A theory exists for the mechanism of why statins increase rhabdomyolysis. For those of you who have been under a rock or lifting with your Sears 110lb cement barbell set, rhabdomyolysis (rhabdo) is a potentially life threatening condition that can occur in response to too much or too intense of exercise. Large amounts of eccentric loading (everyone know which portion of the DL this is?) and or bringing a muscle to complete exhaustion can induces a calcium sequestering problem in muscle cells with the result being all kinds of hell breaking loose. The muscle cell looses integrity and myoglobin (a protein inside the cell) is leaked into the surrounding tissue. This myoglobin oxidizes while being circulated to the kidneys where it generally gums up the works. Electrolyte imbalance can occur and in severe cases cardiac arrhythmias resulting in death. This condition is common in new military recruits, football double-days, marathons and triathlon to name a few activities. Unfortunately there is also a laundry list of medications which can increase one’s likelihood of getting a case of exercise induced rhabdo including (but certainly not limited to) ibuprophen, chemo therapeutics, cough syrup and of particular interest for today, statins.
Statins are prescribed in the misguided attempt to reduce circulating cholesterol levels. They play havoc in vital systems like ubiquinone (Co-Q10) production, increase rates of cancer….and do fuck-all to prevent a heart attack except in a tiny sub-fraction of men who have already HAD a heart attack. Interestingly however, they do not increase survivability….but other folks like Dr. Eades have done a thorough job detailing all that BS. What I’d like to share with y’all, especially those of you who are trainers or who own gyms is this: Statins preferentially bioaccumulate in muscle cells, particularly when those muscles have been worked with high intensity exercise. The statins are actually selectively transported into the muscles. This is facilitated by the carboxolate shuttle, better known as the Lactate Shuttle. You see, high intensity exercise increases the expression of the lactate shuttle complex and thus increases the rate of bioaccumulation of statins. I suspect this is a common mechanism with many of the drugs which increase rhabdo incidence, but this is just my opinion and I have nothing but a guess on that topic at this point.
A good question at this point might be “so what?” Well, like I mentioned, if you make your living as a trainer OR if you own some kind of gym, and you use high intensity exercise as part of your programming I’d screen your folks for statin use. At CrossFit NorCal we have historically just asked if folks feel they are safe to train, and offer a physician release as part of the liability waiver. We have tended NOT to ask much more than that but we will start asking if our new folks are or have been taking statins and we will make them initial a box that they are obligated to inform us IF they begin taking statins. If you are still running the “come one, come all” approach to your operation and let ANYONE off the street roll into your class you are, in my opinion, seriously hanging your heiney on the line. This is part of why we developed an On-Ramp curriculum. So we were safe and our clients were safe. This is simple better business practice that is not fixed by YOU being a rockstar coach. Nor is this a legit approach because this is how things were done in ’02 in Santa Cruz. What if YOU get sick and someone fills in? Are you EVER going to go on vacation? Good business systems make average trainers better, rockstar trainers bullet proof and they protect EVERYONE from the gym owner to the new recruit.
As an interesting side note, do any of you know HOW the lactate shuttle is studied? I did some research on the lactate shuttle that was pretty fracking illustrative. You see, lactate is a byproduct of glycolysis. This is the process of breaking glucose down either into 3-carbon aldehyde’s to be plugged into the Krebs/citric acid cycle or the glucose is broken down to lactate. Normally we’d associate the process of glucoseàlactate being associated with hard physical work but if you want to study the lactate shuttle in a petri dish you don’t look at a pumping bicep…you look at CANCER CELLS. Cancer cells, folks, only run on glucose and the process produces lactate as a byproduct. This is BTW where most of the vegetardian hippies get the whole cancer/acidity thing wrong and recommend you go on a meat free diet. The acid is not the causative factor, it is end-product of cancer metabolism. Essentially, it’s cancer-poop. Incidentally, the shift from the ability to use fat as a fuel to only being able to use glucose as a fuel is a major process in cellular aging…but you will have to wait for the second book to learn more about that. Or, buy me a NorCal Margarita and whisper softly to me “Robby…you are soooo ungrateful…”
Great stuff!! I dropped the statins about a year ago and am glad I did. Isn’t it funny that a drug with MINIMAL effectiveness is the most prescribed one in the country? And it’s going to get more prevalent now that the recommended cholesterol level be at 180 or below.
