Question: I have low cholesterol. My LDL was 17 when last checked, and my total cholesterol was 82. My triglycerides were 32.
I weigh 160 pounds and am 6 feet tall. I cannot find a doctor who thinks my cholesterol numbers are a problem, but I feel awful and have no energy.
How do you raise cholesterol? I have tried shrimp, beef, eggs, butter, bacon, etc. So far, I haven’t had any success.
Answer: Doctors have focused almost exclusively on the dangers of elevated cholesterol. As a result, they may have a hard time conceiving of low cholesterol as a problem.
A study published in the journal Neurology (April 10, 2019) suggests that women with LDL cholesterol below 70 are at double the risk for a bleeding (hemorrhagic) stroke. Those with the lowest triglycerides (under 74 mg/dL) were also more susceptible to bleeding strokes. Data from the Taiwan Stroke Registry involving 40,000 patients demonstrate a link between low total cholesterol and a risk of bleeding in the brain (PLOS One, April 19, 2017).
There are no Food and Drug Administration-approved medications to raise cholesterol. Most health professionals discourage a diet high in saturated fat on the grounds that it might elevate cholesterol and the risk for a heart attack or clotting stroke. Please discuss your dilemma with your doctor, bolstered by the recent research.
Question: I wanted to respond to your column about generic levothyroxine. The person writing to you had taken levothyroxine from three different manufacturers within six months. She worried that such switching might pose a problem.
I am a pharmacist. The reason patients have been getting levothyroxine from different manufacturers is due to shortages, particularly of Mylan medicines. Believe me, pharmacists want patients to stay on levothyroxine from the same company. However, when the product is unavailable, we have to switch manufacturers, or the patient gets nothing.
Why don’t you write about all the shortages of common drugs? The public needs to understand that pharmacists are on their side, but sometimes our hands are tied.
Answer: We share your sense of frustration about drug shortages. This crisis has been going on for years. Although the FDA publishes a list of medicines in short supply, it has not offered solutions to this supply-chain difficulty.
When drugmakers have quality-control problems, they frequently recall substandard medicines. Such has been the case with blood pressure pills like losartan and valsartan. This is challenging for pharmacists, patients and physicians.
Question: I was told by my pharmacist that it was OK for my mother to eat grapefruit with her blood pressure medicine, but not to drink grapefruit juice. He said that pressing the grapefruit for juice releases some chemical from the skin that is the culprit in the drug interaction.
My mother lived to be 94, eating her daily grapefruit. I guess he was right.
Answer: There is ongoing confusion about the grapefruit-drug interaction issue. The Food and Drug Administration disagrees with your pharmacist. So does the world’s leading expert on this interaction. Dr. David Bailey and his colleagues note that “all forms of the fruit (freshly squeezed juice, frozen concentrate and whole fruit) have the potential to reduce the activity of CYP3A4” (CMAJ, March 5, 2013). This enzyme helps break down many commonly prescribed medications. If it is less active because of grapefruit, some drugs become more potent and riskier.
Not all blood pressure medicines are affected, though. People taking calcium channel blockers such as felodipine, nifedipine and verapamil should probably avoid grapefruit. Most other BP drugs are not impacted by grapefruit. Perhaps your mother was taking a medication that was not altered by grapefruit.
Question: Last year I went on the keto diet to lose a few pounds. After three weeks I was shocked at how my knees felt almost no pain. After six weeks they felt better than they had in years. I told my husband I had forgotten how it felt to have no knee pain. I was really amazed and thankful.
Answer: A small study confirms your experience (Pain Medicine, online, March 13, 2019). A low-carbohydrate diet reduced pain intensity and improved mobility.