The People's Perspective on Medicine

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

Could there be a relationship between statins and low LDL cholesterol and nerve damage? A new study from Germany has produced evidence that there is a link.

A new study from Germany reports that there is a connection between low total cholesterol and low LDL cholesterol and nerve damage in patients with type 2 diabetes (JAMA Network Open, May 31, 2019). This will come as a great shock to many cardiologists who believe that there is no such thing as too low a cholesterol level. The researchers from Heidelberg University Hospital recruited 100 patients with type 2 diabetes. They underwent magnetic resonance neurography (MRN). The radiologists who reviewed the scans were “blinded to all patient data.” They found a statistically significant relationship between low LDL cholesterol and nerve damage.

Why Would Cholesterol Impact Nerve Function?

The authors of this study point out that:

“…low serum cholesterol levels are associated with neuropathic symptoms [nerve pain] and impair nerve regeneration after axonal damage in neurons of the central and peripheral nervous systems. This association was mainly attributed to an insufficient supply of cholesterol to neurite tips and adjacent Schwann cells of regenerating axons as a consequence of a decrease in lipoproteins.”

That’s pretty deep into the weeds. In essence these physicians are suggesting that cholesterol is essential for nerve cells. When total cholesterol and LDL cholesterol go too low, there can be damage to axons and people can experience symptoms of peripheral neuropathy.

The investigators go on to say:

“To our knowledge, this study was the first to visualize in vivo [in the body] that low levels of serum cholesterol, specifically LDL-C, were accompanied by peripheral nerve damage in T2D DPN [type 2 diabetes diabetic polyneuropathy]…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. A potential explanation of the associations found in our cohort might be that lowering serum cholesterol levels impairs peripheral nerve regeneration because cholesterol cannot be produced in axons…”

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People with Diabetes Are Like Canaries in Coal Mines:

You no doubt know that that diabetes predisposes patients to a range of cardiovascular complications including heart attacks and strokes. Type 2 diabetes also increases the risk for nerve damage. That is why patients are encouraged to manage their blood sugar levels carefully and take statin-type drugs to reduce the risk of vascular damage.

If people with diabetes are more susceptible to nerve damage after aggressive cholesterol-lowering therapies, what is happening to the rest of us? The statin clinical trials did not detect peripheral neuropathy.

Most clinicians would be astonished to learn that there might be a connection between statin-induced low LDL cholesterol and nerve damage. If one searches the official prescribing information, though, you can find reference to peripheral neuropathy with some statins.

You can read more at this link:

Do Statins Cause Nerve Pain (Neuropathy)?

Reports from Readers about low LDL cholesterol and nerve damage:

C.B. Bell offered this thoughtful comment:

“I have read in numerous articles that statins weaken the myelin sheath (which is at least partially made up of cholesterol) and/or strip nerves/axonal neurons of it. If that is true, then statins most definitely could cause peripheral neuropathy.

“Complaining to providers of any such symptoms is typically met with the line ‘statins don’t do that.’ It’s no secret that lots of money is made from prescribing statins, both by physicians and drug companies. Until patients are actually treated with respect and listened to, statin side effects will be continued to be called ‘rare.’ Those of us damaged by them (especially when prescribed the 80mg megadoses of atorvastatin) know better.”

Joe shared this experience:

“I took statins for around 14 years. Over that time I developed leg muscle problems and neuropathy in the bottom of my feet. I stopped taking my statin due to leg muscle problems against the advice of my doctors.

“Muscle problems have improved and so has the neuropathy, a result not anticipated. About two months after stopping statins I occasionally felt like I was walking on a spongy rubber pad when I was walking on concrete. Some feeling was coming back in the bottoms of my feet. The spongy feeling began to occur more frequently, presumably from feeling feet tissue compress as I walked.

“I am less aware of that sensation now (1.5 years later) as I continue to improve. My balance has improved too since I have another sensor (my feet) providing input.”

Now that the German researchers have confirmed that there is a linkage between low total cholesterol and low LDL cholesterol and nerve damage, perhaps some health professionals will pay attention.

Please let us know how you have fared on statins in the comment section.

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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
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I have been through much of what is discussed here: extreme muscle pain, night leg and ankle pain so severe it disrupts my sleep, yet my PCP and cardiologist insist I need cholesterol-lowering drugs. There is the constant battle with fatigue and general weakening. I suffer from osteoarthritis and face tkr. How much pain and discomfort am I expected to tolerate taking cholesterol-lowering meds just to reach the goal of lower numbers?

I am refusing to take these debilitating statins. I was placed on Zetia, a non-statin. The gastrointestinal problems that ensued, plus increased leg pain and muscle cramping were enough for me. I’m done with Western medicine.

I went off of statins after being on them for about 10 years. I have been dealing with numbness in my left for several years and have been off of statins for 2 years.
Extensive MRIs and CT scans have revealed nerve damage…probably due to lamenectomy and fusion performed in 1988 and chemotherapy ending in July 2016. Doctors tell me there is no cure…I do water aerobics 3 times a week, see a chiropractor and acupuncturist on a regular basis to keep what mobility I have from getting worse.
Any other suggestions?

