Category Archives: Supplements

Stubborn Fat Solution Review Lyle McDonald

I  read Lyle McDonald’s Stubborn Fat Solution years ago.  Here’s my review (with some StubbornFatSolutionReviewupdated ordering information):

As some of my regular readers know, I’ve been a “fan” of Lyle’s for over a decade now (since I read The Ketogenic Diet back in the 90’s). I knew this would be a good read.

Summary:

Lyle explains the way fat functions–the way our body stores it and uses it. He then explains the issue of stubborn fat (usually the hips/thighs in women and “love handles” in men). There are specific issues which cause stubborn fat to be . . . well . . . stubborn (circulation, hormones, etc).

There is some surprising information here. Lyle noted, for example, that female fitness models used to tell him their upper bodies were getting leaner while their lower bodies seemed to be getting fatter. At first he dismissed this, but his research led him to believe there may be something to this claim.

Lyle proceeds to give a solution to the problem: a specific exercise/supplement protocol designed to first mobilize, then oxidize stubborn fat. What he says makes perfect sense, and he backs up his statements with research.

Now, let me explain something: this is not a book for those who have significant weight to lose (you may want to check out his Rapid Fat Loss Handbook/Guide to Flexible Dieting package if you have a lot to lose). It is a resource for those who are already fairly lean and need some help getting rid of the before-mentioned problem areas.  If that describes you then I think you’ll find The Stubborn Fat Solution to be the only thing short of plastic surgery that works.

UPDATE:

UltimateDiet20Lyle is now offering two more books as a part of this package: The Ultimate Diet 2.0 This is a complete manual of  diet, training, and supplements for those who want to get lean while preserving as much muscle mass (and strength) as possible.  I know of some professional bodybuilders who have used this diet to prepare for competitions.

This package also includes The Ultimate Diet 2.0 Addendum.  This book addresses what you should to to prepare for the diet and what to do when you take breaks from the diet.

Just click here if you’d like to learn more about The Stubborn Fat Solution and The Ultimate Diet 2.0.

Examine.com’s Supplement-Goals Reference Review

A few weeks ago I was given the opportunity to look over Examine.com’s Supplement-Goals ExamineReference Guide. I’m familiar with some of the contributors to this website, so I had a feeling it would be worth my time.  It definitely was–here’s my review:

I really like the way this reference is laid out.  You can look up any supplement and find out the possible benefits of taking it (hormonal, performance, etc.).   You can also look up a particular desired effect and see how the evidence is “graded” (A-D) based on the number of studies (grade A would be very strong evidence; grade D would be very weak/limited evidence).  I’ll show you a couple of screen shots.  Here’s part of what you would get if you looked up maca (supplement search):

ExamineMaca

This is only part of the result–if you have the reference you’ll see a grade for virtually every possible effect (libido, depression, etc),

Here’s part what you would get if you looked up an effect, like increasing testosterone:

ExamineTestosteroneKeep in mind this is not something you would want to sit down and try read all the way through–it’s just too massive for that.  As the name implies, it is a reference–something to be used when you want specific information.

I’d recommend the Examine.com Supplement-Goals Reference Review without hesitation.  It only costs $40 for lifetime access–I’d say it is worth it for the amount of money and time you could save.  Just click here if you want to check it out.

 

 

Garcinia Cambogia (Hydroxycitric Acid) Review

A few weeks ago I saw a website advertising garcinia cambogia extract.   The websitegarciniacambogiareview claimed it was a “miracle fat burner.”  It also claimed those who used the supplement in a study lost an average of about 20 lb in under a month  “without diet or exercise.”

The website seemed to be set up to give you a “free sample” then bill you and start sending you a bottle every month (a favorite tactic of the people that push this kind of product).

I decided to do some quick research.  A 2011 study revealed this supplement had a protective effect on the kidneys of rats that were fed a high fat/sugar diet (but the rodents still got fat, so I’m still not sure where fat loss claims are coming from).1

I did find a double-blind, placebo controlled study that was done with human beings.  Overweight men and women were divided into two groups.  One group was given garcinia cambogia extract supplements, the other a placebo.  They ate a low calorie diet for twelve weeks.  As expected, all subjects lost weight.  But there were no differences between those who took the supplement and the ones who took the placebo.  Here’s what I find really interesting:  this study was published over 15 years ago (in 1998).2

A study published about nine years ago (2004) compared two groups of subjects who were put on a 2,000 calorie a day diet.  Half took garcinia cambogia, the other half a placebo. Both groups lost weight, but the group taking the supplement only lost .2% more weight than the placebo group.  Not exactly mind-blowing.3

Maybe I’m missing something, but I don’t understand why this supplement is being touted as some miracle fat burner.  Heck, I don’t even know why it is being called “new.”  This is why you have to be very cautious with any marketing regarding weight loss supplements.

