The Good, The Bad, and the Truth: Cardiologist Explains

Are statins really as dangerous as the internet claims—or are they being misunderstood?

In this episode of Ultra Life Today, board-certified cardiologist Dr. Royce Bargas breaks down the real science behind statin drugs—without fear-mongering or pharmaceutical blind spots.

We cover:
* How statins actually work in the body
* When statins can protect the brain and reduce vascular dementia
* Why muscle pain happens—and how often it really occurs
* The critical difference between fat-soluble vs water-soluble statins
* Why 80 mg atorvastatin is often overused
* The biomarkers that matter more than LDL alone (ApoB, oxidized LDL, inflammation)
* When lifestyle, nutrition, and metabolic health may reduce or eliminate the need for statins

This is a pragmatic, personalized approach to cardiovascular health—from a physician trained in both conventional cardiology and functional medicine.

Listen to the full episode here or watch it on YouTube!: https://youtu.be/MagZkjPGOh8

Visit UltraBotanica.com to learn more about us and how you can get a free sample of our products.

Transcript

0:00:00 - (Dr. Royce Bargas): There's actually, there's a lot of controversy right now and I'm sure we'll get into where that comes from, you know, when it comes to cognitive decline. But there are actually legitimate studies that show that statins can decrease cognitive decline and improve.

0:00:18 - (Josh Bellieu): Did not know that.

0:00:19 - (Dr. Royce Bargas): Cognitive issues. Yes. And so the other interesting thing about statins is that they seem to have a relatively potent anti inflammatory effect within the vasculature.

0:00:31 - (Josh Bellieu): Foreign. Hey everybody. Welcome back to Ultralife Today. Today, Josh bellew, Adam Paine, CEO of Ultra Botanica is on the end. We've got Dr. Royce Vargas here and what a great person to have in the studio with us today. I love this lady because she is pragmatic, no nonsense, she knows her stuff and she'll give you a path forward. But we're going to talk about some subjects that may be quite controversial. The first one today we're talking about is statin drugs and we're saying the good, the bad and the ugly. And no one better to talk to than Dr. Royce Vargas.

0:01:15 - (Josh Bellieu): Welcome back to Ultra Life today. Tell us a little bit about yourself, Royce.

0:01:20 - (Dr. Royce Bargas): I am a board certified cardiologist. I am also certified in functional medicine. I was actually very conventionally trained as an electrophysicist, which is a rhythm expert. I'm the electrician of the heart, not the plumber. So I don't put in stents and open arteries. I manage arrhythmias, pacemakers, defibrillators. I've taken a bit of a step back from electrophysiology, although it will obviously always be in my roots as it is a very extensive training and I'm moving more into primary and secondary prevention for cardiovascular disease.

0:01:55 - (Dr. Royce Bargas): And I have a full functional medicine practice as well. I have an integrative cardiology practice and it's one of the only ones in the region. I can't even think of who might be closest to me. And so what that basically means is more holistic approach to cardiovascular prevention, looking really beyond just the cholesterol, which is kind of the conventional classic marker of cardiovascular risk, and looking more toward the multiple other factors that are very clearly involved and how to optimize all factors, including cholesterol, to decrease risk for cardiovascular disease.

0:02:34 - (Dr. Royce Bargas): I also have a very robust dementia prevention and reversal program.

0:02:38 - (Josh Bellieu): Yeah, can't wait to talk to you about that.

0:02:40 - (Adam Payne): It sounds like we've just, we've covered all the bases. We're good. That should be the end of the podcast right there.

0:02:45 - (Josh Bellieu): Well, but to say simply this, I know people that actually saw your last Interview with us, and they were blown away. They said, I mean, some of them were out of state and said, I wish I could get over there to Oklahoma to see this lady.

0:02:59 - (Dr. Royce Bargas): I wish they could too.

0:03:00 - (Josh Bellieu): Well, they can.

