent liver damage can occur. It is generally accepted that (again) stopping the statin can lead to improvement and reduction of symptoms.

Now comes the challenging part. Is your biliary cirrhosis due to liver damage caused by your long-term statin use, or is it an unrelated condition? This is something that you need to find out. A simple guess is not good enough. I strongly urge you to return to your physician and ask for a referral to an appropriate specialist for further testing and treatment.

If your biliary cirrhosis is not due to the statin, you may benefit from continuing it, as elevated cholesterol levels can result from the disorder. On the other hand, if your liver damage is due to the statin (and unchecked or ignored elevated enzyme levels), it will be important to stop the medication as soon as possible.

Because you also have a heart condition, you should not stop the medication without physician approval because elevated cholesterol levels and CAD (coronary artery disease) can increase the risk of heart attack, stroke and death. It is vital that you are closely monitored.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Shortly after starting them I began having muscle pain in my legs and had heard warnings about statins, including those from your column. I was already taking co-enzyme Q10 so knew it wasn’t due to a depletion. I asked my cardiologist about a cholesterol lowering medication without statins but he said they weren’t any good and switched me to Crestor instead. It was still a statin and despite my concerns, I took it like a good patient. The pain returned so I stopped it and started watching my diet more closely. My cholesterol dropped to 217. During my next doctor visit, I again complained about the statins, hoping this time the doctor would listen. Instead he told me to find another cardiologist and left the room.

I left his office feeling pretty devastated. Was I wrong to refuse to take statins again or should I have just let him think I was still taking one even though I wasn’t? Should I really find another cardiologist?

DEAR READER:
You should absolutely find another cardiologist. Yours was rude and out of line. Having tried two separate brands and experiencing side effects from both, it is clear to me you cannot tolerate statins. While it is true that non-statin cholesterol lowering medications aren’t as effective as their statin counterparts, they are a a viable alternative given the situation. .

Find a new cardiologist, explain your situation and if he or she isn’t willing to work a little harder to help, then move on to another. Once you find someone willing to listen to and work with you, you should find your condition and outlook improving.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Understanding Cholesterol”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I, personally, have had many patients better tolerate statins when given co-enzyme Q10 as well. Please pass this on to your readers and other physicians.

DEAR DOCTOR: Thank you for writing and informing me of this finding. I have received a few sporadic letters regarding administration of CO-Q10 with statins as well as stating some studies have seen depletion during statin therapy. Yours was one of the only that included a reference.

Given this information, I feel I must now recommend that individuals taking statins talk to their physicians about the possibility of adding the enzyme supplement, especially if they are experiencing aching muscles and joints. I must also point out here, that if these symptoms continue to worsen or do not respond to the additional CO-Q10, then it is time to consider non-statin cholesterol reducers.

I took simvastatin for four years. After about two years, I started having a slight weakness and muscle pain in my left leg. I talked to my doctor about whether the statin was to blame and he said no. The pain got worse and I started having restless legs syndrome and cramps at night in my left leg. The weakness progressed to the point that I had to hold on to a railing to climb stairs. When it got to the point that I couldn’t depress the clutch pedal in my stick shift truck I stopped the simvastatin without my doctor’s approval. One month later the weakness, pain, cramps and restless legs syndrome were gone.

DEAR READER:
Restless legs syndrome is not a side effect of simvastatin; however, all of your other symptoms were.

I have received several letters about side effects from statin drugs and doctors claiming that the statin was not blame. I find this astonishing, especially considering all the publicity and manufacturer’s warnings about these potentially serious side effects.

I am glad that you discovered the source of your pain but urge you to return to your physician to discuss other cholesterol lowering options. A low fat diet combined with flax seed oil, omega 3, or niacin may be an appropriate option. Adequate exercise can also aid you in this aspect.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I discussed this with my doctor who had no objection to my taking the supplement so I started taking 100 mg twice a day (morning and night). For whatever reason I have had absolutely no side effects from the statin medication which has brought my cholesterol back to normal limits.

I am a retired registered nurse and an avid reader of your column, especially of what may concern me!

DEAR READER:
Unless you were experiencing side effects that were relieved by the Co-Q10 there is no evidence that this supplement was beneficial to you. You may simply be one of the vast majority of individuals who don’t experience side effects from statin therapy.

