Evidence-based decision support

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.
weight management protocol table

Ingredients for statin-associated nutrient depletions

The use of HMG CoA reductase inhibitors (statins) to lower cholesterol is known to cause various nutrient depletions, particularly of coenzyme Q10 (CoQ10), beta-carotene, and vitamin E. Different statins may result in varying degrees of depletion, necessitating careful discernment and lab testing by healthcare providers to determine the clinical appropriateness of supplementation. CoQ10 supplementation may help prevent or reverse deficiency without impacting the efficacy of statins. (Langsjoen 2003)(Littarru 2007) Similarly, statin therapy may significantly reduce beta-carotene and vitamin E levels, and targeted supplementation may be required to maintain optimal antioxidant capacity. (Jula 2002)(Vasankari 2004) Practitioners should consider individual patient profiles and monitor nutrient levels to ensure comprehensive care.

Address statin-associated nutrient depletions with the evidence-based ingredients in this protocol. 

CoQ10

100–600 mg per day (Qu 2018)(Caso 2017)(Langsjoen 2003)

  • The widespread use of statins to lower cholesterol has been shown to cause a significant depletion of CoQ10. With higher statin usage and doses, CoQ10 deficiency is becoming more prevalent and severe, especially in elderly patients and those with heart failure. CoQ10 supplementation may be beneficial for preventing or reversing deficiency without affecting the efficacy of statins. (Langsjoen 2003)(Littarru 2007)
  • One study showed that CoQ10 supplementation improved statin‐associated muscle symptoms, including muscle pain, weakness, cramps, and tiredness, regardless of the CoQ10 dosage (100–600 mg per day) or the duration of supplementation (30 days to three months). (Qu 2018)
  • Ubiquinol has been shown to have up to 2–3 times higher bioavailability than ubiquinone. (Evans 2009)(Kurowska 2003) This suggests that lower doses of ubiquinol may be used to achieve the same effect as higher doses of ubiquinone.

Beta-carotene

30 mg per day (Institute of Medicine 2000)

  • In a randomized controlled trial of men with hypercholesterolemia, simvastatin therapy decreased serum beta-carotene levels by 19.5%. (Jula 2002) 
  • Another study demonstrated that during the first 12 weeks of statin therapy, low-density lipoprotein (LDL) antioxidant capacity and serum concentrations of beta-carotene decreased by 20%. (Vasankari 2013)
  • Supplementation of 30 mg per day or more of beta-carotene for long periods of time may be associated with carotenodermia, but this effect is more cosmetic than adverse and is considered harmless and readily reversible. (Böhm 2020)


Vitamin E

100–400 IU per day (Pruthi 2001)

  • During the first 12 weeks of statin therapy, LDL antioxidant capacity and serum concentrations of alpha-tocopherol decreased by 16%. (Vasankari 2004)
  • In the same study, after 52 weeks, serum gamma-tocopherol levels in the simvastatin group returned to baseline, but LDL antioxidant capacity and serum alpha-tocopherol levels remained reduced. (Vasankari 2004)

Authors

Laura Dan, BSc, NDTR

Medical Writer

Prior to joining Fullscript, Laura graduated from the University of Arizona with a Bachelor’s degree in Nutritional Sciences and established a foundation in an inpatient clinical setting. She later gained experience in corporate wellness and promoted healthy living strategies to a population of more than 13,000 employees. Her passion lies in helping others reach optimal health through good nutrition and holistic healthcare.

Natacha Montpellier, ND

Medical Science Liaison

Dr. Natacha Montpellier is a registered naturopathic doctor in Ontario, Canada. She currently maintains a private clinical practice focused on hormonal and reproductive health. Dr. Natacha, ND, also serves as a Medical Science Liaison on Fullscript’s Medical Advisory team.