One final reminder:  never sign up for a “free trial” that requires your credit card number.

References:

1. Lipids Health Dis. 2011; 10: 6. Published online 2011 January 14. doi: 10.1186/1476-511X-10-6 Protective effect of Garcinia against renal oxidative stress and biomarkers induced by high fat and sucrose diet

2. JAMA. 1998 Nov 11;280(18):1596-600. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial.

3. J Med. 2004;35(1-6):33-48. An overview of the safety and efficacy of a novel, natural(-)-hydroxycitric acid extract (HCA-SX) for weight management.

101 Ways to Increase Testosterone Naturally Review

I’ve had the chance to look over 101 Ways to Increase Testosterone Naturally by Ryan 101WaystoIncreaseTestMagin.  I’m always interested in learning ways to boost testosterone, so I enjoyed reading through this one.  Here’s my review:

As advertised, this 27 page e-book has over a hundred tips for minimizing your estrogen and maximizing your testosterone.  Magin’s suggestions can be broken down into about four categories: foods, herbs/spices, supplements, workout advice, and miscellaneous tips/tricks (I’m not really listing these in order).

Overall I found this e-book to be helpful, easy to read, and informative–I learned some new things to try and even some things to avoid (or keep avoiding).

I would caution the reader not to get overwhelmed, especially when it comes to Magin’s supplement advice.  Try following the lifestyle advice first, add some of his suggested vitamins (like vitamin D), and don’t worry about the more exotic stuff (like Tribulus Terrestric, etc.).  I’m extremely skeptical about any kind of “testosterone booster” supplement based on the current research.  I believe lifestyle changes (diet, exercise, etc.) are the most important keys to increasing the manly hormone, so that’s the advice I was more interested in while reading.

I’ll share one area where I strongly disagree with Magin.  He encourages the reader to “watch more erotic entertainment,” citing research that doing so can cause a temporary spike in testosterone levels.  I’m a Christian, so I think this is terrible advice.  Even if you don’t object to this on any kind of moral/spiritual basis, there is a growing body of evidence that viewing adult material can actually cause impotence with “real” women, especially when done to excess.

Conclusion:  This e-book is good, but not great.  You can read my article on raising testosterone naturally if you’re interested in a few simple tips.

Alternative program: You may want to look into The Man Diet if you want a complete plan to boost testosterone.

ECY Stack: Ephedrine, Caffeine, and Yohimbine for Fat Burning

A lot people come to this blog looking for information on the ECA Stack (ephedrine, caffeine, and aspirin) and for Yohimbine HCL.  Both are effective supplements, but I will repeat something I’ve said before–don’t take ephedrine and yohimbine together.

primaforce-yohimbineI’ll explain the issue just in case you haven’t read either post: ephedrine is a beta-agonist, meaning it stimulates beta receptor sites.  Yohimbine is an alpha receptor antagonist, meaning it temporarily blocks alpha receptors (“stubborn” fat tends to have more of these alpha receptors, so “turning them off” temporarily can coax them to release their stores).

The problem is your heart has both beta and alpha receptor sites.  Taking both of these drugs at the same time can be kind of like pushing the gas pedal and the brake at the same time.  There is a real risk of a dangerous increase in heart rate and blood pressure.  

Here are the two options I would consider:

1. Use the ECA stack until you get relatively lean, then switch to yohimbine, or

2. Spread the doses out enough for one to wear off.  You could take yohimbine/caffeine, for example, before doing some fasted cardio in the morning then take the EC stack four or five hours later.

Just be careful and use common sense.

 

Creatine Side Effects and Safety

My regular readers/subscribers know creatine monohydrate is one of the few supplements I believe in (see also: Does Creatine Work?).  I’ve been using it for years without any problems, and the extensive body of research speaks to the efficacy and safety of this supplement.

