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…”