Cyclist’s Hands, Overcoming Overuse Injuries

After a ride on your bike, have you experienced numbness, tingling, or pain in your arm, hand, wrist, or little finger? If you have, you could be suffering from an overuse injury. Approximately one-third of all bicycling overuse injuries involves the hands.  The 2 most common are what we call “handlebar palsy” and carpal tunnel syndrome. By making some adjustments to your bike, posture, and by wearing some protective equipment, you can prevent these injuries from occurring.

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Handlebar palsy

Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in your ring and little finger and controls most of the muscular function of your hand. Compression of the ulnar nerve is a common problem for competitive and recreational cycle enthusiasts, alike. Compression is the result of direct pressure on the ulnar nerve from the grip on the handlebars. Often, the nerve may be over stretched or hyperextended (extension beyond its normal limit) when a drop-down handlebar is held in the lower position. The pressure placed on the ulnar nerve results in numbness and tingling in the ring and little fingers or hand weakness, or a combination of both. Symptoms can take from several days to months to resolve, but surgical treatment is rarely necessary. Rest, stretching exercises, and anti-inflammatory medications, such as aspirin, usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding hyperextension can help to prevent a recurrence.

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Carpal tunnel syndrome

Although it is less common than handlebar palsy, carpal tunnel syndrome (compression of the median nerve at the wrist) is another overuse injury that cyclists often experience. Injury often occurs when a cyclist holds the handlebars on top and applies pressure directly on the median nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Symptoms usually resolve quickly once you stop cycling for a short period of time. Although handlebar pressure contributes to these symptoms, there can be other causes for hand pain and numbness; therefore, an evaluation for other possible causes of carpal tunnel syndrome should be performed by your health-care professional.

Prevention with Equipment

Adjust your handlebars, seat and pedals to best suit your body and allow you to sit in a more upright position. Sitting upright will take the weight and pressure off of your hands and wrists. Wearing padded gloves may also reduce shocks and jolts to your body, which travel into your wrist joints from the road and can lead to pain.

The Correct Position for the Wrist

The carpel tunnel is a small gap between the many small wrist bones and a flat ligament at the base of the wrist. Ten tendons go through this small tunnel and are responsible for flexing the hand and fingers. A nerve also passes through this tunnel. Degeneration or mechanical stress can easily injure these small tissues resulting in a loss of function of the hand.

Riding with the wrist flexed like this stresses these small tissues:

I see this position quite often when I conduct rider assessments.

This hand position can lead to injury for two reasons:

1. The tendons are stretched to near full length.

2. Vibration or impact from the front wheel, such as a bump in the road, can then cause a trauma as the wrist is forced to extend too far.

The correct position is with the wrist straight like this:

This position allows shock to travel up the arm while supported by the bones and cartilage, which are much stronger tissues than the fine tendons and ligaments supporting the fingers.

 

Assess and Control Weak Wrist Flexors

One reason we ride incorrectly is simply due to lack of knowledge or bad habits. But another reason can be weak wrist flexors. If you are a regular gym-goer, there are some tests you can do with pressing exercises to assess and control these flexors.

To conduct the test of your hand position you will need a set of grips, a suspension trainer, or a set of rings. You are going to check for correct wrist alignment while you perform a push up on this gear.

Correct wrist position:

Incorrect wrist position:

Elbow Position Is Important, Too

Avoiding injury doesn’t end at hand position, though. Should you hit a large bump in the road, and you manage to avoid wrist injury, the shock will continue to travel up the arm to the elbow. This is the second potential area of injury due to incorrect position.

Elbows should be slightly flexed like the cyclist shown here:

This allows any movement of the handlebars to be taken up by the elbow flexing. If you ride with your elbows stiff or locked, then vibration and shocks may extend the elbow too far and lead to trauma.

So please remember to keep your wrists straight and elbows flexed when out on the bike. 

- Dr. Alex (The Doc)

Sources: http://www.hughston.com/wp-content/uploads/Health-Alerts/vol15no3.pdf

https://breakingmuscle.com/fitness/pain-free-cycling-avoiding-wrist-and-elbow-injury

The Holidays & Stress in General

They're here. The holidays have officially arrived. It's a season that most people have strong feelings about. They love it, hate it, or love to hate it. Why? I blame stress. People always seem to have large expectations for the season be they real or imagined.

I was contemplating this a few weeks ago while scrolling through my Facebook when I stumbled over this article and it just felt like kismet. So, check out this article about stress and how yoga can train us to cope from Yoga International.

