The People's Perspective on Medicine

Statins and Nerve Damage (Peripheral Neuropathy): An Overlooked Side Effect!

Is cholesterol necesary for proper nerve function? Most prescribers are unaware of this idea, but statins and nerve damage in type 2 diabetes are related.

By now, almost everyone agrees that statins like atorvastatin, lovastatin, rosuvastatin and simvastatin can cause muscle pain (myalgia). Most clinicians also acknowledge that statins are also linked to type 2 diabetes. There is far less agreement about statins and nerve damage (aka peripheral neuropathy or polyneuropathy). A study published in JAMA Network Open (May 31, 2019) suggests that lowering cholesterol levels (with or without statins) in patients with type 2 diabetes is associated with nerve damage.

Statins As Lightning Rods:

Statin Enthusiasts:

There are few drugs as controversial as statins to lower cholesterol. On one side are the enthusiasts. These health professionals believe that these drugs are among the most effective and the least dangerous drugs in the pharmacy.

A study published in the European Journal of Preventive Cardiology (March 12, 2014) concluded: 

“Only a small minority of symptoms reported on statins are genuinely due to the statins: Almost all would occur just as frequently on placebo.”

They mention nothing about statins and nerve damage. Even muscle damage (myopathy) is discounted:

“No other symptom was significantly affected [by statins]. Importantly, the many side effects commonly attributed too statins (e.g. myopathy, fatigue, muscle aches, rhabdomyolysis, or rise in creatine kinase > 10 upper limit of normal) were no more common in the statin arm than the placebo arm.”

These conclusions were based on randomized clinical trials. Many were conducted by drug companies seeking FDA approval of their products. Even when statin enthusiasts acknowledge that statins can cause side effects such as muscle-related symptoms, they often conclude that such adverse reactions “generally resolve rapidly when treatment is stopped…” (Lancet, Nov. 19, 2016).

Statin Skeptics:

On the other side are doubters. They believe the benefits are modest for otherwise healthy people and the risks are not trivial.

Lipid specialist, David Dubroff, MD, concluded (Preventive Medicine, April, 2016): 

“The Cholesterol Treatment Trialists meta-analysis of 27 statin trials in people at low risk of vascular disease concluded that there is a clear benefit, but a subsequent meta-analysis of the same 27 studies concluded there was no significant mortality benefit. Similarly, a meta analysis of 11 statin trials involving 65,229 participants in high-risk primary prevention found no mortality benefit.”

Death is the ultimate outcome. We suspect that most statin takers believe their medicines will substantially prolong their lives. Few health professionals actually know the statistics and share them with patients.

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What About Statin Side Effects?

As with many controversies, there is no simple resolution to this debate. Clinical trials designed to convince the FDA a drug is effective do not always uncover all potential adverse reactions.

Pharmaceutical companies don’t always discover serious complications until after a medicine has been on the market for many years. Such was the case with statins and diabetes. Although readers of this column began reporting elevations in blood sugar by 2003, it wasn’t until 2008 that physicians became aware of this possibility.

JUPITER and Diabetes:

A large study called JUPITER tested rosuvastatin (Crestor) to see whether its anti-inflammatory action could prevent heart attacks. It did, but an unexpected side effect was revealed (New England Journal of Medicine, Nov. 20, 2008).  The authors noted, “physician-reported diabetes was more frequent in the rosuvastatin group.”

It wasn’t until February of 2012 that the FDA included information on increased blood sugar and HbA1c levels on statin labels. Initially, many doctors were skeptical. Others agreed with the FDA that even if these drugs raised blood glucose, the benefits of statins outweighed the risks.

Statins and Nerve Damage:

Now a different statin complication has come to light. It isn’t exactly new, however. In April, 2003, we received a letter from a woman who said that her husband had been taking atorvastatin to lower his cholesterol.

It did, she continued:

“but he has developed pain and tingling in his legs. His doctor said it had nothing to do with Lipitor but switched him to Zocor to see if it made a difference. The problems remain.”

She wondered if the statin drugs could be responsible.

There was almost nothing in the official prescribing information. However, a year earlier, Danish doctors had published a case-control study showing that polyneuropathy (nerve pain, tingling and so forth in more than one part of the body) was four to 14 times more likely among patients taking statins (Neurology, May 14, 2002). 

In 2005, Australian researchers reported that (Australian Adverse Drug Reactions Bulletin, April 2005):

“Statin-associated peripheral neuropathy may persist for months or years after withdrawal of the statin”  

This research almost disappeared without a trace. The FDA did not require statin manufacturers to mention anything about statins and nerve damage that persisted “months or years after withdrawal of the statin.”

What Causes Statins and Nerve Damage?

Why might statins affect nerves adversely? It turns out that nerve cells need cholesterol. A recent study from Heidelberg, Germany, demonstrated a link between low LDL cholesterol and neuropathy in people with type 2 diabetes (JAMA Network Open, May 31, 2019).  The authors suggest that nerves can’t repair themselves when cholesterol is too low.

This suggests that neuropathy may not be limited to statins and nerve pain. Other treatments that lower total cholesterol or LDL cholesterol could be affecting nerve function. This may not be limited to people with type 2 diabetes.