Let’s first talk about safety.  One of the concerns I hear about is possible kidney problems, but I don’t see why this would be an issue for those without any preexisting disease.  The Journal of the International Society of Sports Nutrition recently published a randomized, double-blind, placebo-controlled studied done on trainees who were also eating a high protein diet.  Subjects were randomly chosen to either take creatine monohydrate (a loading phase of 20 grams a day for five days, followed by maintenance of five grams a day) or a placebo.  Researchers found so significant differences in kidney function between groups after 12 weeks.1

Now let’s talk about side effects.  The two I hear about most often are gastric issues (stomach upset, etc.) and bloating.  I’ll address both:

I think the simplest solution to avoid any gastric issues is to buy micronized creatine and use warm water to dissolve it before you drink it.   I believe most people have problems because they try to drink this supplement undissolved.  Here’s the issue: creatine doesn’t dissolve very quickly in cool liquids.  Water and other liquids are likely to pass through with undissolved creatine still sitting around in your guts. The body will attempt to solubilize (dissolve) substances like creatine that remain in the digestive tract in powder/granular form.    This is often accomplished by drawing fluids out of the cells inside the digestive organs.  As you can imagine, this isn’t likely to feel good.

creatinemonohydrateNow to the bloating issue.  Creatine causes fluid retention in the muscles, so I’m a little skeptical when it comes to claims of bloating.  I believe this problem is normally the result of inferior formulas that contain sodium and sugar.  It could also be the result of a horrible diet (blame the supplement, not the pizza).  I’m not aware of any research to back up the claims of “bloating.” One study, in fact, found that creatine use did not affect fluid distribution.2

There’s one more thing I should mention in this discussion.  Some unscrupulous supplement companies will try to hype up these supposed side effects of creatine because they are trying to market some “new improved” formula.  Don’t fall for it.

References:

1. JISSN 2013, 10:26 doi:10.1186/1550-2783-10-26 Does long-term creatine supplementation impair kidney function in resistance-trained individuals consuming a high-protein diet?

2. J Athl Train. 2003 Mar;38(1):44-50. Creatine Supplementation Increases Total Body Water Without Altering Fluid Distribution.

Deer Antler Spray Review

Anabolic Antlers?

Anabolic Antlers?

There has been a lot of hype and controversy regarding Ray Lewis and deer antler velvet spray supplement.  The buzz happened right around the time of his Super Bowl appearance, and supplement sales skyrocketed overnight due to the intense media coverage.  The World Anti-Doping Authority just gave the green light to this supplement, meaning is not on their list of banned substances.  This news may put deer antler spray in the spotlight once again.

This supplement supposedly contains Insulin-like growth factor 1 (IGF-1), a hormone associated with muscle repair and growth.  IGF-1 has been used medically for treatment of growth failure in children, and bodybuilders have experimented with it as a way to build more muscle (they use a form called Long R3 IGF-1, which has a longer half-life).  But any therapy/use of these hormones happens through injections, not oral medication.

Want to hear something really ironic?  The New Zealand Medical Journal published a study just weeks before antler-mania took the news media by storm.  Researchers looked at several studies and assessed the benefits of deer/elk antler supplements.  Their conclusion: “Claims made for velvet antler supplements do not appear to be based upon rigorous research from human trials, although for osteoarthritis the findings may have some promise.”1

There’s no reason to believe this supplement will give professional athletes any advantage, and I don’t plan to spend money on it any time soon.

Reference:

1. N Z Med J. 2012 Dec 14;125(1367):80-6. Health benefits of deer and elk velvet antler supplements: a systematic review of randomised controlled studies.

Vitamin D, Muscle, and Testosterone

My regular readers know I don’t put much faith in supplements.  I have a very short list of supplements that work, and I’m very skeptical of bodybuilding supplements in general.  But Vitamin D is one I think every trainee should consider taking.  Here’s an overview:

Vitamin d plays a crucial role building both bone and muscle. We synthesize it when our skin is exposed to sunlight.  We also get it from food (or supplementation, which I will discuss later).

Deficiencies are associated with obesity and weaker muscles–this correlation has been shown through many studies over the years.

Studies have also  shown a positive correlation between levels of vitamin d and sex hormones (both men and women).1  Supplementing with this micro-nutrient, for example, seems to raise testosterone levels in men who are deficient.2

Vitamin d deficiency is very common, probably affecting half of the world’s population.3  Americans are not exceptions to this statistic.  A 2010 study revealed that 24% of the subjects tested (90 young women in California) were deficient in vitamin d, and even more (59%) were at “insufficient” levels (< or = 29 ng/ml).  Those with low levels of vitamin d had a higher % of fat within their muscles (“muscle adiposity”).4

So let’s put all this together:

1. Vitamin d that plays a crucial role in both muscular strength, leanness, and optimum hormone levels (like testosterone).