I took Crestor for 3 years. All was well until I added pomegranate juice daily with my meds. Cramps, muscle pain, it was awful until I discovered promegranate acts like grapefruit with a statin. I stopped Crestor and slowly my aches reduced. Genie

My total serum cholesterol was 210 when I was prescribed 10 mg simvastatin. After a year, it had dropped to 201. I stopped the statin after 20 months due to muscle and joint pain. I had a little numbness in the sole of my right foot and was diagnosed with polyneuropathy. The neurologist I saw blamed this on my slightly elevated blood sugar, but I didn’t have diabetes. Two years later, my TSC dropped again to 190. As more years went by, my peripheral neuropathy spread to both feet and up my legs to my knees, despite losing over 60 lbs and normalizing my blood sugar. Last year, my TSC was 170, and my PN is still just as bothersome. I would say those German researchers are correct, but the “low-cholesterol and PN” condition is simply more predictable in patients with diabetes. I believe it was the statin the caused my PN and that persistent low cholesterol has prevented the repair of my nerves. Now, I eat plenty of saturated fat and am desperately trying to INCREASE my TSC. For the record, I only took the statin for those initial 20 months and will never take one again.

I have naturally low cholesterol (about 110) and have a lot of neuropathy. I wish there were a pill to RAISE cholesterol.

After many years of reading of the difficult, often debilitating, side effects of taking statins, but without these side effects myself, I have now joined the ranks of the statin-users with significant side effects. 15 years of statins, 11 years of 20 mg. Crestor.

In Feb. I was diagnosed as Pre Diabetic (A1c = 5.9) and altered my diet. Next A1c in June had identical results (5.9). This month my left shoulder/arm/wrist began to give me the same pain and inability to use for ADL as my right arm had in August 2018. X-ray, orthopedist, PT, and at home exercises have helped on the right, but left me clueless. A little arthritis and poor posture did not seem consistent with the problem. No one, myself included, suggested statin use as the possible cause. When the left arm began to act exactly the same way as the right had, the overuse of the statin seemed likely. I have decreased my statin and increased my CoQ10. Time will tell if there is a change in my A1c, muscle pain, and lipid panel. The question is, why have I had to figure this out on my own? Where was the appropriate medical assistance?

This has been well known for years you can find all this info on YouTube from people who practice FUNCTIONAL MEDICINE.

My wife had been on Simvistatin for several years. In 2012, she suffered a severe problem that exactly mimicked Alzheimer’s. In fact, she was diagnosed with it, and we were told to arrange for full time care. Never having heard of this condition developing in a matter of a few days, I started researching statins.

I found that, in a very small percentage of cases, statins – and Simvistatin in particular – can cause major cognitive and other disabling symptoms. I discussed this with our internist, who was unaware of it. He took my wife off of Simvistatin, and she was basically back to normal in a couple of weeks. Unfortunately, her short-term memory is permanently damaged, but there are no other apparent residual problems.

Thank you for your continued effort to present the issues about statins in a fair way. I am sure that statins have been very helpful to many people. At the same time statins have also hurt some people. It’s good to know both the advantages and side effects of medicines in order to make a smart decision.

I took Atorvastatin calcium 40 mg for 18 months and recognize your spongy feet as an apt description for my own. I however was not as concerned about them as my mental functioning, which declined significantly. I stopped taking all prescribed meds over time. Four days after stopping the statin, the last to go, I regained significant mental power, though short term memory seems affected. I felt comparatively brilliant.
Four years later, a 2nd heart incident had my cardiologist insisting I take statins. I did. Six weeks later, loss of mental functioning was evident. I forgot my son’s name and couldn’t find the silverware drawer. I stopped the statins. It took longer this time to regain mental clarity.

I have had violent extremely painful reactions to six different statins and non statin cholesterol lowering medicines. Despite what blood tests show, a scan of blood vessels shows that they are clear. I have Wolf Parkinson White Syndrome and two cardiologists have agreed the risk of damage is greater than any advantage, but I still have to resist primary care doctors who are sure I won’t be allergic to this new medicine. They can’t grasp that what I am reacting to is lowering my cholesterol. I have a new primary care doctor and she ordered a new prescription anyway. I just declined it when I picked up my other meds.

How low is “low?”

I’ve had mild IPN (Idiopathic Peripheral Neuropathy) for 20 years. It was only a nuisance until I was put on statins. The first time, I noticed muscle weakness in the first two weeks, and stopped the statin meds. The second time, I was distracted by problems associated with recovering from heart surgery, and only noticed significant muscle weakness after 5 months, and discontinued the statin again, but it was too late. Now, about a year after stopping the statin, I am severely disabled, with no promise of recovery.

I too was having problems with statins, was having leg cramping, no feel also felt that my feet were not there, was starting to lose balance, walking as if drunk. But then my new doctor told me to take B12 and it was a blessing

And yet, the minute someone is diagnosed as pre-diabetic or with type 2 diabetes one of the first recommendations??? We have to get you on a statin! Given the brain’s demand for cholesterol, it would seem self-evident that the entire neural network would be affected. Our current system of reducing the human body to individual organs and problems, with “specialists” in so many areas has resulted in disregard for the body as a complex system with all parts affecting all other parts.

Couple this with the amazing arrogance and hubris of so many in the field and the irresistible siren call of big money, and you have a culture of drugs, more drugs, and more drugs. I think we need a complete overhaul of the entire medical machine focused on creating health, which drugs often do NOT do. A bit more willingness to consider the effects of what you are doing and listening to the patient is in order as well. It is after all PRACTICING medicine which indicates to me the possibility of getting better.

This is good information from which patients’ direct experience with statins is stated and presumed to be accurate. I applaud the peoples pharmacy on this! My cholesterol was checked by my dr. and she wanted to put me on a statin because it was 205! I said let’s try diet and exercise. I also took a large tablespoon of psycillium at bedtime and in 2 months it was 139! Thank you very much. The other lipids were all within normal limits.

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