Here is an important finding of these researchers:

“Our study contradicts the results of previous studies that indicated that lowering serum cholesterol levels potentially slows the progression of DPN [diabetic polyneuropathy] by lowering total serum cholesterol and LDL-C levels. Instead, our findings are in line with results of previous studies that found that the intake of statins and a decrease of serum cholesterol level are associated with neuropathic symptoms, microvascular damage, and an accelerated deterioration of peripheral nerve fibers.”

The authors suggest that lowering serum cholesterol “impairs peripheral nerve regeneration.”

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Stories from Readers:

Scientific language can be daunting. Perhaps it would help to read some stories from readers to better understand statins and nerve damage.

Ron reports this link between statins and nerve damage:

“The medical community appears to be blind to the side effects from drugs like Lipitor (atorvastatin). The side effects of peripheral neuropathy came on slowly for me after a few years. I had to do my own research to find out the evidence of linkage. Then I had to go directly against the advice of my cardiologist and even a 2nd opinion.

“If I had listened to them, I would probably be heading to a nursing home. After 6 months off the statin, things have stopped deteriorating and the nerve damage appears to be slowly getting better. I know there are always accusations of crazy conspiracy theories, but at least for my circumstances the link appears completely legitimate.”

No one should ever stop a statin (or any other drug for that matter) without discussing the pros and cons with the prescribing physician. There are instances where the benefits far outweigh the risks!

Miles in Ohio also describes statins and nerve damage:

“I was on 40mg of Crestor for 12 years. My lipid levels were very well controlled. Over the last two years four specialists have diagnosed the limping and numbness on my left side as neuropathy. They had no idea what the cause might be.

“After some search on various forums I found other people with similar symptoms that stopped their statins and were relieved of problem. They were told by their doctors that the statins were not the problem.

“Have you heard the joke from med school where the final speaker tells the graduating students that ‘half of what we’ve taught you here in the future will turn out not be true, but the problem is we have no idea which half.'”

Vivian reports:

“My experience mirrors Miles in Ohio. Neurologist diagnosed nerve damage but couldn’t determine the cause. My primary care physician believes 40 mg of simvastatin is not the cause.”

You can read more case reports at these links:

Statins, Low LDL Cholesterol and Nerve Damage in People with Diabetes

and 

Do Statins Cause Nerve Pain (Neuropathy)?

Statins and Nerve Damage: What Does the Future Hold?

The FDA may need to bring the new research to physicians’ attention. In the meantime, patients and doctors will need to determine whether the balance of benefit to risk is favorable. For some, the answer is definitely yes. For others, especially those with no history of heart disease, the answer may be less obvious.

Share your own story about statins in the comment section. If you have had no side effects please tell us. If you have experienced statins and nerve damage, please share that information as well.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • Jende, J.M.E., et al, "Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes," JAMA Network Open (May 31, 2019), doi:10.1001/jamanetworkopen.2019.4798
  • Golomb, B. A. and Evans, M.A., "Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism," American Journal of Cardiovascular Drugs (vol. 8(6), 2010), DOI: 10.2165/0129784-200808060-00004
  • Finegold, J.A., et al. "What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice," European Journal of Preventive Cardiology, March 12, 2014, https://doi.org/10.1177/2047487314525531
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I have been on and off of different Statins for many years. Over all those years I developed Type 2 Diabetes and Neuropathy in my legs and feet. I have suffered plenty but the ignorant Doctors who put me on Statins don’t have to suffer one bit for prescribing these terrible drugs. We pay the price and it just isn’t fair. I went off my last Statin med against Doctors advise. I’m into Holistic Medicine now.

All of the cholesterol lowering drugs caused sever body pain. My left foot was numb on top, both arms/shoulders hurt so much the pain woke me during the night. Doctor said there was nothing wrong with my arms; numb foot was nerve damage due to an injury… cholesterol was lower… When my friend died, I did not recognize her name or face in her obituary…

I quit taking the statins! ALL of my pain went away, brain function returned. An Urgent Care doctor recently told me that unlike a car, the body will heal itself. Healthy choices makes such a difference..

I was diagnosed with type II diabetes about 7-8 years ago. There is no history of diabetes in my family, but I am slightly overweight and did maintain a horrible diet for myself. I don’t know what came first – the cart or the horse – but I was prescribed simvastatin around the same time, either to prevent the transition from pre-diabetes or to help control the newly diagnosed diabetes, I don’t recall.

Since that time, I have suffered from joint and muscle pain. After a 2 week trial taking me off the statin and replacing it with fenofibrate, the doctors have attributed my pain to arthritis. My x-rays do show the minimal beginnings arthritis.

However, recently my new primary doctor felt my cholesterol was a little high and I should go back on a statin. I did this for less than a week and the pain in my joints and muscles increased so dramatically that I could not sleep at night.

I quit the statin and the pain decreased slowly, but it has never gone away. I expect it never will.

Is there any information about fibrates and pain?

