#918

I didn’t know that, but anyway you need a prescription to make it legal.

#919

It’s extremely easy to get a prescription (e.g. from EU Doctor). And in any case, no one will ask you for a prescription in most non EU countries (e.g. Turkey) and I don’t think anyone will check at your arrival in Finland, they have other priorities than bempedoic acid :slight_smile:

1 Like
#920

This discussion made my brain ruminate on the preventional aspect of CV health. My risk appetite is pretty low, so the ideal strategy to me (and others with similar inclinations) would be an optimization which would include the following parameters.

  • Decrease in LDL/ApoB: to be maximized - of reasonable quantities

  • Potential side effects: to be minimized - absolute priority

  • Cost: to be minimized - within reason

One possible solution would be alternating 5 mg crestor every other day and 10 mg Zetia every other day. Tom Daysprings in one of his recent podcasts hinted at the efficacy of an intermittent dosage of Zetia, concept which may perhaps be extrapolated to crestor as well.
Cost of the above would be (7+23)/2 = 15 € every 4 weeks period (presently about 16.5 US$).
Efficacy with zero or trivial risk may be increased by adding berberine, which should provide a 10 mg/dL decrease on average, but with the dosages suggested (about 1000 mg/d) it would turn out to increase costs substantially, although the main priority in this scheme would be minimization of side effects.

#921

If you experience muscle pain or weakness from any statin, you should try another statin. Initially I was taking a low dose Rosuvastatin Crestor. I had severe muscle weakness. I switched to low dose Atorvastatin Lipitor and there were no noticeable side effects. My LDL and ApoB dropped from 65 to 48. I’m extremely happy with the results.

3 Likes
#922

Why would ezetimibe (Zetia) be better every other day than every day? And why not just split the pill in half and take 5 mg per day?

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#923

Yes - or even split the ezetimibe into 1/4 tablets: Pill Splitting Ezetimibe and Bempadoic Acid to Save Money, Lower Side-effect risk

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#924

An efficacious dosage of 1/4 of a pill is great news, from the standpoint of collateral effects and that of cost, which for the outlined strategy would drop at 3.5+(23/4) = about 9 € or 10 US$ every 4 weeks.
I wouldn’t be able to split the minuscule Zetia pill in 4, splitting in two would not be easy but feasible unless there are precision pill-splitting devices.

I believe Daysprings said something about an intermittent dosage but I may be wrong since English is not my mother tongue and he sometimes talks in a hurried fashion. I would have no probs in taking 5 mg per day, although 2.5 per day would be impossible unless a precision device is used for splitting.
Splitting Crestor in half would also be all right, If the dose-response is linear until 5 mg, 2.5 mg/d should yield a decrease of about 20 mg/dL LDL, summed to a conservative 10 from Zetia plus a conservative 5 from Berberine, hypothesizing simple additive effects with no synergy nor anti-synergy.

Minus 35 mg/dL from a very cautious (and inexpensive) scheme as the above would sound satisfactory, if starting from a moderate level.

#925

” the lowest dose of rosuvastatin that is marketed, 5 mg, reduces LDL-cholesterol by 45% on average, still more than initially necessary for many patients.
Not mentioned in the recent ATP3 guidelines4 is the fact that 2.5 mg and 1 mg of rosuvastatin reduce LDL-cholesterol by an average of 42% and 34%”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17304-2/fulltext

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#926

Thanks for another good news! I read the abstract of the original paper from Olsson et al., 2001, and it’s really incredible that one mere mg of rosuvastatin can decrease the LDL by 34% on average. The only issue I see here is to split a Crestor pill in 5 parts, maybe a solution could be to split the pill in 2 halves, to be taken intermittently every other day, making it an average 1.25 mg daily dose and potentially a greater than 34% reduction in LDL.

1 Like
#927

Yes rosuvastatin 2.5 mg + ezetimibe 5 mg will probably reduce by more than 40 mg.

There are pill cutters on Amazon. It might be even cheaper to buy rosuvastatin + ezetimibe as single pill and cut that (although I don’t know how the two drugs are “arranged” on the single pill).

1 Like
#928

Great idea, just ordered one, looks precise enough to get four 1.25 mg pieces from a single 5 mg pill and sure better than the crappy one I have.
image

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#929

What is it with folks who are super enthusiastic about berberine? Who says berberine has zero or close to zero risk, especially at doses suggested for efficacy? Are there long term RCTs, adequately powered and not funded by supplement money, that show both efficacy and safety comparable to pharmaceuticals for the same indications? Pharma studies are far from perfect, and often gamed, but at least they have to pass some regulatory hurdles, additionally, medically approved drugs are often then trialled by independent researchers over many years, and accumulate huge numbers of users in clinical settings. There is nothing even close to that kind of research and scrutiny of berberine.

