We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Last time we talked about what cholesterol was, what HDL, and LDL were and how statin medications were very helpful for many people. This time we will talk about raising HDL.
If you remember, cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Medications like the statins are good at reducing the LDL, but what about increasing the HDL or “good” cholesterol? Weigh reduction and physical activity can each increase HDL up to ~25%, stopping smoking can increase HDL by ~5%, statins can increase HDL up to ~15%, and niacin can increase HDL up to ~35%.
If niacin is so good at increasing HDL, why isn’t it used more? There is a lot of confusion about types of niacin, side effects and how it should be used.
Vitamin B3 has two chemical names: niacin or nicotinic acid. There is a different form of niacin called nicotinamide. Both niacin and nicotinamide can be used to prevent niacin deficiency and to treat pellagra. Pellagra is a condition of niacin deficiency that includes rash, diarrhea and dementia. However, only niacin is useful to treat cholesterol problems.
If niacin is just a vitamin and is good at raising HDL, why don’t we all take it just in case? Although you can buy niacin without a prescription, I recommend anyone considering using it to consult their doctor first. Niacin has side effects. The most noticeable one is flushing of the skin and feeling very warm. Although this effect is not harmful, it makes many people uncomfortable enough that they quit niacin. Other common, nontoxic, reversible effects of large doses of niacin are dizziness, nausea, low blood pressure, fast heart beat, headache, and blurred vision. Of more concern is that niacin can raise blood sugar, cause gout, and like other cholesterol pills, niacin has rarely been associated with liver problems. Niacin should be avoided in people with chronic liver disease, severe gout, active stomach ulcers, and certain bleeding problems. It can be used with caution in people with diabetes and mild gout.
If your doctor wants to start you on niacin, they will probably want to do blood tests on your liver, uric acid and blood sugar before they start the niacin and periodically after that.
There are also different niacin preparations. The fast acting niacin tends to give people more flushing, but the slow acting tends to cause more liver problems. There is also a vitamin commonly called no-flush niacin that contains inositol hexaniacinate. Although it may have other beneficial properties, it will not help cholesterol levels.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Tuesday, June 29, 2004
Wednesday, June 09, 2004
What's Good About Cholesterol? Part 1 of 2
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Cholesterol. You’ve read about it. It scared you away from eggs. Then Aitken’s diet and the other low-carb, high protein diets said eat eggs. Starchy snack foods are labeled “Cholesterol Free”. Does that make them good for you? A few years ago a popular prescription chosterol medication called Baycol was pulled off the shelves. Does that make all cholesterol medications bad for you? And what is this good cholesterol, bad cholesterol stuff mean anyway?
Let’s start with, what is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. It is used to make bile acids which help your digestive system work, hormones which help regulate different body functions and it is also found as an important part of the cell membrane which is located around every cell in your body. Although cholesterol is essential for life, you don’t have to eat any. Your body, mostly your liver, can make all the cholesterol you need.
So what does all this LDL, HDL, VLDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Diet and exercise are very important to prevent and treat cholesterol problems, but I’m going to talk about medications. The most common LDL lowering medications are a group of medications called the statins. The statins stop an important step in the liver’s synthesis of cholesterol, so the liver makes less cholesterol. So the statins do a good job of reducing LDL. They are also generally well tolerated. They can cause some stomach upset which can usually be fixed by taking them with food. Much more rarely they can cause muscle pain and/or liver damage. Your doctor will check for liver problems with blood tests, and if you get body aches all over see your doctor. The prescription drug Baycol was pulled off the market because it caused liver problems more often than other statins.
There is a lot of good news about statins. If you take your statin as prescribed and get your LDL, HDL and Triglyceride numbers where your doctor wants you can reduce your risk of having a heart problem or dying of a heart problem by 14-40%. Besides lowering LDL cholesterol they seem to protect the heart in other ways. There are theories that the statins have a good effect on the lining of the blood vessels called the endothelium. There has been some study of statin drugs reducing the risk of breast cancer in women. The results are not conclusive but are interesting and promising. There have been other reports that statin drugs reduce the incidence of prostate and kidney cancer. Again there is not enough evidence for everyone to take statins to prevent cancer, but more research should be done.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Cholesterol. You’ve read about it. It scared you away from eggs. Then Aitken’s diet and the other low-carb, high protein diets said eat eggs. Starchy snack foods are labeled “Cholesterol Free”. Does that make them good for you? A few years ago a popular prescription chosterol medication called Baycol was pulled off the shelves. Does that make all cholesterol medications bad for you? And what is this good cholesterol, bad cholesterol stuff mean anyway?