2. There’s a possibility you are deficient in it.

Here are a few of the factors that would tend to affect your levels of vitamin d:

*Skin tone: melanin protects from sun damage but also limits synthesis (darker skin=higher risk for deficiency).

*Sun exposure: the amount time you spend in the sun, the climate you live in, and the season (summer vs winter) all affect how much vitamin d you produce.

*Age: our ability to produce this vitamin declines with age.

Supplementation:

One study demonstrated supplementing with 800-1000 mg/day way sufficient to improve the strength and balance of elderly patients. 5 The study I quoted earlier (re: raising testosterone levels) used about 3,000 mg/day.  I doubt any adult would have any issues supplementing in the 1,000-3,000 range–the institute of medicine puts the upper level of recommended supplementation at 4,000 mg/day.6  Vitamin D-3 seems to be the best choice as in terms of the type/form of supplement. 7

I use the NOW Foods Vitamin D-3, Structural Support 2000 I.U., 240 Softgels, but any reputable brand would do.

Having said this, I’d highly recommend you ask your doctor for a blood test to know exactly what your blood levels are.  This is the only way to know for sure and develop a precise strategy (supplementation, etc).

References:
1.Eur J Endocrinol. 2012 May;166(5):765-78. Epub 2012 Jan 24.  Vitamin D and fertility: a systematic review.

2. Horm Metab Res. 2011 Mar;43(3):223-5. Epub 2010 Dec 10. Effect of vitamin D supplementation on testosterone levels in men.

3. J Pharmacol Pharmacother. 2012 Apr;3(2):118-26. Vitamin D: The “sunshine” vitamin.

4. J Clin Endocrinol Metab. 2010 Apr;95(4):1595-601. Epub 2010 Feb 17. Vitamin D status and its relation to muscle mass and muscle fat in young women.

5. J Am Geriatr Soc. 2011 Dec;59(12):2291-300. doi: 10.1111/j.1532-5415.2011.03733.x. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis.

6. Institute of Medicine: Dietary Reference Intakes for Calcium and Vitamin D

7. J Clin Endocrinol Metab. 2011 Mar;96(3):E447-52. Epub 2010 Dec 22. Vitamin D(3) is more potent than vitamin D(2) in humans.

Lower Cholesterol Naturally (Without Statins)

Cholesterol

I had a medical checkup about a year ago. I felt great, but I was preparing to get married and wanted to make sure I didn’t have any health problems.

The only bad news was high cholesterol.  I was disappointed because I hoped I had inherited my dad’s tendency for low cholesterol (he and other paternal relatives normally have total levels in the 150’s).

I should clarify something here: my blood lipid profile wasn’t all bad news.  My triglycerides were at very healthy (low) levels, and my HDL/LDL ratio was also good.   I decided to do two things after seeing the test results: 1. Learn everything I could about cholesterol  2. Lower my cholesterol through diet, exercise, and supplementation.

What I’ve learned:

Let me first say this: I’m not a doctor and I have discussed many of these issues with my physician.  I’d suggest you do the same. 

I’m sure most of you are familiar with cholesterol–it is a waxy, fat-like substance found in all cells of the human body.  It plays a crucial role in the synthesis of hormones and other substances.  But high levels of LDL (the “bad” cholesterol) are associated with the accumulation of plaque in the arteries and heart disease.

The link between high cholesterol and heart disease is controversial, and some doctors/scientists have pointed out flaws in the research.  I do understand these points, especially considering the financial gains to be made by marketing statins and other drugs (more on that later).  But trying to decrease my LDL levels seemed like a good idea when considering the majority of the medical evidence.

Particle Size

The most important thing I learned was the importance of particle size.  This is a relatively new development in our understanding of the link between cholesterol and cardiovascular disease.  It seems not all LDL cholesterol particles are equally harmful–smaller particles seem to more easily penetrate the arterial lining and do more damage, but larger, “fluffy” particles are good news.  Here’s a crude analogy: imagine the difference between throwing a beach ball vs a small rock at a window.

High triglycerides and low HDL are associated with small particle size.1  Dividing triglycerides by HDL is, in fact, a fairly accurate way to measure this risk factor–less than a 2.0 ratio (American units) would usually indicate a healthier lipid profile (larger particles).2 In other words, one of the simplest ways to determine your particle size is to divide your triglyceride number by your HDL. A number under 2 means you mostly have the (safe) larger particles, but a number over 3 is a risk factor for heart disease.

A new testing method called the VAP is now available as a follow-up to the standard cholesterol test.  This is what I’d recommend for those who want more definitive information on their particle size.  I believe this test will become more widely available and more commonly used in the future.