That being said, while I have no personal experience with coenzyme Q10 eliminating statin side effects, I have received a few letters from individuals who claim that it relieved their aching muscles.

I am unaware of any reports that show a relation between statin use and depletion of co-Q10 but the supplement is harmless and may be of benefit to some. If you feel you have avoided side effects from your cholesterol-lowering therapy by using it, then continue to do so.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

According to information I found on the internet, cinnamon and honey is a cure for diseases of all kinds. I have included two of the paragraphs from the fact sheet.

“It is found that a mixture of honey and cinnamon cures most diseases. Honey is produced in most countries of the world. Scientists of today also accept honey as a ‘ram ban’ (very effective) medicine for all kinds of disease. Honey can be used without any side effects for any kind of disease. Today’s science says that even though honey is sweet, if taken in the right dosage as a medicine, it does not harm diabetic patients. Weekly World News, a magazine in Canada, on its issue dated Jan. 17, 1995 has given a large list of diseases that can be cured by honey and cinnamon as researched by western scientists.”

“Cholesterol: Two tablespoons of honey and three teaspoons of cinnamon powder mixed in 16 ounces of tea water, given to a cholesterol patient were found to reduce the level of cholesterol in the blood by 10% within two hours. If taken three times a day, any chronic cholesterol is cured. According to information in the said journal, pure honey taken with food daily relieves complaints of cholesterol. By the way, if you are taking cholesterol medicine, STOP! They all contain STATIN which weakens your muscles, including your heart and none has been shown to stop heart attacks or strokes!”

DEAR READER:
After some extensive research and confusion, I am able to answer your question. If you are a regular reader of my column, you may remember a couple of questions I answered about bottled water (frozen or left in a car) and plastic in the microwave. You may also remember that these were email or internet based, and were primarily over-exaggerated lies and half-truths; essentially, hoaxes. The article you have quoted is another one of these instances.

While researching the basis of this article I came across a few websites and articles that were nearly all identical. One of these websites even had an author who appears to have taken bits and pieces of the original and claimed it as her own. Shortly after finding that article, I discovered what appears to be the original online version on www.Snopes.com that started circulation sometime in 1995 which explains the date in the excerpt. It appears to have found a revival on several websites, forums and in spam emails.

This email and the original article that appeared in the Weekly World News (U.S. supermarket tabloid, similar to the National Enquirer, and includes headlines such as “Hilary Clinton Adopted Alien Baby” and “Fountain Of Vermouth Discovered”) claim that cinnamon and honey is a “ram ban” cure (a term I never heard in medical school) for everything from the common cold to cancer.

Like the water bottles and plastic in the microwave, there are some truths to the article but the vast majority contains unsupported claims. Both cinnamon and honey have some medical value. Cinnamon may help control diabetes and honey is good for healing wounds and soothing coughs. But claims that the two combined will cure cancer in one month, acne in two weeks and other disorders as well, is simply nonsense.

Now the claim that all cholesterol medicines contain statin is also false. Statin itself is not an ingredient, but rather a class of medications used to lower cholesterol levels. Many cholesterol medications are indeed statins and muscle weakness is a side effect, but certain brands, such as Lipitor, have proven to lower heart attack and stroke risk. I am also curious to know what complaints of cholesterol are. High cholesterol is a silent disease, causes no symptoms but can lead to plaque and artery build-up which can result in stroke and heart attack. A doctor would not be able to diagnose the condition without laboratory testing.

With all that being said, since you appear to be healthy, take no medications and are physically active, if you choose to drink a glass of tea (eight ounces) with honey and cinnamon once or twice a day, it will not harm you. It is simply a tasty drink. And remember, just because you read it online, doesn’t mean it’s true. Be sure to research the source of the claims and look for reliable websites from places such as Mayo Clinic or the National Institutes of Health for confirmation. Also, tell your doctor about all alternative remedies you are taking, regardless of how safe they may seem.

After doing another internet search, this time on TGA episodes, he found that some people (including a retired NASA physician) think that there may be a connection between these episodes and statins. (He also discovered that red yeast rice is a statin.) He also found, after talking to one of his sisters who takes statins, that she has had as many eight TGA episodes. On several occasions she had to be taken to the ER but the connection with the statins was never brought up and she was never told to stop them.

