DEAR DR. ROACH: I am taking Zetia and niacin for extremely high cholesterol and triglycerides. Exactly what type of diet should I be on to lower my cholesterol and triglycerides? Many of the processed (cheese, ice cream, cookies, etc.) fat-free, cholesterol-free foods are high in sugar. Should I be on the South Beach Diet or a strictly vegetarian diet? How many calories, carbohydrates and fat grams should I consume daily to lose weight? I am a 5-feet-4-inch-tall female who weighs 160 pounds. When I was on the Atkins diet for more than 20 years, I was always slim and had no health problems. Thank you. – J.D.
ANSWER: You are asking how to lower cholesterol, but I think what you really want to know is what diet reduces risk of heart disease. The right question is: What diet should you be on that will help you be healthier in the long term? All of the diets you mention have their strengths and weaknesses. Almost everyone agrees that avoiding sugar and processed grains is a key factor in reducing heart disease risk, but, despite decades of research and controversy, there isn't agreement on the best diet for overall health.
I think it's possible to take some wisdom from all the diets you mention, and to avoid some of their potential pitfalls. Both the Atkins and South Beach plans avoid simple sugars and excess carbohydrates, and I would emphasize that red meat and saturated fats should be kept at reasonable levels. A vegetarian diet emphasizes vegetables and fruits, but some people will gain weight on this diet, especially if they aren't careful to choose good sources of protein and healthy fat, or choose refined carbohydrate sources like the cookies you mention.
I have often recommended the Mediterranean diet, since there is high-quality evidence that it reduces heart disease risk. This diet calls for lots of vegetables and fruits, lean proteins such as fish, healthy fat such as from olive oil and nuts, and whole grains.
The medications you are taking, ezetimibe (Zetia) and niacin, do lower cholesterol, but it isn't certain whether either of them really reduces risk of heart disease. The statin class of drugs is best shown to reduce heart disease risk in people of above-average risk.
DEAR DR. ROACH: I have a difference of opinion with a friend. One of us contends that taking tablets one at a time with a short period in between allows the full strength to get into your system. The other contends that it doesn't matter, and swallowing everything together is just as effective. Your comment? – C.G.
ANSWER: With only a few exceptions, I agree with person No. 2. The body is very good at absorbing medications, whether you take them a few seconds, minutes or hours apart. The exceptions are when one medicine blocks the absorption of another; for example, calcium prevents absorption of tetracycline antibiotics. Some antacids block absorption of many medications. Your pharmacist can tell you whether you should take medications spaced widely from one another.
DEAR DR. ROACH: I have had hot flashes, similar to those experienced by post-menopausal women, ever since my coronary bypass in 1990. I can be sitting quietly in a chair reading or at my computer, and suddenly I find myself dripping with perspiration. I also have had panic attacks, with increased heart rate and other physical symptoms. A few years ago, a 24-hour EKG showed heart-rhythm irregularities and that my heart stopped briefly while asleep.
If these idiosyncrasies of my autonomic nervous system are a consequence of my time on the heart-lung machine for the bypass, I'm not complaining – just curious. You said that studies have been done on almost everything. Is this one? – W.S.B.
ANSWER: I found that a lot of people complain of similar symptoms. I also found that, indeed, the autonomic nervous system (the part of the nervous system that regulates temperature, sweat, blood pressure and many other critical aspects of body function without our being consciously aware of it) can be adversely affected by cardiac surgery. Some authors have suggested that the autonomic nervous system changes are one mechanism by which people are more likely to have depression after cardiac surgery. I found several possible explanations why the ANS changes with bypass surgery, but no clear consensus.
I would want to be sure that there are no other causes of these symptoms. It sounds like you have had an extensive evaluation, but I certainly would be concerned about a sudden fast heart rhythm, such as atrial fibrillation.
The booklet on abnormal heart rhythms explains atrial fibrillation and the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing: Dr. Roach – No. 107W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: Can you explain the condition known as "stone shoulder"? I am a man, 67 years old, and I believe I have it. I spent 45 years as a TV news photographer, handling heavy cameras, tripods, etc. – B.J.
ANSWER: "Stone shoulder" is a new one for me. Maybe you mean frozen shoulder, a condition also called "adhesive capsulitis." It's not a strictly accurate term, since the loss of movement the name implies is gradual. It starts with shoulder pain, often worse at night, lasting for months. Stiffness develops, and then the loss of shoulder movement can be severe. A careful physical exam by a regular doctor, a rheumatologist or sports medicine doctor, or an orthopedic surgeon can make the diagnosis. Often, the doctor will inject a steroid and anesthetic into the shoulder: The pain relief and improved movement within a minute make the diagnosis. I refer patients to physical therapy for a gradually increasing exercise regimen. Sometimes, additional injections are necessary.
In your case, I would worry about a rotator cuff tear or inflammation, which you also might have acquired while doing your job. A careful exam usually can distinguish these. Occasionally, an MRI is required.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2015 North America Synd., Inc. All Rights Reserved