Rhabdomyolisis can cause muscle cramps, particularly in the legs.

by Sapna S. Patel, PharmD (2017)

For many who have been diagnosed with hypercholesterolemia, commonly known as high cholesterol, changes in diet and exercise may not be enough. If your doctor has prescribed a statin medication to lower your cholesterol, you may have heard or read about the potential side effects of statin drugs and their impact on liver function.

Doctors will often prescribe statins to lower the total cholesterol and reduce the risk of a heart attack or stroke in people with high cholesterol levels. While statins are highly effective, they have been linked to muscle pain in some people, and in rare cases, even cause liver damage.

So what is rhabdomyolysis?Coca-Cola colored urine caused by rhabdomyolysis

Rhabdomyolysis is a severe, debilitating muscle pain (interferes with your ability to perform normal daily tasks) due to muscle damage and breakdown. This causes your damaged muscle to release their proteins into your bloodstream, become eliminated through your kidneys (ultimately leading to your kidney(s) shutting down), and appearing in your urine (which explains why the urine color of a patient experiencing rhabdomyolysis is referred to as “Coca-Cola” or “reddish-brown” color).

Some common statin medications are:

Statin medications can be very beneficial to your health. Statins can decrease the amount of “bad” cholesterol, which can clog your arteries, preventing oxygen-rich blood from reaching essential organs. Decreasing your “bad” cholesterol can lower your risk of having a heart attack or stroke. Ultimately, this leads to living a longer and healthier life.

The majority of Patients benefit from using statin medications if indicated by their physician. Less than 3% of patients on statins report muscle pain while less than 0.5% report rhabdomyolysis. So, don’t stop using your statin medication until your physician confirms this side effect.

Common Symptoms of Rhabdomyolysis are:

In the larger muscle groups, like your thighs, shoulders, lower back, and calves:

  • Muscle tenderness
  • Severe muscle pain
  • Muscle weakness/fatigue
  • Muscle Stiffness
  • Muscle Cramping

Other signs of rhabdomyolysis are:

  • “Coca-Cola” or “reddish-brown” urine
  • Skin changes (discoloration or blisters)

How do I know if a statin medication is causing my symptoms?

Ask your Physician for bloodwork to check for abnormal Creatinine Kinase (CK, CPK) levels, liver function, and kidney function tests. These labs are not routinely checked during bloodwork.

Symptoms of rhabdomyolysis usually occur 4-6 weeks after first starting on a statin medication. However, they can occur years after being on a statin medication, so it’s important to always be aware of the symptoms of rhabdomyolysis.

If your only symptom is muscle pain, think about other reasons why your muscles may be painful, sore, stiff, or crampy. Could it be due to unusual physical activity such as hiking up a new trail, shoveling the driveway after a massive snowstorm, or trying a vigorous exercise routine, like spin cycling or high intensity interval training?

What if I do have rhabdomyolysis?

If you do end up with a diagnosis of rhabdomyolysis, your physician will likely stop your statin medication. There are statins that have a lower risk for rhabdomyolisis, such as pravastatin (Pravachol) and fluvastatin (Lescol).

As a final note, if you’re taking a statin, you should also avoid eating grapefruit or drinking grapefruit juice. Grapefruit contains compounds called furanocoumarins that stop your body’s natural enzymes from doing their job. As a result, more of the statin drug is absorbed, making it more powerful than it would normally be.


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low carb high fat diet metabolic syndrome - wellrx image

by James Ketterer, PharmD Candidate
University of Arizona College of Pharmacy

A Low Carbohydrate High Fat diet (defined as either less than 26% of total energy intake coming from carbohydrates or less than 130 grams of carbohydrates per day) may not be the best dietary choice for everyone. Defined as either less than 26% of total energy intake coming from carbohydrates or less than 130 grams of carbohydrates per day. It has, however, been shown to be as safe and effective, if not more so, than High Carbohydrate Low Fat diets, for people with high cholesterol, diabetes, and non-alcoholic fatty liver disease. In fact, clinical studies have shown that Low Carbohydrate High Fat (LCHF) diets effectively lower blood sugar, triglycerides, insulin, and saturated fat. They also can help reduce blood pressure and weight and even increase levels of good cholesterol which could eliminate the need for damaging cholesterol medicines.

Reducing Hunger, Lowering Daily Calories

LCHF diets inherently increase the relative amount of protein and fat consumed per day. These diets are primarily made up of leafy green vegetables, nuts, fish, eggs, seeds, unprocessed meats, dairy, and plant oils. While it may seem counter-intuitive that consuming more fatty foods would cause weight loss, this is not the case. LCHF diets have been known to decrease hunger resulting in an overall decrease in daily caloric intake. It has also been proposed that LCHF diets provide a specific metabolic advantage by encouraging ketosis and ketone burning. This doesn’t go without scrutiny as LCHF is often referenced as a fad diet. As with all lifestyle and diet changes, we strongly encourage any such changes to be done under the supervision of a physician..

A 24-week clinical study looked at 363 overweight and obese patients who chose to start either a LCHF diet or a ‘low calorie, high nutritional value’ diet. In the 102 patients with Type 2 Diabetes, weight loss was significantly greater (−12.0% vs −7.0%) and their A1C and fasting blood glucose levels decreased significantly more with the LCHF diet. More patients on the LCHF diet were able to decrease or discontinue their diabetic medication as well.

A Decrease in Cardiovascular Risks

The increase in dietary fat consumption in LCHF diets has led to many misconceptions. One of the biggest concerns is risk for developing cardiovascular disease. However, several studies have shown that LCHF diets actually decrease cardiovascular risk more than HCLF diets. The increase in dietary protein has led some to worry that kidney function could be impaired. To date there has not been any evidence to suggest these negative effects occur in people with normal kidney function including diabetics. The most common side effects that do occur are fatigue, headache, and muscle cramps. Most people that experience these effects, do so within the first few weeks of adapting to the diet, then these events subside. The most common failure of all diets is lack of adherence. Studies have shown that people find it no more difficult to adhere LCHF diets than to others, and some people may even find it easier due to the hunger reducing effects.

The individual responses to dietary strategies may change from person to person, but LCHF diets have been proven to be a safe and effective option for improved health outcomes, especially in patients with metabolic syndrome.

References

Noakes, Timothy David and Johann Windt. “Evidence For The Prescription Of Low-Carb High-Fat Diets”. Medscape. N.p., 2017. Web. 22 Feb. 2017.

 

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