It’s the great American marketing machine at it’s best.
Thanks for posting this Rob. And yes, I’ll buy you a margarita but I’m NOT whispering in your ear 🙂
Thank you for the responsible reporting. God knows that there are bunch of trainers who want to maintain their street credit by kicking the backside out of any newbie who walks through their door. And since so many doctors RX statins, you can’t judge a newbie bye his cover.
thanks Rut!
It’s big stuff and if folks are going to take it all as professionals the standards need to be high.
Hey Robb, its the down (at least for the post. chain)- muscle lengthening during contraction. Great stuff, thanks for the info!!
Laurie
Hahahaha! “Cancer-poop!” I love it!
Robb,
I’ve been reading your blog and have been taking in a buttload of new information regarding nutrition.
This post you made about the statins though brought up an issue with myself and I was wondering if you may be able to shed some light on my situation.
I’m a 19 year old healthy male (a little on the heavy side after Starting Strength) and I’m being tested for life insurance (it’s a parental thing). The tests came back fine with the only issue being my cholesterol (triglycerides and everything else were excellent). My total cholesterol sits at around 220 with my good cholesterol around 48. I’ve got to get the total down by around 20 points in 1 month in order to qualify for this insurance.
I’ve been zoning for a few weeks and crossfitting for 2 months so all that should be in check. To lower those points though I was going to supplement with Red Yeast Rice – Something which natural contains the statin lovastatin.
I have no doubt that crossfit and zone are the key to actually getting “healthy” cholesterol levels but will this supplementation hold similar risks regarding rhabdo as prescription statins? Do you have any ideas how statins would effect someone my age as a short term treatment?
Am I going to get rhabdo??? No… But in all seriousness thanks for the info. It is definitely something to think about and any thoughts would be appreciated.
Philip
Philip-
Your best bet IMO is a paleo/zone approach, high dose fish oil and high intensity exercise (crossFit). This will bring up good cholesterol, bring down “bad”. I’d also recommend that you demand an LDL particle size in the next go around as you can have a significant modification in your CVD risk based on the distribution of small vs large LDL particles.
“Robby…you are soooo ungrateful…”
Gawd, this is so timely it’s uncanny. I have a close personal relative who just went on Crestor at the urging of his G.P. for “high cholesterol”. Despite my explanation of conventional cholesterol dogma, despite my explanation of VLDL and IDL shifts to benign large LDL due to fish oil intake, and despite my urging to go low carb, this unfortunately has happened, and I have a hard time condemning someone for listening to a medical doctor over a firefighter. Perhaps this will add more ammunition to my arguments.
Excellent point on screening new clients; as CF gains more and more momentum, we are seeing a different demographic of clientele, and proper screening for THEIR and OUR safety is just proper due diligence.
Would you train someone on statins? What would your approach be? My father-inlaw has been told by his doctor to start lifting weights. He had a mild heart attack a few months ago and is on a boatload of meds. I am hoping to get him going on some basic strength moves when he finally decides to do it, but I don’t want to kill him when he gets his first taste of intensity after a few weeks.
Thanks.
Tim-
We are currently training someone on statins. You need to figure out what is good for your situation but we have simply limited eccentric movement, kept these folks well away from failure, rotated movement planes frequently (not beating the dog piss out of the legs multiple days in a row).
With a paleo diet and fish oil most of our folks have improved lipid panels such that their docs grudgingly take them off the meds.
Hey Robb once awesome info u put out from that intelligent mind of yours,
i have been paleo since feb 09, i do .com wods i get extremley sore from most workouts generally sleep 7hrs take 3tsp fish oil, eat low low carb high fat, just curious if u know of anything that could cause this much innflamation?????
thank u
jeremy
That’s a lot of work. You could try modifying the workload (MEBB) and/or I’d try increasing your fish oil.
Holy blog posting Robb-ster. I can hardly keep up with your output these days (3 in one week is it?) and all the Q and A stuff in the comments. Just makes me that much MORE excited for the book…but then I am thinking you’re going to need to have a Robb hotline for all the questions you’re going to get. 800-EAT-MEAT?