Namaste,

-Leta (The Yogi)

How Yoga Trains Us to Deal With Stress

August 30, 2016    BY Kristin Diversi

I was recently faced with the necessity of having a difficult conversation with someone I love. You know the kind: there was no avoiding it, but I would rather have been anywhere but there. I felt trapped and vulnerable. And I felt that if I didn’t tread carefully, our friendship would be irreparably hurt.

As I took a deep breath and created space from my hurt feelings, I felt deep gratitude for my yoga practice and how it has taught me to sit with myself—and the situation—before I react out of anger or sadness. Yoga has taught me how to be a better friend: to others, and to myself.

How can ten breaths in warrior II prepare me for a tough sit-down with a friend, you may ask. Scientists have been studying the effects of yoga on our stress response systems for years. In the last decade, largely thanks to yoga’s increased popularity, they’ve ramped up their efforts.

How can ten breaths in warrior II prepare me for a tough sit-down with a friend, you may ask.

When we think of yoga, we often think of a practice that is inherently relaxing: Lying on a mat and getting totally blissed out, feeling amazing from the first om to the final namaste.

By and large, that is a very incomplete picture.

The reason yoga works long-term is that the practice is designed to trigger our stress response. Think about it: what could be more stressful than holding a weird shape for an indeterminate amount of time, while your legs are burning and your arms feel like jelly? Even in restorative yoga you are being asked to hold a static shape—one that is probably not natural for your body—while  you also release the thoughts you are holding.

Yoga works because in the midst of these stressful situations, something else is happening: We are actively working to train our minds and bodies to relax, despite the stressful situation. We are reorienting our stress response from the innate (fast, heavy breathing, panicked thoughts, and tense muscles) to the learned (slow, deliberate breathing, calm thoughts, and engaged but not clenched muscles). By training our mental reactions, we are also modulating our physical reactions: We are lowering our heart rates, blood pressure, and easing our breathing. We are letting the body become a secondary concern, rather than the primary driving force of our practice.

We’ve all felt that magical moment in yoga class when the stress we carried in from the day—the angry boss, the fight with the spouse, the money worries—all drop away. If we can learn to consciously cultivate this while under physical stress, we can also learn to cultivate it when under emotional and mental stress.

Yoga teaches us how to train our stress response systems—something most people will never learn how to do, because they never develop the tools. Most people become stuck in patterns of reactivity, whereas, after training in yoga, we can become proactive. By learning to release our physical and mental stress during a yoga class, we can learn to release it when we are not on our mats—for example, when we are overwhelmed or in difficult situations.

In an emotional situation, we can learn to step outside of our emotionally reactive selves, just as we do on the mat when asked to do something we think is impossible, or the teacher asks us to hold a pose a bit longer. Instead of saying, “No!” or crying, or becoming angry, we learn to cultivate a peaceful response. We can let everything that is not the present moment fall away—all of our fears, anger, and all of our attachment to “our side” of the argument—focusing instead on the situation we are in, and the best outcome for everyone involved.

Meditation is another yogic tool we can utilize during times of emotional and mental stress. Different types of meditation are helpful for different things: a simple breath meditation is useful for learning how to be present in the moment. The practice of observing our thoughts is useful for learning how to recognize obsessive or negative thoughts—and eventually training them to be less aggressive or reactive, or even preventing them from becoming worse. A loving kindness meditation may help us to put ourselves in others’ shoes, and better understand their perspectives (even when it seems impossible to do so).

Pranayama, or breath practice, is another way that yoga can help us move through complicated situations. There are many wonderful breathing practices, but I’ve found three to be most helpful in working through difficult life situations:

• At times when you feel the need to calm down and take big, deep breaths, do it intentionally: Practice ujjayi breath. This breath is soothing and will help the nervous system to slow down.
• When you need to recenter yourself, literally and figuratively, try alternate nostril breathing, or nadi shodhana. This breath is also calming, and will help you find balance when you feel off center.
• Finally, when you feel the need to just let go of some energy or even to scream, try lion’s breath: let it all out, envisioning the release of all of your pent-up feelings and excess energy, leaving you free to move past them.

By engaging in practices where we focus on retraining the automatic response to stress—reaction, discomfort, pain, fear, anger, frustration—and instead learn how to move through difficult situations with some level of grace—patience, stillness, equanimity, composure—we learn how to engage more mindfully. We are learning how to return to that magical place on the mat when everything becomes calm and still and quiet—whenever we need to.

