I have no opinion on the use of statins. I don't take them, I don't
prescribe them. Such non-surgical treatment is well outside the paradigm by
which I treat disease and I know about as much about that class of drugs as
a typical Internist or Family Practicioner knows about gallbladder surgery
(very, very little).

I do know that the "gallbladder disease" that statins might cause is
gallstones - statins do not cause primary gallbladder disease. How the OP
got his gallstones is irrelevant. Now he's got them, they're symptomatic,
and his gallbladder needs to be removed. Stopping simvastatin will have no
bearing on what happens to his gallbladder from now on - the damage is done.

Note that this does not imply that I think that his gallstones were caused
by statins. In the sum total of gallbladder disease around the world, the
contribution of that class of drugs to that surgical problem is minor.

HMc

http://www.impostertrial.com/physician.htm

How to Treat Patients with Hypercholesterolemia Who Can't Take Statin
Therapy

We see many patients who have already suffered statin induced
rhabdomyolysis or who have suspected statin associated myopathy with
normal CK.  Many of these patients have biopsy proven myopathy.  Some
have less certain diagnoses because of typical symptoms or marked
improvement during a two week trial off of statins.  For each of theses
patients, the decision about how best to treat their hyperlipidemia is
based on the balance between how important it is to lower their plasma
lipids and how certain the diagnosis of statin associated myopathy is.
At one extreme are patients whose statin therapy was based on elevated
lipid levels in a low risk individual (primary prevention) and who may
have a solid diagnosis of statin induced myopathy by biopsy.  These
patients are told to remain off of statins and depending on the
severity of their lipid disorder we may recommend some combination of
the therapies below.  At the other extreme are high risk individuals,
e.g. post myocardial infraction with diabetes, in whom the suspicion of
statin associated myopathy is less certain.  Barring pathological
evidence of myopathy or severe weakness we usually continue these
patients on a reduced dose of statin therapy in combination with some
of the therapies described below.

No matter where the patient falls on the spectrum of atherosclerotic
risk vs. certainty of myopathic diagnosis, we explain the uncertainties
and give them this hand out so that they can participate in the
treatment plan (patient handout).

The therapeutic options which we offer to patients with hyperlipidemia
who can not take statins include:

   1. Low Fat Diet

   The best low fat diets are also high in viscous fiber and in plant
sterols.  The best tested of these diets, known as the Portfolio Diet
uses additional dietary options to increase the effectiveness of a diet
already consisting of reduced saturated fats and dietary cholesterol.
This diet conforms to the National Cholesterol Education Program (NCEP)
Adult Treatment Panel III recommendations. In clinical trials, the
Portfolio Diet reduced LDL Cholesterol levels up to 29% comparable to
some statin therapies. The main components of the Portfolio Diet are
summarized here:

       *

         this is a vegetarian diet
       *

         margarine enriched in plant sterol esters is used daily
       *

         10 grams of viscous fiber daily per 1000 calories of diet
consumed:  oats, barley and psyllium (Metamucil)
       *

         okra and eggplant are included as vegetable sources of
viscous fiber, with 100 and 200 grams of these vegetables on alternate
days
       *

         21.4 grams of soy protein daily per 1000 calories consumed:
soy milk, soy meat alternatives
       *

         14 grams of whole almonds daily per 1000 calories consumed

   A typical day's diet is formatted in the "Further Reading"
section below.

   2. Mediterranean Diet
   3. Exercise
   4. Resins and Cholesterol Absorbing Drugs:

       Brand Name     Generic Name
       WelChol     colesevelam
       Questran     cholestyramine
       Colestid     colestipol

   5. Non-statin Cholesterol Lowering Drugs

       Brand Name     Generic Name
       (n/a)     niacin*
       Lopid     gemfibrozil
       Tricor     fenofibrate
       Zetia     ezetimibe

       * niacin is available in multiple slow release formulations

   We have discovered that over half of patients who are intolerant of
statins have muscle side effects on these other cholesterol lowering
drugs as well.  Despite the fact that some of these drugs are marketed
as a safe alternative for patients where statin muscle toxicity is a
concern, they have not been tested in this patient group.  We have now
published our experience with a high incidence of ezetimibe causing
muscle symptoms in patients with previously diagnosed statin muscle
toxicity and a report of ezetimibe monotherapy causing myopathy is in
review.  Our preference as of 2005 is to proceed with resin therapy as
the first alternative lipid-lowering option in any patient who is
statin intolerant.

   6. Plant Stanols and Sterols 2 grams a day at lunch are advised
(see 1. above)

   7.  Policosinol (an aliphatic alcohol made from sugar cane wax with
HMG-CoA reductase properties and no described myopathy).  This
neutraceutical is not regulated by the FDA and has been tested and used
in Cuba.  Available data are tabulated and referenced on the
policosanol page.  There is also a patient information sheet available
on the join a study page.  We have completed a preliminary study of 25
patients with prior statin intolerance using a U.S. source of
policosanol (Greco T, 2003 pending publication).  While there was no
myopathy in this indicator patient group, the U.S. formulation did not
lower cholesterol levels as the Cuban formulations have.  Thus we
advise caution before recommending this unregulated neutraceutical.

   8.  Red yeast rice   This product is included in a number of
neutraceuticals which have been banned by the FDA.  They contain active
statin and have been associated with both myopathy and rhabdomyolysis.
These products are dangerous in patients with prior reactions to
statins.

----------snip----------

Per outrider:

It sounds like somebody thinks I'm "statin-intolerant".  Have I got that part
right?

If so, based on what?   Gallstones?    Low testosterone?  

It's anecdotal, but I think I know quite a few people who have had gallstones
but never been on a statin - not to mention occurrances of the condition
throughout history.

As far as low testosterone goes, unfortunately I do not have a base line from
youth or before beginning Zocor.   But all my life I have had abnormally small
testicles.    Never seemed to slow me down any... but now with advancing age,
couldn't one just pass it off on general loss of function?  I'd suspect that no
organ, gland, muscle, or whatever in my bod is performing with anything like the
efficiency it did in youth - or even middle age - and is probably deteriorating
steadily and normally.

i.e. maybe one needs a certain minimum hormone level and symptoms like fatigue
et. al. don't appear until one's level falls below that minimum - and if the
glands are marginal to begin with, one might fall below that minimum as a normal
part of the aging process.

If it sounds like I'm fighting this, you're right.   You're talking  beeeeeg
ideas here....flying in the face of my little frog-in-the-well view of the
scientific/medical establishment.... so I'd say it's deserving of some critical
thought on my part before accepting anything.