0:03:01 - (Adam Payne): They can fly in.

0:03:02 - (Dr. Royce Bargas): Come on over.

0:03:02 - (Josh Bellieu): Okay, so this crazy sub of statin drugs that I remember hearing about, the first one, I won't name it, but it was back in like 1988 or 1987. Yeah, there you go. And it was crazy. And then there was a big named one that came out in about 98 that ended up being like the most money making drug for so many years. You know the name of it, of course. But can you let us know how do statins work and what's their role in lowering cholesterol? Because that was always like the big thing. It's like, oh, your cholesterol is awful.

0:03:36 - (Josh Bellieu): The charts. And I also want you to tell us a little bit about the measurement of cholesterol. And are there, is it, is it a false thing for us to be so concerned about high cholesterol? So how do statin drugs, cardiovascular disease, cholesterol work?

0:03:51 - (Dr. Royce Bargas): Okay, so statins block HMG COA reductase, which is an enzyme involved in the production of a cholesterol molecule in the liver, there is HMG COA reductase in other organs, namely the muscle, which we'll get to when we talk about side effects of statins. So they block that enzyme, thereby blocking production of cholesterol, thereby lowering cholesterol in the blood. Now, cholesterol is intimately involved in the development of atherosclerotic heart disease. It's what causes the atherosclerotic plaque which develops within the wall of the artery, any artery, not just arteries to the heart.

0:04:32 - (Dr. Royce Bargas): It's just when it gets in the artery to the heart, it can cause blockage. And if that blockage becomes significant enough, then you can have what's called angina, which is basically a symptom. Chest pain, shortness of breath that comes from the heart not getting enough blood supply when it needs. Also obviously results in a heart attack which typically results from. This is kind of getting away from statins, but results from a lower level of stenosis.

0:05:02 - (Dr. Royce Bargas): A lot of heart attacks, like the heart attacks come from a level of blockage that wouldn't necessarily cause you to have chest pain when you're exercising.

0:05:12 - (Josh Bellieu): Wow, interesting.

0:05:13 - (Dr. Royce Bargas): Yeah. And so that plaque is caused by cholesterol. Cholesterol is not the only factor. I would argue it's not even the most important factor, but it definitely without a Doubt is a factor. And if you can decrease the production of cholesterol and decrease the available cholesterol to work its way into the artery and cause the plaque, then you can decrease atherosclerotic burden and you can decrease heart attacks, angina, the need for revascularization, and very important, vascular dementia, because the arteries to the brain are much tinier than the arteries to the heart and they take a much lower level of plaque in the wall of that artery to cause ischemic burden to the brain, which is vascular dementia.

0:05:58 - (Adam Payne): Ischemia being like a lower amount of blood supply.

0:06:01 - (Dr. Royce Bargas): Sorry. Yeah, ischemia basically just means lack of blood flow.

0:06:04 - (Josh Bellieu): Yeah, yeah, thanks for that awesome translation.

0:06:06 - (Adam Payne): Well, I mean, not every.

0:06:07 - (Josh Bellieu): I mean it is a medical term.

0:06:09 - (Adam Payne): Yeah, it's hard sometimes, as you know, medical professionals, it's easy to use the medical term because we know very specifically what that means. But it doesn't necessarily translate to everybody.

0:06:19 - (Dr. Royce Bargas): I mean, truthfully, it means no oxygen gets where it needs to and cells die.

0:06:24 - (Josh Bellieu): So when statins came along, and you've been doing this for how long in this field now?

0:06:30 - (Dr. Royce Bargas): Oh wow, 22 years.

0:06:33 - (Josh Bellieu): Okay, so you came in when statins were riding a high wave and explain to us how they work and why you do or don't use them in your practice and what you're looking for.

0:06:46 - (Dr. Royce Bargas): Well, statins are interesting. They're definitely very effective at decreasing cholesterol. They're not the most effective actually, but they are very effective. And there's tons of outcomes data for statins. So they've been. There have been over 20 large scale, very well designed randomized control trials confirming the benefits of statin not only for cholesterol reduction, but also for reduction of major cardiovascular events.

