Q&A: necessity of statins; turmeric for joint pain; elevated liver tests; & managing migraines
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In this week’s reader-submitted Q&A, we’re tackling these questions:
Do I really need to take a statin?
Does turmeric do anything for joint pain?
Should I be concerned about elevated liver enzymes?
Should I try a CGRP inhibitor for chronic migraines?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: STATIN DRUGS
I’m a 42-year-old woman with normal cholesterol except for an LDL of 135. My doctor recommended a statin, but I feel fine and eat a fairly healthy diet. Do I really need medication? It’s so confusing when to take meds versus making a few changes to my diet, etc. What do you advise your patients?
-Rachel
Hello Rachel,
I fully understand why you would question whether cholesterol-lowering medication is necessary, especially when you feel healthy and eat well. The key to helping you make an informed decision about taking a statin is understanding your other risk factors for atherosclerosis (cholesterol plaque accumulation in the arteries). Why does this context matter? Because the blood cholesterol levels that are best for you depend entirely on it.
In other words, whether you need a statin depends on your overall cardiovascular risk rather than a single LDL reading. Doctors consider multiple factors when deciding on treatment, including age, blood pressure, family history of heart disease, smoking status, and other conditions like diabetes. The ASCVD risk calculator is often used to estimate your 10-year risk of heart disease or stroke. If your risk is low, lifestyle changes may be a reasonable first step. If your risk is moderate or high, a statin might be more strongly recommended.
Another tool I commonly use is the coronary artery calcium score. A zero percent score suggests the absence of known cholesterol plaque in the heart - and this can reduce or eliminate the necessity of cholesterol-lowering meds. The Lipoprotein (a) blood test also can be helpful to help you stratify risk. (I wrote about it here.)
If your ASCVD risk score is low and/or you have a normal coronary artery score, the next steps to reduce your LDL cholesterol may include increasing dietary fiber (especially soluble fiber from oats, beans, and flaxseeds), adding more healthy fats like omega-3s from fish or walnuts, and making sure you're getting regular exercise. Even small changes, like reducing saturated fats and refined carbs, can help lower LDL.
The upshot: ask your doctor about your overall risk score and whether trying lifestyle modifications for a few months before reassessing is a safe option. Some people with slightly elevated LDL but otherwise low risk can manage their cholesterol with diet and exercise alone, while others with a strong family history or other risk factors may benefit from medication.
It’s always good to have an informed conversation with your doctor, weigh the risks and benefits, and decide on a plan that makes sense for you. If you're still unsure, getting a second opinion or repeating labs in a few months after lifestyle tweaks may provide more clarity. Does that help?
QUESTION #2: TURMERIC FOR JOINT PAIN
I’ve been dealing with mild joint pain and stiffness, and a friend told me to try turmeric supplements. Is there any real science behind this, or is it just a trendy “anti-inflammation” thing?
-David
Hi David,
This is a popular supplement for a reason. Turmeric, specifically its active compound curcumin, has been studied for its anti-inflammatory properties, and there is some solid science behind its use for joint pain and stiffness. Curcumin has been shown to help reduce inflammation by blocking certain pathways in the body that contribute to pain and swelling, similar to how NSAIDs like ibuprofen work, but without some of the gastrointestinal side effects.
Several studies suggest that turmeric supplements may provide mild to moderate relief for conditions like osteoarthritis. Some research has even found curcumin to be comparable to over-the-counter pain relievers in reducing joint pain, though results can vary from person to person. The challenge with turmeric is absorption—curcumin alone is not well absorbed by the body. Taking it with black pepper (which contains piperine) or a fat source can significantly improve absorption.
If you’re interested in trying it, look for a high-quality supplement with black pepper extract or a formulation designed for better absorption. Typical dosages in studies range from 500 to 1,500 mg of curcumin per day, but it’s always a good idea to check with your doctor, especially if you take blood thinners or other medications, as turmeric can interact with certain drugs.
While turmeric isn’t a miracle cure, it can be a helpful addition to an overall joint health plan, especially when combined with regular movement, strength training, and an anti-inflammatory diet. If your joint pain persists or worsens, getting evaluated by a doctor can help rule out underlying conditions like arthritis or autoimmune issues.