Thanks for what you do to better our communities. You rock the casbah. I’m tempted to say you do more for humanity than Chuck Norris, but that might be a stretch….
Jules-
Humanity IS Chuck Norris. but thanks for the consideration!!
Robb you’re en fuego! Great series of posts. Keep it up. The Atlantic Ocean view is waiting for you & K-Star when you’re ready. Since reviewing your On-Ramp syllabus a while back, we’ve vastly revamped our intro class and rehoned our trainers on scaling the newbies. Nicole and I have grown up in CrossFit under the direct and indirect tutelage of Rutman and you, and our business and clients are benefiting for it. We are on an MEBB model and my Paleo Tin Foil hat proudly hangs under a sign reading “wear in case of grains or conventional wisdom.” Keep up the great work. Make sure you offer a bulk-sell option for your book. We’ll be stocking our box with it!
-Jeremy
Jeremy-
You are too kind amigo and I cannot wait to get out to your place. I’m not sure how a lecture at the beach will go…can I require the chicks to wear bikinis?
Got me rethinking how I run my free Sunday morning session. Thanks.
Freddy-
I’d just do some sniffing around on folks. We have worked with a surprising young and otherwise healthy chunk of folks who were on ore being recommended statins.
Robb,
As a 5 year cancer survivor that is endlessly disseminating science, hype and misleading correlative studies in search for the best ways to be responsible for my own health, I thank you from the bottom of my still-pumping heart. You’ve enlightened me on ketogenic diets and it’s effect on cancer and a host of topics relating to health and performance from a scientific perspective, which I totally geek. I get it. Too bad most others who are looking for a “cure”, don’t.
I don’t intend on ever ingesting a statin but this is good fuel for the continuing “conversation” I have with my parents.
Keep those big words a comin’! Can’t wait for book #2!
Sarah-
Thanks girl! I lost a girlfriend in High school to a brain tumor…I wrote about it on here, you might have read it. As one might imaging, it left a mark. it happens to have been an astrocyte brain tumor…responds very favorably to a ketogenic diet. i rarely go a week without thinking about some kind of time travel scenario…
Thanks for the kind words, and the support.
Wow, you’re giving them the option for clothing! How kind.
Check out how we intro our newbies to Paleo:
http://www.crossfit-hr.com/Site/3_Thing_to_Change.html
I even threw a fat RD reference in there for you. Didn’t fit Vegetard in though…i’ve gotta find a spot for it.
J
hi, im a 35yr old male whos been training hard, eat clean and did apparently a pretty good job. At 6`0 i weight 180.5 with bodyfat around 8-9 %. I squat 300 3X5, benchpress 280 3X5, DL 350 1×5. I train 5 times a week with 2 strengt session and 3 of running, roping, cycling. 2 months ago ive got my blood checked. Total cholesterol 2 times more than normal, LDL (the bad one) almost 1.5 more than normal. Ive got ok triglyceride level, ok blood pressure and ok blood glucose. I was on a low carb diet, eating clean but the doctor said that statins are my only hope so i started, jumping on 40 mg dose daily. While kept on training, i cut all the cheese from my diet, eating basically just chicken, tuna, mackerel, only white eggs and kept on getting around 230-250 gr proteins every day from a 2400 kcal diet. Im fasting 2 days a week for 18 hours.
After one month ive got a new blood check which showed a decreased cholesterol, decreased LDL-cholesterol. My question is: could have it been a very strict diet, just the statin treatment or a combination of these two that did the trick? I wonder if i can stop taking the pills, i really dont like doctors who keep telling me that this is a livelong treatment. Any thoughts? I would appreciate it. Regards
Luca-
this is a common situation. “eating clean” is a really subjective thing! Often times we see some items that might drive LDL’s up, but that is not the whole story as we want to see what the particle sizes are, triglycerides etc.
I think it’s areasonable thing to approach your doc and ask for help managing this via nutrition/lifestyle. Up your fish oil to .5g/10lbs bw/day. Ask the doc to help you titrate downa nd then re-assess. Make sure he checks your LDL particle size on the next go through.
Cancer metabolism is so interesting because it relies primarily on glycolytic pathway.