0:07:14 - (Dr. Royce Bargas): There's actually, there's a lot of controversy right now and I'm sure we'll get into where that comes from, you know, when it comes to cognitive decline. But there are actually legitimate studies that show that statins can decrease cognitive decline and improve.

0:07:33 - (Josh Bellieu): Did not know that.

0:07:33 - (Dr. Royce Bargas): Cognitive issues. Yes. And so the other interesting thing about statins is that they seem to have a relatively potent anti inflammatory effect within the vasculature. And I think that is where acutely, after you have a heart attack or a stroke or you get a stent, they can be very beneficial because of the decrease in inflammation within the artery. The cholesterol problem is a long term problem. You develop plaque over a lifetime and even it starts very early in life. Biopsy reports from very healthy military, active military personnel who have been died, who have been killed or died in any other way. They did a large scale study and they looked at the did arterial biopsies on them and they already had population.

0:08:26 - (Josh Bellieu): You'Re talking about pretty young population to 24 year olds. Wow. Okay.

0:08:30 - (Dr. Royce Bargas): And so plaque development is a lifelong process, but vascular inflammation is an acute process.

0:08:38 - (Josh Bellieu): Well, help me out here because I have some very close friends. Over the years, their physician prescribed statin drugs to them. They began to have all kinds of horrifying muscle aches and pains and body aches and stuff to the point. And that's the only thing that they could point to that had changed in their world when they got off them, they went away. So how does that tie into the whole idea of anti inflammatory what's going on there? And is that a small subset of statin people or is that a large amount of people that take them most.

0:09:11 - (Dr. Royce Bargas): Commonly because there is a large penetrance of some statins into the muscle because there are a lot of HMG CoA receptors in the muscle. And so statins can have a pretty robust effect in the muscle. Myalgia, which is the medical term for my muscles hurt, is not uncommon, but it's more common to not have it. The literature is very mixed because the trials, you know, this is a whole separate soapbox we could get on. But the data is not always correctly or super accurately reported in the trials.

0:09:52 - (Dr. Royce Bargas): And there's some thought process that if you don't have muscle injury, which is myositis, like the death of a muscle cell, then you don't have a problem. And some of the trials would allow the enzyme that we measure when a muscle cell dies. It's called creatinine kinase or ck. That's how if we want to objectively identify is a person really having muscle damage from their statin which can occur, you check the CK and the trials would allow the CK to be 10 times the upper limit of normal and still keep you on your statin.

0:10:27 - (Dr. Royce Bargas): I would not do that. Like I don't want you to take a statin if it causes you any side effect because there are other ways to skin the cat.

0:10:36 - (Josh Bellieu): Right?

0:10:36 - (Dr. Royce Bargas): Yeah, can't wait to talk about that. Which is, you know, not always recognized. A lot of times in the conventional world it's just statin, statin, statin. And you know, I would love to talk about the different kinds of statins and the dose of statins and why this whole, the whole controversy has occurred to why the whole world thinks they're awful. They're not awful, they just have to be used appropriately.

0:11:02 - (Dr. Royce Bargas): And so I would say there is some data to support about 5% for myalgia. So that's only 1 in 20 people. And I would say that's similar to my experience and practice of people would get muscle aches and pains, but it is a not uncommon cause. And if you're on a statin and you get muscle aches and pains and you stop your statin and it goes away, I always ask for a retrial because you never know is something else going on?

0:11:34 - (Dr. Royce Bargas): Retry the statin. If it comes back, then you don't tolerate the statin, don't take it. It doesn't mean you won't tolerate all statins. And so I think one of the big problems with why statins have gotten a bad rapid. I'll not get on my soapbox about conspiracy theorists and how the pharmaceutical industry has completely shot themselves in the foot by not being completely honest all the time. And their motivations are not the health of the American people. And that's very clear.