QUESTION #3: ELEVATED LIVER TESTS
My annual bloodwork showed slightly elevated liver enzymes. I don’t drink much, and my doctor said it’s probably nothing, but now I’m worried. You probably hear this a lot but the internet has convinced me I’m dying of some awful disease.. like cirrhosis or a parasite infection. What could be causing this, and when is it wise to get more tests?
-Jason
Hi Jason,
This is a common issue I finding on routine blood work, so thanks for asking. What you are talking about the ALT and AST liver function tests, or liver “enzymes,” proteins that come from liver cells that can “spill” into the bloodstream when the liver it irritated. Elevated liver enzymes certainly can signal a serious liver issue, however when they are only slightly elevated, they likely reflect temporary and/or reversible liver injury that can be caused by a variety of factors.
Alcohol and weight gain are probably the most common reasons for elevated liver tests. (Since you don’t drink much, alcohol-related liver damage is unlikely.) Other possible causes include recent illness, recent vigorous exercise, NSAID drugs such as Advil/Aleve/Ibuprofen, and fatty liver disease, which can occur in people with normal weight and no obvious risk factors. Other potential causes include viral infections, metabolic conditions, or inflammation from diet or lifestyle factors.
Medications and supplements can irritate the liver, too. Beware the myth that supplements are always harmless! Even if something is deemed “natural,” anything you put in your mouth can be a potential irritant to your digestive organs.
If your doctor isn’t concerned, he or she may want to simply monitor your levels with a repeat test in a few months. In the meantime, supporting your liver by staying hydrated, maintaining a balanced diet, and avoiding unnecessary medications or supplements that can stress the liver is a good idea.
The liver is a fairly forgiving organ, however if your enzyme levels remain elevated or increase over time, additional tests—such as imaging (ultrasound or FibroScan) or more detailed liver function tests—may be considered. Of course, if you have any new symptoms like fatigue, unexplained weight loss, or digestive issues, it’s worth checking in sooner. Otherwise, a watch-and-wait approach with a follow-up test is often the best next step. I hope that helps!
QUESTION #4: CHRONIC MIGRAINES
I have chronic migraines and have tried everything—triptans, beta blockers, Botox—but I still get them weekly. My doctor suggested a CGRP inhibitor, but I’m worried about the cost and long-term effects. Are they really worth trying?
-Jessica
Hi Jessica,
Chronic migraines can be incredibly frustrating, especially when you've already tried multiple treatments without lasting relief. CGRP inhibitors are a newer class of migraine medications that have been life-changing for many people who haven’t responded well to other treatments. They work by blocking calcitonin gene-related peptide (CGRP), a protein involved in migraine pathways.
Unlike traditional migraine treatments like triptans (Imitrex, Relpax, Maxalt, etc) or beta blockers (Atenolol, Metoprolol, etc.), CGRP inhibitors are designed specifically for migraine prevention and have been shown in clinical trials to significantly reduce both the frequency and severity of migraines. Some people experience a dramatic improvement within the first few months, while others may take longer to see results.
Cost is a valid concern, as these medications can be expensive, but insurance coverage has improved in recent years. Many manufacturers also offer patient assistance programs or copay cards that can make them more affordable. It’s worth checking with your insurance provider and your doctor’s office to explore coverage options.
As for long-term effects, CGRP inhibitors have been generally well-tolerated. The most common side effects are mild and may include injection site reactions, constipation, or fatigue. Since they don’t constrict blood vessels like triptans, they may be a safer option for people with cardiovascular concerns. However, because they’re relatively new, long-term data is still being collected.
If your migraines are still significantly impacting your life despite trying multiple treatments, a CGRP inhibitor could be worth considering. Having a conversation with your doctor about the risks, benefits, and financial options may help you decide whether it’s the right next step. Wishing you well!
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Thank you Dr. McBride! Do you have any favorite tumeric supplement brands you can recommend?
Such wise advice, Lucy, and my absolute favorite curcumin supplement that has really helped with tight Achilles joints in midlife for me is Dr. Terry Real’s Curamin Extra Strength and the proprietary complex has over 2,500 mg.