And that is the goal of yoga practice, isn’t it? To be able to access that place all of the time. With each practice, we’re getting closer.

Class Payment Page Up and Running!

Hey everyone!

We have some really exciting news! As some of you may already know, The Doc & The Yogi website is now officially set up and able to receive payments for yoga classes.

What does this mean?

Well, it means that you now have the option to pay for your Yoga with Leta classes through the website. No more need to worry about bringing cash or your checkbook to your next class.

More Payment Options!

I am now offering Monthly Passes for the Healthy Living Yoga classes that happen Tuesday and Thursday evenings from 7:00 - 8:00pm at the First Presbyterian Church of Sand Springs. There are 2 passes available; a 1 class per week and a 2 class per week option. These are a flat fee of $50 and $100, respectively. By purchasing a Monthly Pass you can save anywhere from $10 - $35, depending on the number of weeks that month. I recommend purchasing your Passes at the beginning of the month in order to get the most savings. *Please note that Passes do not roll over from month to month. Ex: A Monthly Pass purchased on December 8th would expire on December 31st regardless of how many classes you were able to attend.*

You can also purchase by the class, private, and semi-private sessions through the website.

How does it work?

Simply go to the "Class Payment" page under "Yoga with Leta". Select your class option, and checkout! There are NO added fees or taxes to purchasing online, just the ability to streamline so you don't have to worry about paying for your class the night of.

Bonus!

You can also purchase classes or Passes for someone else! So feel free to give the gift of yoga - it just might change someone's life.

Namaste,

-Leta (The Yogi)

Statins for Women? Follow up article.

Statins for Women? Not for My Patients

Blog By: Kelly Brogan, M.D. Holistic Women’s Health Psychiatry, NYC

Sometimes, pharmaceutical companies and their doctorly friends collectively make a bold move that shows their hand. Usually, this is in the form of indiscriminately and categorically broadening the eligible candidates for the suddenly lifesaving benefits of a pre-existing product. Recent changes in guidelines put forth by the American Heart Association and the American College of Cardiology aim to expand the recommendations of lipid-modifying statins to include those for whom there is a stated “10-year risk of 7.5 percent or more” of cardiac events, based on a calculator that now eliminates LDL targets. Many thoughtful clinicians have come forth to express their concerns about the impact of this expansion of prescription treatment to 70 million patients, including Dr. Redberg and John Abramson, for the New York Times, stating:

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them.

I’d like to talk about what this means, as a women’s health psychiatrist,  for my people — women, in America, suffering from depression, anxiety, and symptoms of mental illness. Several times a week, I “discuss” (euphemism) with colleagues, including integrative doctors, the fact that I do not want a single one of my patients on statins, for any reason, ever.

Here’s why:

Wrong-Headed Indication

As discussed by Dr. Tom O’Bryan, there is a 17-year lag between availability of paradigm-shifting data and implementation. Misconceptions about dietary — cholesterol and saturated fat — drivers of heart disease still linger despite widespread abandonment of this perspective. This was discussed in an important, recent BMJ commentary by British cardiologist, Dr. Malhotra, who states:

Virtually all the truths about preventing heart attacks that physicians and patients have held dear for more than a generation are wrong and need to be abandoned.

Based on unabated rates of cardiovascular disease despite a generation of statin users, and studies that demonstrate that patients presenting to the hospital with heart attacks don’t have elevated total cholesterol, but they do have (66 percent of the time) metabolic syndrome, or a constellation of findings such as obesity, high triglycerides, low HDL, and insulin resistance. This phenomenon is driven by sugar and trans fat, not dietary, naturally-occurring saturated fat, and not by a lack of statins, but, perhaps, is exacerbated by the statins themselves, and particularly, in women.

This is why, even in the only demographic that has been shown to benefit from statin use (men who have had a previous heart attack) 82 will experience no benefit before one will.  This is at the expense of interference with energy production in every cell because of coQ10 depletion, an unintended but tragic side effect.  In that 83rd patient, anti-inflammatory effects of statins (and not cholesterol-lowering) are thought to drive benefit. These effects are highly achievable in more benign and widely beneficial ways.