0:12:07 - (Dr. Royce Bargas): And Covid has not helped that. And so there's this whole population of people that are so anti big pharma that they're going to believe every single thing that's posted on the Internet about statins. And then they unfortunately throw the baby out with the bathwater and ward off all statin therapy, no matter what. They're never going to take one milligram of any statin. And that is not doing yourself a favor.

0:12:32 - (Josh Bellieu): Well, it sounds like you have a real selective approach in the way you prescribe statins to individuals. I know you. And later on we'll get into talking about your approach to be able to potentially help an individual, not even ever have to go on those. But so is it. And it sounds like how do you dial in on which statin to use with the individual? Is it just based on the feedback that you're getting or are you utilizing certain tests to determine, hey, this statin drug is not working well, we're going to switch to this one. This was.

0:13:02 - (Josh Bellieu): I didn't realize there was such a difference, and I'm picking that up from you. There's a big difference.

0:13:06 - (Dr. Royce Bargas): There's a huge difference. And so part of the problem with what have has given statins such a bad rap is that there were a couple very large trials using 80 milligrams of atorvastatin and they were positive outcome trials. And I would say right now with my colleagues, definitely interventionalists, the guys that are putting in the stents, the default is 80 milligrams of atorvastatin. Well, I have two problems with that.

0:13:34 - (Dr. Royce Bargas): First of all atorvastatin. And I'm not gonna blame them. They're very data driven. And the trial showed if you got a stent and you took 80 milligrams of atorvastatin, you didn't need another stent or you didn't have a heart attack after your stent, it really works. But the problem is that that is again not personalized medicine. It's just a blanket approach. Everybody needs 80 milligrams of atorvastatin.

0:14:00 - (Dr. Royce Bargas): So the two issues are that atorvastatin is a lipid soluble statin, there are water soluble and there are fat soluble statins. And a fat soluble statin is going to have a much higher propensity to cause problems because very easily penetrate into muscle tissue. And concerns for me are that they saturate the brain immediately because the brain is over 90% fat. And so they get into every brain cell. And so when you're thinking about are they gonna cause cognitive issues or are you gonna have the very common muscle aches, if you use a lipid soluble statin, you are much more likely than a water soluble statin. So rosuvastatin, that's great information.

0:14:43 - (Dr. Royce Bargas): Rosuvastatin is my go to statin. It comprises probably over 90% of any statin prescription that I write. And my colleagues would be like, well, it doesn't have the data of atorvastatin 80. And they're right, it doesn't. But I practice personalized medicine and I do what's right for my patient. It's well known to be the best tolerated statin in women and it's very potent. And so every side effect from a statin, I'm not even going to say side effect, I'm going to say effect.

0:15:12 - (Dr. Royce Bargas): Because we know that drugs and supplements all have effects and either they're the good or they're the bad, they're beneficial or they're detrimental. And every effect of a statin is dose dependent. So the more statin you use, the more likely you are going to get that effect. The great thing about Rosuvastatin is that you get huge reductions in cholesterol with teeny tiny doses. And so your chance of having any sort of brain fog, cognitive issue, muscle pain, liver damage, which is also another common side effect of statins, are extremely lower. From 5mg the lowest dose, or even 2 1/2mg half of the lowest dose of rosuvastatin than the cannonball of 80 milligrams of atorvastatin.

0:15:59 - (Josh Bellieu): So you're a functional medicine doctor and you've kind of danced around it. But if you have someone in from a functional medicine perspective, you talk about personalized medicine. How do you make just your patient sometimes say, I'd really like to avoid my patient pharmaceutical. Okay, okay.

0:16:19 - (Dr. Royce Bargas): That's why they come to me.

0:16:20 - (Josh Bellieu): But are there times though that you're educating your patient to where that person that may have said, I'm by golly, I'm never going to take a statin drug, you're saying, you know, in this particular situation it would be a great intervention and then I'm going to teach you some other things along the way. Do you.