Let’s start with, what is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. It is used to make bile acids which help your digestive system work, hormones which help regulate different body functions and it is also found as an important part of the cell membrane which is located around every cell in your body. Although cholesterol is essential for life, you don’t have to eat any. Your body, mostly your liver, can make all the cholesterol you need.
So what does all this LDL, HDL, VLDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat, so it doesn’t mix with blood, which is mostly water, very well. The liver has to mix the cholesterol with proteins and other stuff to get it to stay in the blood. This mixture of cholesterol (a lipid or fat) and protein is called a lipoprotein. If you take a blood sample and spin it really fast, it separates based on density. So different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol and other lipids from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol and other fats from the cells lining the blood vessels to the liver. This can decrease the chance of blockages.
Diet and exercise are very important to prevent and treat cholesterol problems, but I’m going to talk about medications. The most common LDL lowering medications are a group of medications called the statins. The statins stop an important step in the liver’s synthesis of cholesterol, so the liver makes less cholesterol. So the statins do a good job of reducing LDL. They are also generally well tolerated. They can cause some stomach upset which can usually be fixed by taking them with food. Much more rarely they can cause muscle pain and/or liver damage. Your doctor will check for liver problems with blood tests, and if you get body aches all over see your doctor. The prescription drug Baycol was pulled off the market because it caused liver problems more often than other statins.
There is a lot of good news about statins. If you take your statin as prescribed and get your LDL, HDL and Triglyceride numbers where your doctor wants you can reduce your risk of having a heart problem or dying of a heart problem by 14-40%. Besides lowering LDL cholesterol they seem to protect the heart in other ways. There are theories that the statins have a good effect on the lining of the blood vessels called the endothelium. There has been some study of statin drugs reducing the risk of breast cancer in women. The results are not conclusive but are interesting and promising. There have been other reports that statin drugs reduce the incidence of prostate and kidney cancer. Again there is not enough evidence for everyone to take statins to prevent cancer, but more research should be done.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Thursday, June 03, 2004
Vitamins and Your Eyes
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A couple of years ago, people kept coming into the pharmacy looking for vitamins with lutein in them. I, frankly, had no idea what they were talking about. Then vitamins like Icaps, Ocuvite and Vitalux among others started appearing with lutein in them. Lately, I’ve seen patients come in with recommendations from their optometrists for Vitalux AREDS for macular degeneration. So can vitamins help you eyes? Should you just eat lots of carrots? Do carrots help you see better anyway?
Let’s start with carrots. Carrots contain carotenoids. Carotenoids are yellow to red pigments found in a variety of plants. Carotenoids are a group of chemicals that include beta-carotene, lycophene, and lutein. I am over simplifying the chemistry here, but for this article we will consider beta-carotene as a water soluble version of vitamin A and the other carotenoids as antioxidants that are good for your eyes and other things. Not enough vitamin A can cause night blindness, so eating carrots and getting beta-carotene can prevent nightblindness. So, yes in that way carrots are good for your eyes. In an odd twist, though, people who smoke or have a history of asbestos exposure should not use beta-carotene supplements. There is some evidence to suggest this increases their risk of lung and prostate cancer.
It is less clear what lutein does for you. Lutein is believed to work in two ways. First it filters blue light. If you remember back to high school physics, blue light has the shortest wavelength of the visible light spectrum, so it has the highest energy. So lutein filters high energy blue light which is protective for the eye. The second thing lutein does is act as an antioxidant. Lutein finds and destroys “bad” oxygen molecules. Oxygen can be turned into a oxygen radical by things like being hit with light. Free oxygen radicals are “bad” because they are just dying to react chemically with anything they touch. If they react chemically with certain parts of your body’s cells they can damage or kill the cell. So it is a good thing that lutein gets rid of these reactive oxygen species. Researchers also believe that the more people consume lutein, the less they get eye problems like age-related macular degeneration (AMD) and cataracts.
The lutein data is promising but not conclusive yet. There was a small study of 90 patients called the LAST (Lutein Antioxidant Supplement Trial) in the journal Optometry in 2004 that showed that lutein alone or in combination with other nutrients improved visual functions in patients with AMD. But because the study was so small and had mostly men in it and didn’t go on for very long (1 year), it is not the final word yet.