Inexcusable Risk

Contrary to what is demonstrated in industry studies, intolerable side effects occurred in 20 percent of those treated with statins in an eight-year retrospective cohort study. Given the total lack of demonstrated benefit in women, as a demographic, we are now, in the realm of iatrogenesis, or doctor-induced harm, which may include decreased cognitive function, cataracts, sexual dysfunction, depression, muscle pain, and now, diabetes. Understanding the pathogenisis of cardiovascular disease, induction of diabetes in women, who will then be put at risk for cardiovascular events, is inexcusable. We have known, at least since this study in the Archives of Internal Medicine, that the risk of new onset diabetes in postmenopausal women was increased by 48 percent. Plain and simple: “Statin medication use in postmenopausal women is associated with an increased risk for DM.”

Brain and Hormone Sabotage

As a women’s health psychiatrist, I am principally concerned with the effects of a low fat diet, poor cholesterol production, and medication-disrupting lipid effects because cholesterol is a primary component of cell membranes, acting as both a filter and a structural reinforcer. Cell membranes are where all of the action is at including receptor function and trafficking of nutrients and toxic elements. Cholesterol is also the precursor to vitamin D, and to pregnenolone and the sex hormones that derive from it, making it critical for appropriate production, feedback, and balance. I discuss these relationships, and its relevance to risk of depression, here:

Perhaps related to these vital functions, perhaps to others yet undiscovered, low cholesterol has also been linked to suicide and depression. (Kunugi et al, Biol Psych, 1997) (Modai at al, J Clin Psych, 1994) ( Lindberg et al, BMJ, 1992) In patients hospitalized for affective episodes, significantly more patients than controls were noted to have low plasma cholesterol. Another looking at the Melbourne Women’s Midlife Health Project suggested that improved performance on memory testing was achieved with increased total cholesterol in women longitudinally monitored.

Controlling for multiple confounding variables, 300 women in Sweden were found  to be significantly more depressed when they had the lowest percentage of total cholesterol in the cohort. This is a concerning correlation in light of recommendations that aim to throw women under the cholesterol-sabotaging bus.

Better Medicine for Healthier Brains and Hearts

Cardiovascular disease is a multi-factorial inflammatory problem with disparate drivers in different people. Lifestyle medicine is the best and most sophisticated intervention, and the only one indicated here, with no exceptions for women.  This begins with good old exercise and diet. I advocate for no grains and sugar, consistent with what our genome is expecting to see. This is a naturally high fat approach with a focus on pastured meats, wild fish, eggs, nuts, and seeds. Know that any increase in cholesterol that may occur is consistent with beneficial profiles, and improvement in inflammatory markers.  Most of the time, however, I am aiming to increase cholesterol to support my patient’s mental and hormonal health, working at improving liver synthesis and healthy dietary fats.

Most of my patients know that I’m a huge eggophile. Studies such as this one that noted three eggs (yolks) daily with carbohydrate restriction resulted in improvement in all lipid parameters and HDL help to support my assertion that whole, natural foods do not promote diseases that have only come into existence since the gifts of the industrial revolution and Snackwells over bacon type recommendations.

We all know, intuitively, that exercise is a critical answer to the burning question of how do we heal ourselves, and particularly, in a population concerned about cardiovascular disease and the Interheart study demonstrated that 90 percent of first cardiac events could be prevented by lifestyle modification. The known and validated benefits of exercise, however, may be eclipsed by use of a statin, which is just the cherry on top!

What are the parameters that relate, in a predictive manner, to metabolic syndrome and associated inflammation? Unfortunately, none of these figure into the handy calculator the AHA is planning to use for the new statin indications.  These include:

• fasting insulin
• hemoglobin A1C
• homocysteine
• NMR or VAP lipid profiles which screen for particle density
• hsCRP
• fasting glucose

Balancing thyroid function is an important and vastly overlooked variable, particularly in women, because of its role in the enzymatic processing of LDL cholesterol in the liver — i.e., you don’t have a “cholesterol problem” if you also have a “thyroid problem,” which is grossly overlooked by most conventional physicians, as I discuss here.

Strategic implementation of activated B vitamins such as B12 and folate and vitamin D can also mitigate inflammatory compounds such as homocysteine and hsCRP.

All told, we have here an unsafe, unnecessary product that will now be recommended to healthy people to make them sicker, all when simple, health-fortifying lifestyle changes have been proven to be effective and globally transformative in ways no pill could ever hope to be. Women, listen up, and listen good to those trying to save you from a pharmaceutical fate. It’s a depressing, confusing, libido-less, fat, and potentially lethal destiny, and there’s a path to vitality paved with common sense. Walk it.

Statins, is the Help Worth the Harm?