Honestly, I am disappoited in the scientific community to connect the dots on this topic especially since there’s HUGE evidence in the lab like you mentioned. In addition, to
(1) cancer using primarily glucose in the lab (aka Warburg effect), we have
(2) p53 tumor suppressor regulating metabolic activity between glycolytic and oxidative pathways + damage + arresting cell growth….. p53 gets shut off (50% of all cancers!!)
Plus, the fact that p53 transcription is induced by oxidative stress… aka exercise which bodes well for those who do.
(3) mitochondrial pathway induced apoptosis to kill off defected cells… in cancer cells, mitochondria are turned off.. hence one turned off apoptosis pathway
The evidence is there indicating that preferential glucose metabolism of cancer cells and the importance of maintaining proper oxidative/mitochondrial metabolism, yet no one “credible” in the science world can make a connection or get it out to the news media or whatever. Dumb.
Hi Robb,
I’m having GI side effects from fish oil at 10g/day (loose stools, gas). I was ok at 5g/day. Any advice?
Kevin-
You could try an ultra-purified form like Nordic Naturals or dial back to a level with no GI issues.
I am going to add this to my waiver. I now have an on-ramp class and it is awesome for so many reasons. Thanks to both you and Nicki for publishing that article. Daughter is moving to Roseville but NorCal margs are on me next time.
Great article, Rob. Why not recommend to others that those with higher cholesterol levels have their insulin blood concentration checked and/or decrease their sugar intake? We both know that cholesterol has little to do with CVD but the general public and much of the medical field needs more education on the matter.
I know I’m a little late on the comments here, but I just discovered this forum thanks to my sister…
Anyway, I can attest to the fact that if you are training people, you DEFINITELY need to ask VERY specific questions. Don’t assume clients are going to voluntarily surrender all pertinent info. Sometimes it’s a case of them simply not knowing that the info is important to you as a trainer. This is why it is OUR job to pay attention to details and ask the right questions. I learned this the hard way, and I was very lucky the outcome was not worse.
I had a client, a 63 yo male, history of CV disease, quadruple bypass at 57,…on statins. He disclosed the fact that he was on statins when he began training with me, and I was aware of the risk of rhabdo. I asked if he was exercising already, and he said yes, he was biking and swimming…great, right? Well, I didn’t ask how much because I wrongly assumed that being older and a CV pt, he wasn’t going on epic rides. Turns out, he was biking 50-70miles at a time, and swimming for an hour at the pool. EVERYDAY.
The scary part is that we were doing mostly postural correction stuff,t wice a week for a half hour at a time, with very minimal load, and he ended up collapsing in the gym. Now, was it my workout that pushed him over the edge? Maybe. Maybe not. But either way, if he had died, I would’ve had to live with that forever. And potentially had a very costly lawsuit on my hands. A very scary lesson for me to learn. ASK QUESTIONS. LOTS OF QUESTIONS. If people don’t want to train with you because you are being too thorough, you probably aren’t going to get very far with them anyway!
Anneke-
Thank you for this, I’m forwarding this to my trainers.
Cool…mistakes are for learning from, so I’m glad that others will learn from my phenomenal f-up on this one. It was quite a while ago, but is still fresh in my mind with every new client I take on.
Thanks for the info on the other meds causing rhabdo. I had no idea…Definitely great stuff to know, esp for my Marine clients, who live on ibuprofen for everything from headaches to internal bleeding! lol
A very good article, by chance I was looking for this article. I also asked for permission, this article will I published in my blog and include links from this article ..
thanks dude..
Rhabdo | Rhabdomyolysis
Interesting site! Yea, that’s fine and thanks for asking.
Hey Robb, great site!
I know this comment comes pretty late on this post so if I don’t receive a response I’ll just try again on a more recent and relevant post of yours. Ive been doing crossfit for the past few years and started low carb-paleo a few months ago. In light of the most recent information I’ve been gathering about statins (from reading your blog as well as others) I’m a bit torn. I have FH and have been on statins for the past 5 years now (I’m currently only 23). I’d love to get off them, but I’m unsure if the same advice given to others holds true for me and my condition as well. I’ve searched on other blogs for any information relating to FH, but it doesn’t seem the author’s were well versed enough to provide a response. Any advice? I appreciate it.
Stephen-
what is fh? I’m blanking here.
Sorry about that…familial hypercholesteremia