Statins

I also studied statins, drugs that interfere with the liver’s ability to produce cholesterol.  These drugs are effective, but side effects such as muscle pain/weakness seem to be fairly common.  Professional athletes, for example, usually discontinue statin therapy due to these issues.3  There’s also some evidence that suggests statins may reduce testosterone levels and libido.4 For the record I should say that the benefits of these drugs might outweigh the risks for many patients based on the overall research.I also think some of the side effects of statins may be reduced/eliminated by simply supplementing with CoQ10 (though research hasn’t confirmed this).  But I wanted to try to avoid this type of medication after considering all the evidence.

A Helpful Book

One of the most helpful resources I ran across was The New 8-Week Cholesterol Cure (by Kowalski).  The author outlines an effective protocol for lowering cholesterol without statins.  The chapter on niacin was worth the price of the whole book as far as I’m concerned.

What I Did

Phase 1

Exercise: I continued training with weights 3-4 times a week as before.  Exercise is known to lower cholesterol and should be part of any health regimen.  Note: there are many great programs out there if you are interested in building muscle, losing fat, and transforming your body.

Diet:  I did not eliminate anything from my diet–I knew that wouldn’t work for me.  But I did reduce my intake of foods that I knew would be bad for my cholesterol.  I cut back on fried foods, fast foods, pork and red meat.  Most of the time we eat chicken or fish here at home (baked or steamed).  In other words, I ate healthy most of the time.

I also ate a big bowl of oatmeal very regularly (pun intended).  Oatmeal and other high fiber foods basically pull cholesterol out of the body.  This fact has been well established by several studies (oatmeal manufacturers are actually allowed by the FDA to make health claims on their labels because of this).

I followed the Renegade diet approach (a form of intermittent fasting) to keep my calories in check and keep my body fat level low.

Supplements: The most important supplement I took was niacin.  The before-mentioned book has a whole chapter on the role of niacin in healthy blood lipids.  This vitamin, when taken at high dosages, is particularly effective for raising HDL levels.6 It also lowers levels of LDL and VLDL.7

I took 1,000 milligrams of regular niacin every night before going to sleep.  A more effective strategy would be taking it throughout the day, but I wanted to see how effective this simple approach would work.  I usually experienced the skin flush associated with taking this supplement, but I simply don’t trust most of the “no-flush” formulas out there.  It didn’t bother me as much since I was in bed in our air-conditioned room.

One word of caution: It is very important to have your liver checked if you want to use niacin at the doses required to improve blood lipids.  Niacin at these levels would be considered a “drug” instead of just a “supplement.”

I also took 3-4 grams of fish oil per day.  This supplement has multiple benefits, and I would have taken it regardless of my cholesterol test results.

Initial Results

I dropped my cholesterol level by about 40 points.  My overall cholesterol and LDL were at “borderline” levels, and my ratios were still good.  My liver test also came back normal.  My doctor was pleased with the change in blood lipids (he seemed a little surprised).  I have no other risk factors (hypertension, diabetes, etc), so he was comfortable allowing me to continue with what I was doing.

Phase 2

I was pleased to see some improvements, but I really wanted to get my cholesterol down to a healthier level.  I decided to switch from regular (immediate release) niacin to a wax matrix niacin called endur-acin (available at Endurance Products).   This is the only sustained release formula recommended in the before-mentioned book, and the research (though limited) seems favorable.8  My doctor gave me the nod to try it, so I started out with 750 milligrams a day.

Here’s another important note: extended release niacin formulas must be treated as if they were double the dose of regular (“immediate release”) tablets as far as your liver goes.  Taking 500 mg of the Endur-Acin, for example, would be the equivalent of 1000 mg regular niacin (something else I learned from the 8-week Cholesterol Cure).

About six months passed before I was tested again (I should not have waited this long and didn’t intend to, but life happens).  My overall cholesterol level was about the same (still at borderline levels), but some of my ratios had moved in unfavorable ways.  I wasn’t too surprised since holiday season/eating had just passed and we had also experienced a death in my family.  My exercise and diet weren’t exactly ideal in the weeks leading up to this test.  But my liver enzymes were completely normal, meaning I was tolerating the new niacin formulation.  I told my doctor I’d like to try the full dosage (1,500 mg).