I’ve been on Atorvastatin for several years. In the past year I occasionally have had a quick stabbing pain in my foot. It lasts just a second or two but is enough to make me jump. I don’t know whether this is related to the statin but this article got me thinking about it. At 78 it is often difficult to know whether minor aches and pains are significant or just part of getting old.

I started on statins about 10 years ago without thinking about side effects. In the last 3 years I’ve stopped them off and on after hearing about side effects of muscle pain and brain fog. I lost weight, increased my exercise and watched my diet. I tried natural holistic options. My cholesterol always went back up and my internist recommended that I continue to take them and agreed to half the dose.

I have tingling and numbness in my hands every night. I will share these studies with her and my husband who is also taking a statin and recently developed type 2 diabetes.

I knew a neighbor woman who began taking statins and within a year she was unable to walk and became bed ridden with nothing wrong with her physically that her doctors could find. She soon checked herself into a nursing home because she could no longer care for herself. I don’t know what happened to her after that.

I have been taking Simvastin for a number of years. I presently have decreased feeling in both my feet and find that this is traveling up my legs and stops at myknee caps. I can feel touch but no pain. I do not have any pain in my lower extremeties. My doctor has placed me on CoQ10 to help with this effect.

I have taken atorvastatin for approximately 20 years with no side effects whatsoever. I am 76 years old.

I have been taking statins for 15 years, first Lipitor, then simvastatin, and now prevastatin. About 5 years ago I noticed a numbness in my left toes but my doctor checked my circulation and didn’t find any problems. I’ve noticed lately that the toes seem to be getting worse and I plan to discuss this with my doctor on the next visit. I really would like to discontinue my statin drugs but am afraid to do so.

I have been on 40 mg of Simvastatin for 19 years. No neuropathy or noted nerve damage yet.

I’ve had one prescription filled by a reputable Canadian pharmacy, which I found in The People’s Pharmacy book Saving Money on Medicines. Now, having used up the prescription refills, I must request a new paper prescription from my doctor. I was able to get the original paper prescription from him by stating that I wanted to have it with me when I travel. However, I’m uncertain about using the same excuse again.

Any comments about what I might say to my doctor when requesting a new paper prescription will be much appreciated. My understanding is that if I tell him outright he’ll refuse to issue it, because technically it’s illegal to order drugs from Canada.

Thanks. Ed Q.

I have tried all statins and all have given me leg Cramps. My doctor Prescribed Livalo 4mg and said there is no side effects. It has lowered my cholesterol to under 200, however after 6 months I am now experiencing nerve pain on both feet. It hurts to walk in the mornings however goes away as the day passes. Not sure what level of cholesterol is needed to repair nerve issues. Prior to this med, cholesterol was 274! I have heart disease in my family.

About 25 years or so my wife started taking statins. She fell three times breaking four bones over the next 10 years or so. She also gradually lost her ability to move her feet. A neurologist thought it might be a case of hereditary spastic paraplegia and asked me if anyone else in her family had problems. I said her mother hesitated before she started to walk so HSP was the diagnosis. I did not say she seemed to walk OK afterwards but the neurologist had his diagnosis so could feel successful.

At this time my wife could walk around the house which I had modified with rails. The neurologist prescribed Baclofin for spasms which she was having. After that something (the neurologist thought the Baclofin) my wife had several episodes of what seemed to be petit mal seizures. The neurologist added some anti-seizure medicine to the mix. Three days later my wife could not walk, and never really has since and ended up in a nursing home. After two months I took her out and became a full-time caretaker since the nursing home OT/PT people could not help her in spite of trying hard. She was a zombie on the medications.

Since my wife is from a family of ten with lots of nieces and nephews and nobody has HSP I always wondered about the diagnosis. My bet is our situation came from the statins made worse with the anti-seizure medication added to the mix. Another option was she really has HSP and the statins made the gait disorder worse.

We were able to get off the anti-seizure medication after about a year but in spite of the fact the neurologist’s office said she could not stop. We got help from another doctor who said he could not tell her to stop the anti-seizure medication but here was how to do it. He had her on and off of Baclofin so helped us stop that also. We started taking magnesium and she now has few spasms but who knows for sure if that helped. She has had a few of the seizure-like episodes but the cause could not be the Baclofin like the neurologist thought. She never had any before taking statins.

Her walking only came back a little and only for short periods of time so we need a ‘sit to stand’ lift to keep her living at home. We also stopped her blood pressure medication and also her cholesterol medication without help but fortunately did not have any problems. Her blood pressure was normal without the medication when she last saw a doctor. I should add my wife had a UTI and was in the hospital getting IVs with antibiotics for two days and modern medicine was wonderful. It’s the statins I wonder about. I should add a ‘thank you’ to People’s Pharmacy for telling me about Duane Graveline’s book ‘The Statin Damage Crisis’.

Many years ago, I took Crestor and, later, Lipitor and developed Neuropathy… burning, pain, cramps, you name it, in my feet. After I stopped taking them, the Neuropathy did not progress to other areas, but the burning, pain and cramps continue. I wake up several times a night with severe pain in my feet and have to walk around a while. I do not have diabetes.

I have controlled the Cholesterol with diet, which I should have done instead of taking those drugs. Doctors are way too quick to try to fix stuff with a pill.

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