0:16:34 - (Dr. Royce Bargas): That is normally always my conversation. So my job is to educate my patient and to give them their options, which is very different than the conventional approach where they're told, this is your one option, do it. It's the best thing. You'd be silly not to. I don't and I don't always use a statin either. There are other things that can be done. They are very effective and I do use a fair amount of them, but not always.

0:17:11 - (Dr. Royce Bargas): I take a lot of people off atorvastatin 80. Some of them go back on a statin, some of them don't. Some people have been given 80 milligrams of atorvastatin and don't even have high cholesterol. And that stems from a couple of the trials showing that the trials somebody has a heart attack and gets a stent, there's data not in the setting of acute heart attack, just angina. They get a stent and they all the trial was you either received atorvastatin 80 or you didn't.

0:17:43 - (Dr. Royce Bargas): And it didn't matter what your cholesterol is. And so there's this belief that atorvastatin 80 will be effective at preventing future events even in the setting of normal cholesterol. And I think that that comes from the very potent vascular anti inflammatory effect of statins.

0:17:59 - (Josh Bellieu): So are there biomarkers other than cholesterol that you look at in your practice to determine whether someone should use a statin or not?

0:18:07 - (Dr. Royce Bargas): 100%. And so I think cholesterol.

0:18:10 - (Josh Bellieu): How do you do that?

0:18:11 - (Dr. Royce Bargas): Sure. So like I said, cholesterol is definitely in a plaque. And I recently, I follow a couple integrative cardiologists and I recently referred to listen to one who will remain Nameless, that I completely respect him. And he literally said cholesterol doesn't cause plaque, which is just so naive. Like, when you do histopathology on the plaque, it is cholesterol. And so to say cholesterol is not the problem is just naive and completely ignoring very classic data.

0:18:43 - (Adam Payne): But isn't it oxidized cholesterol that's really the problem there?

0:18:47 - (Dr. Royce Bargas): It's oxidized cholesterol. It's teeny, tiny particle numbers, cardiovascular inflammation, it's sugar, sugar, sugar. It's a lot. Cholesterol is not the only problem. But if you want to believe it's a component.

0:19:01 - (Adam Payne): Right?

0:19:01 - (Dr. Royce Bargas): Yeah. If you want to believe that a plaque is not made up of cholesterol, that's just naive. Okay, so what other factors you asked me what other biomarkers do I use? So I look at cholesterol. Interesting. The ldl, which is classically what's used in conventional approach, because that is the marker that was used in every single clinical trial that looked statins. That's my least. That matters least to me when I'm thinking of all markers. And so I measure everybody's apolipoprotein B.

0:19:35 - (Dr. Royce Bargas): And so this is the carrier of the ldl. And I describe it to my patients very simply, think about your cholesterol as a traffic jam, a traffic jam in your bloodstream. And if you're wanting to think like, how bad is this traffic jam? You want to account how many vehicles are in the traffic jam, not how many people are in all the cars. Because it really matters not if there's one person in each car or if you have a bus with 100 people in it. What matters is the car or the bus.

0:20:07 - (Dr. Royce Bargas): And so measuring the LDL is like counting the people, but measuring the apolipoprotein B is like counting the cars. It's really the important predictor. And then you want to know of the bad, bad cholesterol, which is also kind of a misnomer. What are the particles like? Because you can have a high apolipoprotein B and you can have a high ldl, but they're kind of all these large, fluffy particles that float around the vasculature and don't really cause problems, or they can be the thousands of teeny, tiny particles that work their way into the arterial wall and cause disease.