References

  1. Böhm, V., Lietz, G., Olmedilla-Alonso, B., Phelan, D., Reboul, E., Bánati, D., Borel, P., Corte-Real, J., De Lera, Á. R., Desmarchelier, C., Dulinska-Litewka, J., Landrier, J., Milisav, I., Nolan, J., Porrini, M., Riso, P., Roob, J. M., Valanou, E., Wawrzyniak, A., . . . Bohn, T. (2020). From carotenoid intake to carotenoid blood and tissue concentrations – implications for dietary intake recommendations. Nutrition Reviews, 79(5), 544–573. https://doi.org/10.1093/nutrit/nuaa008
  2. Caso, G., Kelly, P., McNurlan, M. A., & Lawson, W. E. (2007). Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. the American Journal of Cardiology, 99(10), 1409–1412. https://doi.org/10.1016/j.amjcard.2006.12.063
  3. Evans, M., Baisley, J., Barss, S., & Guthrie, N. (2009). A randomized, double-blind trial on the bioavailability of two CoQ10 formulations. Journal of Functional Foods, 1(1), 65–73. https://doi.org/10.1016/j.jff.2008.09.010
  4. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington (DC): National Academies Press (US); 2000. 8, β-Carotene and Other Carotenoids. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225469/
  5. Jula, A., Marniemi, J., Huupponen, R., Virtanen, A., Rastas, M., & Rönnemaa, T. (2002). Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men. JAMA, 287(5), 598. https://doi.org/10.1001/jama.287.5.598
  6. Kurowska, E. M., Dresser, G., Deutsch, L., Bassoo, E., & Freeman, D. J. (2003). Relative bioavailability and antioxidant potential of two coenzyme Q10 preparations. Annals of Nutrition & Metabolism, 47(1), 16–21. https://doi.org/10.1159/000068910
  7. Langsjoen, P. H., & Langsjoen, A. M. (2003). The clinical use of HMG CoA‐reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. BioFactors, 18(1–4), 101–111. https://doi.org/10.1002/biof.5520180212
  8. Langsjoen, P. H., & Langsjoen, A. M. (2013). Comparison study of plasma coenzyme Q10 levels in healthy subjects supplemented with ubiquinol versus ubiquinone. Clinical Pharmacology in Drug Development, 3(1), 13–17. https://doi.org/10.1002/cpdd.73
  9. Littarru, G. P., & Langsjoen, P. (2007). Coenzyme Q10 and statins: Biochemical and clinical implications. Mitochondrion, 7, S168–S174. https://doi.org/10.1016/j.mito.2007.03.002
  10. Pruthi, S., Allison, T. G., & Hensrud, D. D. (2001). Vitamin E supplementation in the prevention of coronary heart disease. Mayo Clinic Proceedings, 76(11), 1131–1136. https://doi.org/10.4065/76.11.1131
  11. Qu, H., Guo, M., Chai, H., Wang, W., Gao, Z., & Shi, D. (2018). Effects of coenzyme Q10 on Statin‐Induced myopathy: An Updated Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association. Cardiovascular and Cerebrovascular Disease, 7(19). https://doi.org/10.1161/jaha.118.009835
  12. Šabovič, M. (2014). Coenzyme Q10 supplementation Decreases Statin-Related Mild-to-Moderate muscle symptoms: a randomized clinical study. Medical Science Monitor, 20, 2183–2188. https://doi.org/10.12659/msm.890777
  13. Vasankari, T., Ahotupa, M., Viikari, J., Nuotio, I., Strandberg, T., Vanhanen, H., Gylling, H., Miettinen, T., & Tikkanen, M. J. (2004). Effect of 12‐month statin therapy on antioxidant potential of LDL and serum antioxidant vitamin concentrations. Annals of Medicine (Helsinki)/Annals of Medicine, 36(8), 618–622. https://doi.org/10.1080/07853890410018844

Disclaimer

This site is intended solely as an informational reference tool for practicing healthcare professionals. The content provided is not intended to be for medical diagnosis or treatment, is not a substitute for your professional judgment, and is not meant to provide you with medical or professional advice. You should evaluate and independently confirm the appropriateness of the content provided, and you should rely on your experience and judgment and other available resources when applying the provided content to an actual patient care situation. While content has been obtained from sources believed to be reliable, we cannot and do not guarantee the accuracy, validity, timeliness, or completeness of the content.