My husband has since decided it best to avoid all statins, despite a family history of cholesterol problems. Given his past experience and that of his sister I cannot blame him so we are working together to modify his diet. We have read your cholesterol newsletter and while he isn’t totally inline with it, he is close and eats oatmeal, grapefruit and bananas on a daily basis. He will have his cholesterol tested in a few weeks to see if it is working. Oh, and he is lactose intolerant so high fat diary products are very easily avoided.

DEAR READER:
Transient Global Amnesia is a sudden and temporary episode of memory loss. It is not associated with any neurological condition. During an “attack”, the sufferer’s ability to recall recent events disappears. They do not know where they are or how they got there and in some cases the individual cannot recall events from a day, month or even a year ago, yet they remember who they are and recognize family and long-time friends.

During an episode it is important to get the individual to the hospital to rule out other causes of amnesia, such as epilepsy, stroke, or transient ischemic attack (TIA or mini-stroke). Transient Global Amnesia doesn’t appear to have any lasting complications but can cause plenty of emotional distress so after an episode it is important to relax.

Nearly half of all TGA episodes occur immediately after physical or emotional stress such as sudden immersion in hot or cold water, medical procedures (such as angiography), strenuous physical activity and more. Individuals who suffer chronic migraines and are between the ages of 56 and 75 appear to be at a higher risk.

That being said, both you and your sister appear to have had similar effects of TGA episodes after taking statin drugs. While medical science may have no answer for this, it is likely that there simply are not have enough reports from consumers to warrant further testing. The medical community can only know as much as drug manufacturers and scientists tell us and if they have failed to research properly these complaints or have simply not informed consumers of this possible side effect, then shame on them.

In my opinion your husband is taking appropriate steps. If diet alone does not work (which is likely because there seems to be a genetic predisposition) I recommend he try omega 3 oil, flax seed oil, or niacin. He still needs to have his cholesterol tested regularly to determine if his modifications are working. Niacin can have the uncomfortable side effect of flushing and can raise liver enzymes (rarely) but can be used in lower quantities (to reduce side effects) in conjunction with either or both of the oils. Be sure to inform your husband’s doctors of any and all changes and medication (even over-the-counters) he is taking to ensure he has proper testing and follow-up.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I would like to know if statins can suppress the immune system. My husband and I usually catch the same cold but I recover in three days while his takes up to a month, sometimes more. Right now he has had cold symptoms (congestion and fatigue) for 10 days. It doesn’t seem to have progressed to a sinus infection yet. It is the same with every cold.

I haven’t spoken to my personal physician yet, but I don’t believe he would even consider the possibility of a link. I have done my own research on Google and there seems to be a possible connection but finding a reliable source that says so is difficult.

DEAR READER:
Your question at first glance seemed fairly easy to answer but upon further investigation, I found it quite complicated.

As you have noted there is very little in the way of reliable information on the internet but I did come across a study on the effects of three statin drugs (simvastatin, lovastatin, mevastatin) on multiple sclerosis symptoms. The results showed that the medications appeared to modify the immune response. The findings were cited in many medical journals including International Immunology, the Journal of Immunology, the Journal of Clinical Oncology, and several others.

Whether the Lipitor is responsible for your husband’s prolonged colds is difficult to say but there is some evidence that this may be possible. The best way to determine if this is the case is to look into your husband’s medical history. Was he susceptible to colds before the medication was started? Did he have prolonged or quickly worsening symptoms? Does he have more viral and/or bacterial infections now than he did before the statin? These are all things that you can and should discuss with your husband’s physician. If he refuses to listen and passes it off, perhaps you should ask for a referral to allergy and immunology specialist to discuss the situation. The specialist can also order testing to determine if your husband has a weakened immune system or if indeed his medication is causing this reaction.

As an aside, if your husband’s physician immediately passes off strange symptoms because he doesn’t know the answer or simply doesn’t care to investigate, you should voice your concerns. In medicine, nearly everything is within the realm of possibility. As a whole, very little is known about the body, how it works when healthy and more importantly, how it works (or stops working) when ill. Every person is different and how different illnesses, infections and diseases affects them also varies. It is always vital to investigate patients’ concerns not only to make them feel better but to ensure that something serious isn’t missed.

Let me know how this turns out as I would like to know if, indeed, statin medications can alter immune responses.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.