Phase 3

I took 1,500 mg of Endur-Acin a day:  one 750 mg tablet in the afternoon and another after dinner (three 500 mg tablets would have been more ideal, but I don’t always eat 3x a day).  I’ll mention something else here–another benefit to wax matrix niacin is you don’t experience the “flush” associated with regular (immediate release) niacin.  I occasionally feel a slight tingling sensation, but nothing like when I was taking regular niacin.

I also added phytosterols and pantethine (as recommended by Kowalski) after a few weeks.

My diet and training were also back on track.  I wasn’t 100% consistent, but much better than the holidays.

Success!

I had another test done about seven weeks after starting this new regimen.  I was pleasantly surprised with the result–my total cholesterol was under 200 (lower than it was when I was in my 20’s).  I wasn’t expecting such a drastic improvement.  I don’t feel comfortable publishing my exact profile numbers (just a privacy thing), but my ratios are all healthy.

My liver enzymes are slightly elevated, but this is very common for someone taking any form of supplement/medication for cholesterol, including statins (I was expecting this, and the slight elevations didn’t concern my doctor).

Phase 4: Maintenance

I had one more test done about seven weeks after the “phase 4″ date.  My numbers/levels were almost identical to the previous test.

My cholesterol is now safely under control through supplements, diet, and exercise.  I consistently take 1,250-1,500 mg of the wax matrix niacin daily, but I don’t always use phytosterols and pantethine.  I also take (drink) a teaspoon of a sugar-free psyllium fiber supplement almost every day with dinner (this specific type of fiber helps reduce cholesterol, and I can take it without adding carbs/calories to my diet).

More on Statins:

What if this strategy had not worked?  I was prepared to bite the proverbial bullet and take medication (my legendary stubbornness does have its limits).  My doctor had already written a prescription for rosuvastatin (Crestor) after my “phase 2″ test.

But I probably would have talked to my physician about taking a much lower dose than the standard 10 mg.  I would recommend considering the following options if you can’t get your cholesterol under control through diet/supplements:

Intermittent therapy: subjects in one study significantly lowered their LDL cholesterol and triglycerides by taking 5 mg of rosuvastatin 2-3 times a week.  Even a once-a-week dose lowered LDL by 23%.9

Low dose therapy:  I was surprised to learn that just 2.5 mg/day of rosuvastatin can lower LDL by a whopping 42%, and just 1 milligram per day will typically lower it by 34%.10 You’d need a pill cutter for this strategy, since (for reasons unknown) the smallest available dosage of rosuvastatin is 5 mg.11

Final Thoughts:

I’m not necessarily opposed to statins (or any other drug, for that matter).  But I decided to take a different route for improving my health.  I hope this post (and the resources mentioned) will help you made decisions about what is best for you.

I’ll remind you one last time–please talk with your doctor about this and get medical supervision. 

See Also:  Niacin and Fat Loss

References:

1. Mayo Clinic: A New Way to Measure Cholesterol: Particle Size Indicates Risk

2. J Atheroscler Thromb. 2003;10(3):186-91. Assessment of LDL particle size by triglyceride/HDL-cholesterol ratio in non-diabetic, healthy subjects without prominent hyperlipidemia.

3. Br J Clin Pharmacol. 2004 April; 57(4): 525–528. Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

4. Br J Clin Pharmacol. 2004 September; 58(3): 326–328. Is decreased libido associated with the use of HMG-CoA-reductase inhibitors?

5. J Am Coll Cardiol.2012 Sep 4;60(10):875-81. Epub 2012 Aug 15. The controversies of statin therapy: weighing the evidence.

6. N Engl J Med September 22, 2005; 353:1252-1260 Low HDL Cholesterol Levels

7. J Intern Med.2005 Aug;258(2):94-114. Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review.

8. J Clin Lipidol. 2012 Mar-Apr;6(2):121-31. doi: 10.1016/j.jacl.2011.07.003. Epub 2011 Jul 23.  A systematic review on evidence of the effectiveness and safety of a wax-matrix niacin formulation.

9. Curr Med Res Opin. 2012 Mar;28(3):371-8. doi: 10.1185/03007995.2012.657302. Epub 2012 Feb 7. Daily and intermittent rosuvastatin 5 mg therapy in statin intolerant patients: an observational study.

10. Am J Cardiol. 2001 Sep 1;88(5):504-8. Effect of rosuvastatin on low-density lipoprotein cholesterol in patients with hypercholesterolemia.

11.  The Lancet, Volume 364, Issue 9445, Page 1579, 30 October 2004 doi:10.1016/S0140-6736(04)17304-2 Should rosuvastatin be withdrawn from the market? Jay S. Cohen