0:20:43 - (Dr. Royce Bargas): And so the markers that look at that are called the SD ldl, small, dense ldl, and the LDL particle. And that's very important information to have, too. And then beyond that, there's all the factors beyond cholesterol that cause the problem. Like you alluded to, Adam, I always measure somebody's oxidized LDL in my integrative practice. I want to know. Oxidized LDL is literally like rancid fat in your bloodstream. It's super atherogenic. It's very inflammatory, and it really works its way into the arterial wall.

0:21:16 - (Dr. Royce Bargas): I want to know about inflammation. Inflammation, I believe, is the root cause of all disease. Cancer, heart disease, dementia. And so if you have inflammation, you need to put out that fire, no matter what your cholesterol number is. And I want to know, do you have systemic inflammation? There are biomarkers to look at that. Do you have inflammation in your arterial wall? You can actually measure that.

0:21:41 - (Dr. Royce Bargas): And then I want to know what your metabolic health is, because at the end of the day, hyperglycemia is incredibly damaging to your artery. It actually creates the tiny tears in the arterial wall that allow bad cholesterol plaque to work its way into the arterial wall.

0:21:56 - (Adam Payne): Yeah, yeah. These are. I mean, I'm so glad you're bringing up all these points because it's really what we've seen from practicing and helping people from the nutraceutical side, it's that, you know, the doctors that are really helping people are taking a multifactorial approach.

0:22:12 - (Dr. Royce Bargas): You have to.

0:22:12 - (Adam Payne): It's inflammation. It's, you know, one Kyle Drew, I think, calls, you know, high density of sugar on the red blood cells. Like sandpaper.

0:22:24 - (Dr. Royce Bargas): It is.

0:22:25 - (Adam Payne): It's like. It's literally. It's scraping and causing damage to the vasculature.

0:22:29 - (Dr. Royce Bargas): It's very damaged, to the very delicate endothelial.

0:22:33 - (Josh Bellieu): To end this episode, I've got a question that. So there was a book that came out from a very famous heart doctor, Dr. Sinatra, way back in the day, I think it was called the cholesterol myth. And one of the things he was doing is he was looking at empirical diets of cultures in various areas and saying people in this area have massively high cholesterol, no incidence of heart disease. You know, he would kind of go down the list, and that's, I think, where the kind of popularized the whole Mediterranean diet idea.

0:23:02 - (Josh Bellieu): So do you look at somebody's cholesterol? Obviously you don't, but I know a lot of doctors do. But high cholesterol is not necessarily a bad thing on a per case basis, individual to individual, is it? Especially if they actually, you're looking at their diet and things, and you're going, great lifestyle, great diet. Cholesterol is elevated. Do you still look at that and.

0:23:24 - (Dr. Royce Bargas): Go, hmm, I have goals for your cholesterol. I want your LDL particle number down. I want your SDLDL down. I want your APOB down now. Do I get more aggressive in some people than others? 100%. Am I willing to allow things to ride a little bit higher than my typical goals? If you have no inflammation, you have NO oxidation, your omega 3 levels are high, your 6 to 3 ratios are optimized, you have absolutely no metabolic dysfunction. Your coronary calcium score is zero.

0:24:01 - (Dr. Royce Bargas): Yes, it is a fact that there are people with very high cholesterol that don't get disease. And it's an even bigger fact that people with low cholesterol do get disease. And so again, cholesterol is not the only variable. But in my practice, I want to optimize all variables and cholesterol is definitely one of them.

0:24:21 - (Josh Bellieu): Very good. Well, you've been listening to Dr. Royce Bargus, D.O. board certified cardiologist, amazing lady Adam Payne on the end, adding some killer science to this while I sit here, jaw dropping. You have really opened my eyes to a lot of in 20 minutes. It's fantastic. So don't be discouraged and don't feel hopeless. We've got somebody here that's going to give you some answers. So we're going to have another episode that's going to take place and we're going to move into prevention and lifestyle and all kinds of things coming from someone that has seen hundreds, if not thousands of people completely turn around their heart health.

0:24:59 - (Josh Bellieu): Josh Bell, you hear Ultra Life today. Sam.