There is continuing disagreement over diet, fitness and cholesterol-lowering drugs


August 31, 1993|By Joe Graedon and Dr. Teresa Graedon | Joe Graedon and Dr. Teresa Graedon,Contributing Writers/King Features Syndicate

When it comes to cholesterol you can't win. Doctors disagree, often vehemently, about whom to treat and how to do it.

We thought the controversy was primarily between British cardiologists and their U.S. counterparts.

This was clear in the case of Margaret, who spends half the year in the United States and half in London. Her American doctor wants her on the cholesterol-lowering drug Pravachol because her total cholesterol is 234 and he wants it below 200. But her British physician thinks that strategy is typical American overkill. Her good HDL cholesterol is high (86) and her risk factors are low, and he points out that such medications haven't been proven to prolong life.

Faced with such confusion, Margaret caved in to her American doctor. He was a good salesman for medicine and she decided to "play it safe" and take the Pravachol.

After we told Margaret's story, we heard from Dr. David Pitts, director of the Chattanooga Cardiovascular Risk Prevention Clinic. He pointed out that U.S. doctors are not unanimous about cholesterol treatment; Dr. Pitts agreed with Margaret's British physician that overzealous treatment is inappropriate.

He referred to the current guidelines as stated in the Journal of the American Medical Association for June 16, 1993, which, Dr. Pitts said, "would not endorse treatment for this lady. It sounds like many people are being treated unnecessarily while others who need treatment are left untouched."

The new guidelines suggest that for people like Margaret, whose total cholesterol is between 200 and 239 (borderline-high), "the level of HDL cholesterol and the presence or absence of multiple other CHD (coronary heart disease) risk factors determine the follow-up." In her case, the experts counsel instruction in healthy eating and proper exercise, and having her return for another cholesterol test in a year or two.

But drug companies have been very aggressive in promoting their newest cholesterol-lowering medications. Focusing only on total cholesterol may simplify decision making, but can do patients a disservice.

Physicians like Dr. Pitts are sensitive to the complexity of risk reduction and encourage their patients to make changes in activity and diet to improve overall health.

Others are cynical about people's ability to change. Many physicians see their overweight, smoking patients return year after year and become discouraged about the practicality of lifestyle changes. They are also dubious that diet can make much of an impact on cholesterol levels. In fact, a review of studies shows that the suggested diet only lowers cholesterol about 2 percent, not enough to make much difference for most people.

But Americans are winning the battle with heart disease. Cholesterol levels have dropped 15 points since 1960. Heart attacks and strokes are also down substantially.

For now, experts like Dr. Pitts recommend following the guidelines of the National Cholesterol Education Program.

I can't believe I read in your column that Skin-So-Soft bath oil doesn't work as an insect repellent. I use it and have not been bitten by pesky insects when doing gardening. I put a drop on my ear tips and along the top edge of ears, across my forehead, under my chin, on my nose, arms and legs.

I can hear mosquitoes singing around me but they never land. Before, I would have bites all over. I garden when I get off from work in the evening and that's when it's biting time. But no more.

P.S. I tried a squirt of it in the threshold corners of doors to outside and around my sink and it deters ants also.

Whoops. Although the experts at Consumers Union maintain that in their tests Avon Skin-So-Soft was ineffective against mosquitoes, our readers love this bath oil for its repelling properties. Jacquelyn from Orlando writes that she has been using it for fishing, hunting, camping or just sitting outside. She urges, "Use it! It keeps the bugs from bugging you and moisturizes your skin at the same time."

I am totally confused about potassium. For six years I took a water pill called hydrochlorothiazide to control blood pressure. My doctor also prescribed K-Dur to replace potassium and told me it was essential.

My new doctor has just changed my prescription to Dyazide. He was emphatic that I should stop K-Dur. Won't that be harmful? He also prescribed Premarin. Does this hormone decrease the need for potassium?

Dyazide is a combination of hydrochlorothiazide, the diuretic you took before, and triamterene, a potassium-sparing diuretic. That's why your doctor warned you to stop K-Dur. In combination with the Dyazide, extra potassium could lead to a dangerous buildup of this mineral. Too much potassium is as bad as too little.

Dyazide and Premarin may deplete your body of folic acid, however. A supplement that also contains vitamin B-6 and vitamin E would be sensible.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert. Their newest book is "Graedons' Best Medicine" (Bantam Books).

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