Cracking the Cholesterol Myth: How Statins Harm The Body and Mind

by Kelly Brogan, MD and Sayer Ji

A new study finds the chemical war against cholesterol using statin drugs was justified through statistical deception and the cover up of over 300 adverse health effects documented in the biomedical literature.

Better safe than sorry, right? This is the logic that defines the grasp that the pharmaceutical company has on our psyche. Perhaps your mother, father, brother, and boyfriend have been recommended cholesterol-lowering medication, just to help hedge their bets around a possible chest-clutching demise. In fact, recent guidelines have expanded the pool of potential statin medication recipients, so that there are very few of us who seem to be walking around with acceptable levels of artery clogging sludge.

But how is it that drug companies got a foothold? How have they convinced doctors that their patients need these medications, and need them now? They are banking (literally) on the fact that you haven’t brushed up on statistics in a while.

It turns out that a common sleight of hand in the medical literature is the popularization of claims around “relative risk reduction” which can make an effect appear meaningful, when the “absolute risk reduction” reveals its insignificance.  In this way, 100 people are treated with statin medications to offer 1 person benefit, and the change from a 2% to a 1% heart attack rate is billed a 50% reduction rather than a 1% improvement, which is what it actually is.

Perhaps this would still qualify as better safe than sorry if these medications weren’t some of the most toxic chemicals willfully ingested, with at least 300 adverse health effects evident in the published literature so far, with at least 28 distinct modes of toxicity, including:

• Muscle damage (myotoxicity): view 80 studies here.
• Nerve damage (neurotoxicity): view 54 studies here.
• Liver damage (hepatoxocity): view 32 studies here.
• Endocrine disruption: view 16 studies here.
• Cancer-promoting: view 9 studies here.
• Diabetes-promoting: view 8 studies here.
• Cardiovascular-damaging: view 15 studies here.
• Birth defect causing (teratogenic): view 11 studies here.

Beyond the known fact that statin drugs deplete the body of two essential nutrients: coenzyme Q10 and selenium, they are also highly myotoxic and neurotoxic. Because the heart is one of the most nerve-saturated muscles in the human body, these two modes of toxicity combined represent a ‘perfect storm’ of cardiotoxicity – a highly ironic fact considering statin drugs are promoted as having ‘life-saving’ cardioprotective properties.

A powerful expert review by Diamond and Ravnskov decimates any plausible indication for these cholesterol-lowering agents, giving full consideration to the above mentioned side effects.

They plainly state:

“Overall, our goal in this review is to explain how the war on cholesterol has been fought by advocates that have used statistical deception to create the appearance that statins are wonder drugs, when the reality is that their trivial benefit is more than offset by their adverse effects.”

The Cholesterol Meme

It’s tempting to look the number one killer of Americans in the eye, and say, “WHO did this? Who is responsible?” It is also consistent with American perceptions of health and wellness to demonize a natural and vital part of our physiology rather than look at lifestyle factors including government subsidies of inflammatory food products.

Not only is low cholesterol a problem, but it puts an individual at risk for viral infection, cancer, and mental illness because of the vital role that lipids play in cell membrane integrity, hormone production, and immunity.

A broadly toxic xenobiotic chemical, statin medications have only been demonstrated to be of slight benefit by statistical manipulation. For example, Diamond and Raynskov elucidate that:

• The JUPITER trial of Crestor vs placebo resulted in increased fatal heart attacks in the treatment group which were obscured by combing fatal and nonfatal infarctions.
• In the ASCOT trial was used to generate PR copy boasting Lipitor’s 36% reduction of heart attack risk, a figure arrived at through use of relative risk reduction from 3 to 2%.
• The HPS study has 26% drop out rate prior to the beginning of the trial (which also demonstrated a 1% improvement with treatment), so that those with significant side effects were functionally excluded from the study.

While no study has ever shown any association between the degree of cholesterol lowering and beneficial outcomes described in terms of absolute risk reduction (likely because they would be perceived as insignificant), the adverse effects are not only always presented in these terms, but are also minimized through the technique of splitting common side effects up into multiple different categories to minimize the apparent incidence.

These side effects are real and common and include “increased rates of cancer, cataracts, diabetes, cognitive impairment and musculoskeletal disorders”.  Their paper focuses on three primary adverse effects, all of whichare likely to land you in the “sorry to have thought I would be better safe than sorry” category.