Well what is this age-related macular degeneration anyway? AMD is the leading cause of blindness in people 65 and over in the Western world. People with AMD may notice such things as the center of their vision getting blurry. Lines on graph paper may appear wavy, and the squares may appear distorted.
So what about Vitalux AREDS for macular degeneration? Well, the National Eye Institute in the US sponsored the Age-Related Eye Disease Study (AREDS). The AREDS study concludes that zinc plus antioxidants can slow the progression of intermediate or advanced AMD in high risk patients. At the moment, it has not been showed that these vitamins help people with early AMD. The patients in the AREDS study used a vitamin C 500mg, vitamin E 400 IU, zinc 80 mg, and beta-carotene 15 mg. This is the dose you get with 2 tabs of Vitalux AREDS.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
A couple of years ago, people kept coming into the pharmacy looking for vitamins with lutein in them. I, frankly, had no idea what they were talking about. Then vitamins like Icaps, Ocuvite and Vitalux among others started appearing with lutein in them. Lately, I’ve seen patients come in with recommendations from their optometrists for Vitalux AREDS for macular degeneration. So can vitamins help you eyes? Should you just eat lots of carrots? Do carrots help you see better anyway?
Let’s start with carrots. Carrots contain carotenoids. Carotenoids are yellow to red pigments found in a variety of plants. Carotenoids are a group of chemicals that include beta-carotene, lycophene, and lutein. I am over simplifying the chemistry here, but for this article we will consider beta-carotene as a water soluble version of vitamin A and the other carotenoids as antioxidants that are good for your eyes and other things. Not enough vitamin A can cause night blindness, so eating carrots and getting beta-carotene can prevent nightblindness. So, yes in that way carrots are good for your eyes. In an odd twist, though, people who smoke or have a history of asbestos exposure should not use beta-carotene supplements. There is some evidence to suggest this increases their risk of lung and prostate cancer.
It is less clear what lutein does for you. Lutein is believed to work in two ways. First it filters blue light. If you remember back to high school physics, blue light has the shortest wavelength of the visible light spectrum, so it has the highest energy. So lutein filters high energy blue light which is protective for the eye. The second thing lutein does is act as an antioxidant. Lutein finds and destroys “bad” oxygen molecules. Oxygen can be turned into a oxygen radical by things like being hit with light. Free oxygen radicals are “bad” because they are just dying to react chemically with anything they touch. If they react chemically with certain parts of your body’s cells they can damage or kill the cell. So it is a good thing that lutein gets rid of these reactive oxygen species. Researchers also believe that the more people consume lutein, the less they get eye problems like age-related macular degeneration (AMD) and cataracts.
The lutein data is promising but not conclusive yet. There was a small study of 90 patients called the LAST (Lutein Antioxidant Supplement Trial) in the journal Optometry in 2004 that showed that lutein alone or in combination with other nutrients improved visual functions in patients with AMD. But because the study was so small and had mostly men in it and didn’t go on for very long (1 year), it is not the final word yet.
Well what is this age-related macular degeneration anyway? AMD is the leading cause of blindness in people 65 and over in the Western world. People with AMD may notice such things as the center of their vision getting blurry. Lines on graph paper may appear wavy, and the squares may appear distorted.
So what about Vitalux AREDS for macular degeneration? Well, the National Eye Institute in the US sponsored the Age-Related Eye Disease Study (AREDS). The AREDS study concludes that zinc plus antioxidants can slow the progression of intermediate or advanced AMD in high risk patients. At the moment, it has not been showed that these vitamins help people with early AMD. The patients in the AREDS study used a vitamin C 500mg, vitamin E 400 IU, zinc 80 mg, and beta-carotene 15 mg. This is the dose you get with 2 tabs of Vitalux AREDS.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Pregnancy Testing at Home
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.mb.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is nothing quite so scary/exciting/bewildering/overwhelming as looking at a small chunk of plastic in your wife’s hand and having that little chunk of plastic tell you that you are going to have your first child. It was two years ago that happened to me now, but I still remember the stomach churning feeling. So what about these tests? Do they work? Do they make mistakes? When can you use them?
Let’s start with how these tests work. All the tests are looking for a hormone in the woman’s urine called human chorionic gonadotropin. Since that is a mouthful, let’s just call it HCG. If an egg (ovum) is fertilized by a sperm, it floats down the fallopian tube, gets to the uterus (womb) and attaches itself to the uterus wall (endometrial wall). The connection to the endometrial wall is called the placenta. The placenta produces HCG. So in healthy women HCG is a good thing to look for because it is only produced by the placenta.