I know it’s a very hyped supplement these days, especially by various influencers, but to me it’s really without sufficient independent and adequate validation.

I am not here to try to discourage anyone from taking berberine - you do you, and I am not trying to rain on anyone’s parade. If you like berberine, or feel some benefits, fantastic, more power to you. The only context in which I express any views is if someone makes a claim about those purported benefits with zero scientific evidence provided - one is subective opinion and feeling which everyone is entitled to, and the other is a matter of facts asserted, which must be backed by scientific evidence. Again, I’m not trying to dispute anyone’s subjective or anecdotal experience with berberine, and not saying berberine is bad or whatnot. I’m just saying that for me, if you’re making assertions of fact, you need to supply good evidence.

Personally, I’m staying far away from berberine, as to me it has the same smell as the resverastrol hype… tons of pushing and little evidence. But, hey, to each their own. YMMV.

4 Likes
#930

I agree that it is good to cultivate some skepticism in this field. I have but done a cursory search in the most recent literature on berberine and there seems to be some evidence of moderate benefits, sometimes trivial benefits. I have yet to dig deeper, though.
What I have noticed is that supplements on their own appear often to provide limited or no benefits, whereas if used in conjunction with prescribed pharmaceuticals they exhibit a synergy which sometimes may be more than additive.
At least, this is what many doctors are doing now, suggesting some supplements together with a more traditional prescription. I was surprised when I saw this done in psychiatric pharmacology.
An ensemble of supplements (SaME, magnesium, and Valerian if I remember well) allows in many cases to keep low the dosages of SSRIs used in depression and is used as a first-line medication in mild cases.
Bottom line: I have yet to place that berberine order.

2 Likes
#931

Can you please post a link to that Cool pill divider. The quartering ability is not something I have seen before.

#932

Of course, however it refers specifically to the European and British Amazon sites, it might be available elsewhere. The producer is Dzmuero from China.

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#933

And for US based consumers, it is here:

https://www.amazon.com/Cutter-Divider-Cutting-Vitamins-Tablets/dp/B09WGX7BFD/

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#934

I take Berberine, but not Resveratrol. Berberine has a lot of long term research on it. Resveratrol is another cox-1 inhibitor. I don’t like inhibiting cox-1.

1 Like
#935

Berberine is generally considered safe for most people and is on the shelf of most retailers selling supplements.

The problem I have with berberine is (N=1) that I did not find it effective at the recommended doses and I did experience some of the side effects.

The studies of berberine are not very convincing so I dropped it from my supplement list.

Common Side Effects
Gastrointestinal Issues:
Nausea: Some individuals may experience nausea when taking berberine.
Diarrhea: Diarrhea is a common side effect, especially at higher doses.
Constipation: Conversely, some people may experience constipation.
Abdominal Pain and Cramping: Berberine can cause abdominal discomfort and cramping in some individuals.
Bloating and Gas: Gastrointestinal bloating and gas are also reported.
Less Common Side Effects

Hypotension: Berberine may lower blood pressure, which can be problematic for individuals with already low blood pressure or those taking antihypertensive medications.
Serious Side Effects

Liver Toxicity:
Hepatotoxicity: While rare, there have been reports of liver toxicity associated with berberine supplementation, particularly at high doses or with prolonged use. Symptoms can include elevated liver enzymes and jaundice.

Interactions with Medications:
Cytochrome P450 Enzymes: Berberine can inhibit certain cytochrome P450 enzymes (CYP3A4, CYP2D6, CYP2C9), which are involved in drug metabolism. This can lead to interactions with various medications, potentially increasing their effects or side effects.

Anticoagulants: Berberine may enhance the effects of blood-thinning medications, increasing the risk of bleeding.

Antidiabetic Medications: Berberine can enhance the effects of antidiabetic medications, potentially leading to hypoglycemia (low blood sugar).

Vitamin B12 Absorption:
Reduced Absorption: Some studies suggest that berberine may reduce the absorption of vitamin B12, which can lead to deficiencies over time.

#936

Still another U-shaped curve:

1600×1203 187 KB

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#937

Back to a basic cholesterol-lowering strategy, today I dropped off the local pharmacy and discovered that there is a product, called Rosumibe, which provides in a single, circular-shaped pill, 5 mg rosuvastatin and 10 mg Ezetimibe. Its cost is 9 €, about 10 US$.
This pill can be relatively easily split into four, constituting 4 single doses of 1.25/2.5 mg Rosuvastatin/Ezetimibe.
By taking a quarter of a pill daily, the monthly cost would be less than 3 €.
I’m an extremely cautious guy, but this is starting to be convincing, I may even contemplate a quarter of a pill every other day, at least to start out with.

image

4 Likes