Cancer

In at least four trials, statistically significant increases in cancer incidence was found, and handily dismissed by all authors as insignificant because they claimed “no known potential biological basis” is known.  This may be because the authors are still thinking of cancer as a genetic time bomb that has nothing to do with mitochondrial dysfunction, loss of lipid integrity, or environmental exposures.

With statistically significant increases in cancer incidence and deaths, in some trials, the minimal cardiovascular benefit is far eclipsed by the cancer mortality. In one of the only long-term trials, there was a doubling of the incidence of ductal and lobular breast cancer in women taking statins for more than ten years. One of many reasons that women should never be treated with these medications.

Myopathy

As one of the more well-known side effects of statins, muscle breakdown and associated pain, or myopathy has also been obscured in the literature.  Despite an incidence up to 40% in the first months of treatment, researchers only catalogue patients who had muscular symptoms in addition to elevations in a blood measure called creatine kinase (CK) at ten times normal for two measures (not 9.9, not 8, and not one measure).

In fact, a 2006 study in the Journal of Pathology found that statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia,” indicating that statin-associated muscle damage may be a universal, albeit mostly subclinical problem for the millions put on them.

Central Nervous System Dysfunction

Linked to suicide in men, depression including postpartum, and cognitive dysfunction, low cholesterol is not a desirable goal for the average psychiatric patient, aka half of the American population.

It turns out that 25% of the total amount of cholesterol found in the human body is localized in the brain, most of it in the myelin sheath that coats and insulates the nerves:

 “It has been estimated that up to 70% of the brain cholesterol is associated with myelin. Because up to half of the white matter may be composed of myelin, it is unsurprising that the brain is the most cholesterol-rich organ in the body. The concentration of cholesterol in the brain, and particularly in myelin, is consistent with an essential function related to its membrane properties. “[i]

The cell membrane, specifically, is highly vulnerable to damage by statins:

“The cell membrane is an 8 nanometer thick magical pearly gate where information, nutrients, and cellular messengers are trafficked through protein gates supported of phospholipids and their polyunsaturated fatty acids. Cholesterol and saturated fat provide essential rigidity in balance with other membrane components. Without them, the membrane becomes a porous, dysfunctional swinging gate. In a self-preservational effort, cholesterol supports production of bile acids, integral to the breakdown and absorption of consumed essential dietary fats.” Source

By extension, behavioral and cognitive adverse effects may be the manifestation of this fat-based interference.  Diamond and Ravnskov state:

A low serum cholesterol level has also been found to serve as a biological marker of major depression and suicidal behavior, whereas high cholesterol is protective [54–57]. In a study by Davison and Kaplan [58], the incidence of suicidal ideation among adults with mood disorders was more than 2.5-times greater in those taking statins. Moreover, several studies have shown that low cholesterol is associated with lower cognition and Alzheimer’s disease and that high cholesterol is protective.

A review article called Neuropsychiatric Adverse Events Associated with Statins: Epidemiology, Pathophysiology, Prevention and Management discusses the state of the literature around the intersection between mental health and cholesterol control. Despite generally dismissing a strong signal for concerning psychiatric adverse events, the article seems to conclude the following:

• Severe irritability, homicidal impulses, threats, road rage, depression and violence, paranoia, alienation, and antisocial behavior; cognitive and memory impairments; sleep disturbance; and sexual dysfunction have all been reported in case series and national registries of those taking statin medications.  Sound like the laundry list of rapidly spoken side effects at the end of a drug commercial? To anyone with a history of or current psychiatric symptoms, the role of these now ubiquitous medications should be appreciated.
• The signal for lipophilic statins – simvastatin and atorvastatin – was stronger which makes mechanistic sense since these medications penetrate the brain and brain cholesterol deficiency has been implicated in bipolar, major depression, and schizophrenia.

Of course, none of these findings nor their suppression should be surprising because there is no pharmaceutical free lunch, and because Americans are so accustomed to interfacing with human health through the lens of a one pill-one ill model. We are yanking on that spider web and expecting only one thread to pull out.  This perspective would be less disturbing if it didn’t serve as the foundation for medical practice, determined by boards such as the American College of Cardiology and The American Heart Association , the majority of whom have extensive ties to the pharmaceutical industry. An industry that has paid out 19.2 billion dollars for civil and criminal charges in the last 5 years alone.

So, the next time you hear of a doctor recommending a cholesterol-lowering intervention, tell him you’ll take that 1% risk and spare yourself cancer, cognitive dysfunction, myopathy, and diabetes. And then go have a 3 egg omelette WITH the yolks.