10Core Questions to Ask Your Doctor About Food and Cholesterol

1. What is my LDL, and what should it be?

2. What is my HDL, and what should it be?

3. Which foods/drinks raise LDL?

4. Which foods/drinks lower LDL?

5. Which foods/drinks raise HDL?

6. Which foods/drinks lower LDL?

7. How long should it take to change my cholesterol levels with food?

8. Do you know a specialist who can help me learn more about this?

9. Have you had any patients who have controlled their cholesterol with diet?

10. Is there an eating plan for me to follow that will help me with this?

What You Should Know About Vytorin: An Insider’s Guide

Vytorin isZetia (ezetimibe) plus Zocor (simvastatin). It has been available for prescription in the U.S. since 2004, and is a statin medicine—part of the statin class.
Each tablet contains 10, 20, 40, or 80 mg simvastatin and10 mg of Zetia. 2 drugs in one tablet.

Vytorin is a strong choice because it is powerful: it is more effective than Zocor alone, and it costs less than Zocor, and less than most other statins.

How effective? Vytorin20/10 mg lowers LDL (lousy) cholesterol by about 50%. That’s the equivalent of about Zocor 80 mg, or Lipitor 40 mgor Crestor 10 mg.
How inexpensive? Vytorin costs $25-$50 less every 30 days than nearly all of Zocor or Lipitor. Vytorin and Crestorcost about the same, because they are both new drugs.
So why not use it? Well, you should, if your physician recommended it. But here are some cautions: physicians generally try to use the least powerful drug they can to achieve the greatest effect, to avoid side effects, especially to start. More power, more side effects---at least that seems to be how statinswork.
What side effects? The same side effects and drug interactions as other statins. Specifically, liver and muscle problems. And drug interactions: if you are taking immunity drugs (cyclosporine,HIV protease inhibitors), antifungals (itraconazole, ketoconazole), antibiotics (erythromycin, clarithromycin), antidepressants/SSRIs (nefazadone) or drinking lots of grapefruit juice, your liver is working harder, and your level of one or more of these drugs changes.

Muscle effects: the most severe is rare but sometimes fatal (rhabdomyolsis). But muscle aches and myopathy are not rare with statins. Other drugs, like gemfibrozil and niacin (for cholesterol) can interact with Vytorin.So can heart medication, like amiodarone and verapamil
If you take Vytorin,take it at night: your liver makes all the cholesterol you need, and most of it is made at night. Zocor is more effective at night, and Vytorin is too.

Ask your doctor about lifestyle change, and foods you can eat in the right doses to lower LDL and raise HDL if you decide to take a statin: these strategies work together.

What You Should Know About Crestor: An Insider’s Guide

The FDA recently found that Crestor, a newer statin, has side effects similar to other statins—not bad enough to be taken off the market. But many patients have had more protein in the urine and more muscle aches with Crestor than with other statins…thus the 2005 FDA investigation.

People at risk for liver problems or muscle problems because of advance age, or reduced kidney function, or because of other drugs (named above) which may interact with statins should be wary of Crestor, for just those reasons.

If you are of Asian ancestry, or are Asian yourself, ask your doctor is you should be taking Crestor: there are recent reports in the medical literature that Crestor levels are twice as high in Asians than Caucasians. No one understands clearly why.
And if your doctor wants to double the Crestor dose, because your LDL is not dropping, be careful here too: doubling the dose often helps a little (less than 10%), but not double, for statins.

What You Should Know About Your HDL: An Insider’s Guide

HDL may be more important for protection against heart disease than LDL. Yours must be above 45 milligrams/dl.
What raises HDL? Aerobic exercise: 5% to 30%. Weight (fat mass) loss” 5% to 20%. Smoking cessation: 5%. And red wine (10 ounces for men and 5 ounces for women, daily): 5 to 30%. And, of course, estrogen.
Fish oil has no effect on HDL, in usual amounts.

Other oils have been considered: Enova oil, in Japan (inconsistent data); Rice Bran Oil (pulled from the market); even nut oils (no HDL effect).

Paradoxically, a high-fat, high-cholesterol diet raises plasma HDL: HDL is protective against LDL, and the body pumps out HDL to protect its arterial walls. This is one reason why some people who followed the Atkins Diet had elevated HDL, measured.
Some drugs raise HDL: most statins raise HDL 5% to 15%, as do some fibrate drugs.
Vitamin B3 (Niacin) is very effective: but you need a lot to raise your HDL. When it works, it’s remarkable: HDL can go up 35%.
You would think long-acting Niacin would be better---but actually the short acting niacin works best to raise HDL. Many people take a full aspirin one-half-hour before their Niacin to combat the facial flushing that is common.

The long-acting niacin, though, can be liver-toxic---it does have to be taken only once daily, and does cause less flushing. But most doctors don’t think the risk to the liver is worth the side-effect trade-off.

Niacin itself can have other effects---on blood sugar, on the liver (as above) and on uric acid levels, which can precipitate gout. “No-flush” niacin (inositol) has not been well-tested, and is not advised.

7 Peer-Reviewed References: Vytorin, HDL and You

 Ballantyne CM, Blazing M, King TR, et al. Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia. Am J Cardiol 2004;93:1487-94.

 Feldman T, Koren M, Insull W, et al. Treatment of high-risk patients with ezetimibe plus simvastain co-administration versus simvastatin alone to attain National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol goals. Am J Cardiol 2004;93:1481-6.

 Grundy SM, Vega GL, McGovern ME, et al. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes. Arch Intern Med 2002;162:1568-76.

 Goldberg AC, Sapre A, Liu J, et al. Efficacy and safety of ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc 2004;79:620-9.

 Pieper JA. Overview of niacin formulations: Differences in pharmacokinetics, efficacy, and safety. Am J Health-Syst Pharm 2003;60 (suppl2):S9-14.

 Toth PP. High-density lipoprotein and cardiovascular risk. Circulation 2004;109:1809-12.

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