Cholesterol should be put in perspective

  DEAR DR. DONOHUE: I am 87 years old and weigh 114 pounds. My cholesterol is 238 mg/dL (6.2 mmol/L). My LDL cholesterol is 140 (3.6) and my HDL cholesterol is 56 (1.5). My doctor has had me on five different cholesterol medicines, and every one of them caused muscle pain. Is there any medicine that doesn’t cause muscle pain? I eat fish three times a week. I eat mostly fruits and vegetables, and lots of fiber. I eat whole wheat. I never eat red meat. What more can I do? -- E.M.

ANSWER: You’re doing everything you can. Your diet is perfect. The medicines that gave you muscle pain were probably the statin drugs -- Zocor, Pravachol, Crestor, Lescol, Lipitor and Mevacor. They are the most-often-prescribed cholesterol-lowering medicines, and they are the ones most often implicated with muscle pain. There are other cholesterol-lowering medicines not related to statins -- Niacin, Questran, Welchol, Colestid, Lopid and Tricor, and they don’t usually cause muscle pain. However, do you really need a cholesterol drug?

Your total cholesterol is slightly over the desirable 200 (5.2) mark, but it’s within a range called borderline high -- not something to lose a lot of sleep over. Your good HDL cholesterol is just fine. Your bad LDL cholesterol is slightly high, but again it’s in a range called borderline high. I don’t believe you have a big worry. We have all gone crazy over cholesterol because it’s given in a number by which we can judge “healthiness.” That’s putting too much emphasis on one health factor. Others are equally important: blood pressure, diabetes, smoking, obesity, peripheral artery disease. You apparently have no other great risks for heart disease or stroke. You can be a little less cholesterol-vigilant, especially at your age.

I entered your information into the Framingham Risk Calculator. According to this evaluation, at your present cholesterol level you have a 6 percent chance of having a heart attack in the next 10 years. If you lower your cholesterol to 200 (5.2), you have a 5 percent chance -- not exactly an eye-popping change. Common sense ought to intervene here. Ask your doctor if you can ease up on cholesterol medication. I believe you can.

The booklet on cholesterol explains this national obsession in detail. Readers can order a copy by writing: Dr. Donohue -- No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have been told that if you drain the whey from yogurt, it is less fattening. Is this true? Do you also remove some of its benefits?

I have a problem knowing which vitamins metabolize better if taken separately. Is it better to take a vitamin between meals, or only in the morning with breakfast?

Is calcium supposed to be taken with vitamin D? Can fish oil be taken with orange juice, since oil and water don’t mix? -- S.

ANSWER: The watery liquid that collects at the top of some yogurt brands does have vitamins and minerals. It should be stirred into the rest of the yogurt. I can’t believe that throwing it away reduces the calorie load appreciably. One reader, a certain Ms. Muffet, is offended that you throw away whey. She eats both curds and whey, and she is in excellent health.

A multivitamin, like yours, is best taken with or after a meal that contains some fat. Vitamins A, D, E and K are fat-soluble vitamins. That means they need some fat for full absorption.

Vitamin D enhances calcium absorption, but you don’t have to take the two at the same time. I can’t find any information that fish oil and orange juice are incompatible.

DEAR DR. DONOHUE: In the paper, you listed 13 drugs for high cholesterol. Every one of those drugs has bad side effects. Maybe it’s better to control cholesterol with diet and exercise. I wouldn’t take those drugs even if someone gave me a million dollars. After all, no one lives forever in this dictatorship world. -- Anon.

ANSWER: No one argues with you. Cholesterol lowering should begin with a change in diet and with exercise.

How did you manage to work a “dictatorship world” into this discussion?

       * * *

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.