When a patient is on a statin, nutritionists should advise that they don’t have to suffer from the side effects of statin-associated muscle pain (myalgia). Studies are showing that supplementation with two key compounds are useful for decreasing the pain. The first is ubiquinone (coenzyme Q10, coQ10) and the other is cholecalciferol (vitamin D3).
Statins such as Lipitor, Zocor and Mevacor reduce cholesterol synthesis by directly inhibiting the enzyme HMG-CoA reductase and deplete production of its product, mevalonate (1). Mevalonite, however, is also the precursor to coQ10 and squalene. Both of these are vital nutrients with profound effects on the body.
CoQ10 is a lipid-soluble antioxidant playing a protective effect in the membranes of every cell in the body. In that capacity, it serves to protect against oxidative damage to cells. Equally important, the compound is necessary for electron transfer in the mitochondrial electron transport chain for producing energy (2). Without it, our muscles could not function in their full capacity.
Supplementation with coQ10 combined with statin treatment helps reduce muscle pain (not to mention improve energy levels). According to a double-blind study in 2007 at Stony Brook University, which compared coQ10 supplementation (100mg/d) with vitamin E (400 IU/d), showed that patients taking the coQ10 had 40 percent decrease in the severity of their pain (3).
Squalene is important because it is the precursor for 25 hydroxyvitamin D (25(OH)D) as well as other steroid hormones. For this reason that, it is suggested that statin drugs can lead to 25(OH)D insufficiency or deficiency. Vitamin D is not only critical for speeding up calcium absorption for bone health, but emerging studies are finding that it’s also vital for the health of muscles (4).
Low vitamin D levels are also associated with statin-induced muscle pain. When researchers from the Cholesterol Center at the Jewish Hospital in Cincinnatti in Ohio treated myalgia in 38 statin-treated patients with vitamin D (50,000 IU/week for 12 weeks), 35 of the patients experienced 92 percent reduction in pain symptoms (5).
Reducing muscle pain with supplementation
If you must take a statin, then supplementation can be to your advantage. As in the studies, supplementation with coQ10 at 100 mg in an absorbable form can potentially help to keep pain under control by replenishing coQ10 that is lost. In addition, keeping 25(OH)D to levels in the plasma to “sufficient” amounts (32 ng/mL) through supplementation with vitamin D and sensible sun exposure can go far to reduce pain.
1. Scharnagl H, Marz W. New lipid-lowering agents acting on LDL receptors. Curr Top Med Chem 2005;5:233-42.
2. Jeya M, Moon HJ, Lee JL, Kim IW, Lee JK. Current state of coenzyme Q(10) production and its applications. Appl Microbiol Biotechnol 2010;85:1653-63.
3. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.
4. Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010.
5. Ahmed W, Khan N, Glueck CJ et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6.