With lab equipment, it is possible to detect HCG as little as six days after conception, but all the information I read on the home urine tests said the earliest they could detect HCG was the day of the first missed period. The amount of HCG in a woman’s body varies during the day. It is highest between 9 am and noon (so this is usually the best time of day to do the test). The amount of HCG increases exponentially in the woman’s body and peaks at about 60 days from conception. Then the HCG level drops. So it is possible that if you do a home pregnancy test too late in the pregnancy, it might give you a false negative (same you are not pregnant when you actually are).
Most tests on the market now can be done one the first day of the missed period. They all give results within one to three minutes. They all have a control indicator. This shows you that a test was actually done. For example if you did the test and the symbol for not pregnant appeared and the control symbol also appeared, you should be relatively confident you are not pregnant. If you did the test, got a not pregnant symbol, but no control symbol appeared, the test is meaningless and should be disregarded. Most tests don’t require you to collect urine in a cup. They can be put directly into the urine stream. Most test claim it doesn’t matter what time of day the test is done, but remember HCG should be highest in the morning.
Eventhough today’s tests are quick and easy, mistakes are possible. Human error is still the most common problem, such as holding the wrong end of the device in the urine stream. The control is your best friend for this kind of error. Remember that if the control symbol does not appear, some part of the test wasn’t done properly and the results should be discarded.
There are other things that can give false results on a home pregnancy test, including:
· Testing before missing your period (i.e. testing too soon)
· Testing after 60 days of conception (i.e. testing too late)
· Contaminating the device with soap, dirt etc.
· Urine with blood or protein in it
· Use of fertility drugs
· Something else in the body producing HCG like a tumor (rare)
· Doing test after a missed or incomplete abortion
If you do have a positive pregnancy test, see your family doctor. They will want to confirm the test, and if you are pregnant, early pre-natal care is important.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is nothing quite so scary/exciting/bewildering/overwhelming as looking at a small chunk of plastic in your wife’s hand and having that little chunk of plastic tell you that you are going to have your first child. It was two years ago that happened to me now, but I still remember the stomach churning feeling. So what about these tests? Do they work? Do they make mistakes? When can you use them?
Let’s start with how these tests work. All the tests are looking for a hormone in the woman’s urine called human chorionic gonadotropin. Since that is a mouthful, let’s just call it HCG. If an egg (ovum) is fertilized by a sperm, it floats down the fallopian tube, gets to the uterus (womb) and attaches itself to the uterus wall (endometrial wall). The connection to the endometrial wall is called the placenta. The placenta produces HCG. So in healthy women HCG is a good thing to look for because it is only produced by the placenta.
With lab equipment, it is possible to detect HCG as little as six days after conception, but all the information I read on the home urine tests said the earliest they could detect HCG was the day of the first missed period. The amount of HCG in a woman’s body varies during the day. It is highest between 9 am and noon (so this is usually the best time of day to do the test). The amount of HCG increases exponentially in the woman’s body and peaks at about 60 days from conception. Then the HCG level drops. So it is possible that if you do a home pregnancy test too late in the pregnancy, it might give you a false negative (same you are not pregnant when you actually are).
Most tests on the market now can be done one the first day of the missed period. They all give results within one to three minutes. They all have a control indicator. This shows you that a test was actually done. For example if you did the test and the symbol for not pregnant appeared and the control symbol also appeared, you should be relatively confident you are not pregnant. If you did the test, got a not pregnant symbol, but no control symbol appeared, the test is meaningless and should be disregarded. Most tests don’t require you to collect urine in a cup. They can be put directly into the urine stream. Most test claim it doesn’t matter what time of day the test is done, but remember HCG should be highest in the morning.
Eventhough today’s tests are quick and easy, mistakes are possible. Human error is still the most common problem, such as holding the wrong end of the device in the urine stream. The control is your best friend for this kind of error. Remember that if the control symbol does not appear, some part of the test wasn’t done properly and the results should be discarded.
There are other things that can give false results on a home pregnancy test, including:
· Testing before missing your period (i.e. testing too soon)
· Testing after 60 days of conception (i.e. testing too late)
· Contaminating the device with soap, dirt etc.
· Urine with blood or protein in it
· Use of fertility drugs
· Something else in the body producing HCG like a tumor (rare)
· Doing test after a missed or incomplete abortion
If you do have a positive pregnancy test, see your family doctor. They will want to confirm the test, and if you are pregnant, early pre-natal care is important.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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