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Doctors' Answers to "Frequently Asked Questions" - Cholesterol

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

High Cholesterol and Birth Control [posted 1/11/99]
Question: In January 1998 I completed a home-kit to test my cholesterol level. Too much of my surprise, it read in the 300's. I am 22 years old, 5 feet 1 inch, and weigh 120 pounds. When I did a follow up with a cardiologist, the results came back at 472. Needless to say, this became a huge concern of mine. The doctor started me on Lipitor and took me off of my birth control and after 4 months on the medicine my cholesterol has decreased to 240. Do you think it is possible to go back on the birth control pill? I do not want to affect my health, but I am also not ready to start a family.

Answer: I doubt that the birth control pills were the problem. Restart them and see what happens to your cholesterol.

Mylanta/Zantac effects on Cholesterol [posted 1/7/99]
Question: Could the taking of an anti-acid such as Mylanta or Zantac have any adverse effect on cholesterol? I have a hiatal hernia and have so for many years. The Mylanta was prescribed at that time. I also have reflux, which presents a problem. My dosage of Mylanta is probably one to two tablespoons each night. I hate to take such controversial drugs.

Answer: Wouldn't think so, but you can experiment by stopping it for a month and see.

Cholesterol Medications &   Elevated CPK [posted 12/10/98]
Question: For the past 11 years I have been on a variety of cholestrol lowering medications, starting wiyh Questran, Mevacor, Lescol,Provaststin,Zocor and now Lipitor. All have worked at lowering my 350 level cholestrol to about 220 currently, but all (except Questran, which had only a small effect on my T. Chol) have caused an elevation in my CPK levels. For the past 10 years my CPK levels have been in the range of 300-370 mg/dl with 175 mg/dl listed as normal max. My doctor in the past has been concerned about these levels but more concerned about the cholestrol level. I have no muscle soreness or any other symptoms. My kidney function appears to be normal. I have been unable to find any info on long term consequence (other than possible kidney effects) with elevated CPK. My new doctor feels I should stop the Lipitor. I have concerns about this as it seems my choice is heart disease or damaged kidneys. Is there a range of eleveated CPK that is considered 'safe' longterm? Are there other problems associated with elevated CPK? Thanks for the help!

Answer: Most physicians and the company would recommend stopping the HMG Co A Reductase drugs if you have an elevation of CPK. Usually, bigger doses of Questran will work. Also, Lopid should not have this interaction.

Cholesterol & Problems [posted 12/04/98]
Question: I am a 37 year old woman who has had elevated cholesterol readings for the last 11 years. In spite of modified diet and regular aerobic excercise, my cholesterol level has fluctuated from 203-282, back and forth over the years. No matter how much I excercise, my HDL has never been any higher than 41, and no matter how much I restrict my diet (short of becoming a vegetarian), my LDL levels and Triglycerides remain high. My ratios have been as high as 7:1. This is extremely frustrating. Since I am not overweight, have low blood pressure, and do not smoke, my doctor has not recommended cholesterol lowering medication, even though heart disease runs in the family. My maternal grandmother had a heart attack at 54, and my Dad had a heart attack at age 60. He says that although medication would lower my numbers, he's not sure that medication would be appropriate at this time. He feels that "down the road" it may be indicated. I guess I'm wondering what he's waiting for and at the same time, wondering if I should get a second opinion. He is concerned that since I'm only 37, I could be potentially taking this drug for 50 years. He mentioned possible side effects concerning liver function. I don't want to solve my cholesterol problem by potentially creating a problem with my liver! I would like some advice regarding long term health risks (re: liver function) associated with the use of Lipitor and whether these risks would be  outweighed by the long term benefit of lowering cholesterol levels before a problem with my heart develops. I'd appreciate any information you could give me.

Answer: Most physicians would treat you with some lowering agent with your family history and your low LDL. As to the risk/benefit, this is currently under research by the NIH. This is an area which has been neglected by the NIH. I would recommend treatment until further research comes in;but, would not push the dosage and warch closely for toxicity. Also, Vitamin E(400 units or so a day) might be a benefit. This has been shown to reduce cardiac risk without much/any toxicity. This issue is a style thing-some physicians would treat some not until more data is available. With your family, I would opt for treatment. Also, you might check your homocysteine levels-if elevated might be an additional factor to consider. Lastly, unless there is a high risk of breast cancer, you need to be on estrogen when you hit menopause.

High Cholesterol & High Triglycerides [posted 12/01/98]
Question: Initially was diagnosed with high cholesterol & high triglycerides. Lipitor was prescribed but the desired effects were not achieved at lowering triglyceride levels. Was sent to a specialist who   prescribed Niaspan (niacin) in addition to the Lipitor. Currently, am taking 40mg Lipitor & 2g  Niaspan daily. Both cholesterol & triglycerides are dropping, but am concerned about any dangerous interactions between the two. Will I have to continue monitoring blood/liver CPK levels every 6 weeks? Should I be cautious when taking any OTC med. or when taking daily multivitamins?  

Answer: Well, I think lowering triglycerides is pointless unless they are above 2,000 (which gives a risk of pancreatitis). Not every physician would agree with me. But Framingham data shows minimal correlation between elevated trigs and coronary artery disease. However, if you need to lower your trigs you need to monitor it closely for the first 6-9 months, then you can usually lower the frequency of monitoring unless you increase your dosage. The tests are correct and the frequency correct. But, the frequency will decrease over time(for most physicians).

High Cholesterol [posted 11/25/98]
Question: I am a six foot 270 lbs male. I recently had my first physical in six years. My cholesterol was approx. 197, triglysorides 402 and my HDL 25. I went back today to have more blood drawn for liver function tests. From what I have been told and figured out on my own, I need to cut back on sweets and to lose weight. Is this all I need to worry about or is there something more serious I need to be looking for?

Answer: A cholesterol of 197 isn't bad; but, could be better. The problem is that your LDL(bad) cholesterol is high relative to your HDL(good) cholesterol. Exercise and losing weight will improve these numbers from just OK to very good.

Lipitor & Chlosterol
Question: I have been taking Lipitor 10mg for the past six months for high chlosterol. The reading has decreased from 6.2 to 4.3 which is very good according to my G.P. My question is , will this be a lifetime medication, and is the cost going to decrease? I pay 205 dollars canadian for 100 tabs.

Answer: The options for lowering cholesterol are losing weight and strict fat restriction in the diet. This can lower cholesterol-short of this you're in for the duration. You might be able to lower costs by buying the 20 mg and cutting them in half. This is certainly true in the states. Also, check the price in Mexico. Many of my patients go to Mexico to fill Rxs for cheaper.

Question: I am a 72 year male. Had a heart attack and then an angioplasty. All my cholesterol readings are great except my HDL of 33 won't increase. However, my potassium serum is just above max at 5.2. My Sodium serum is low at 135. My BUN is high at 27. My Creatinine serum is high at 2.1 Three questions: 1. Is there heart risk with a high potassium and low sodium ? 2. Is there kidney risk with the high BUN and Creatinine? 3. How far above or below the normal range can each of those be without really being a serious problem. What can I do to improve, individually, each of these?

Answer: Doesn't seem to be. Very high levels like 5.5-6.0 can cause a problem; but, less likely if it is chronic versus acute. The kidneys are already functioning at less than 100% to get this level of Creatinine. A normal creatinine is up to 1.6 or so. This is high-although still a way from dialysis. This would indicate either an outlet problem with your prostate or flow limitation due to vascular disease to the kidneys. Other causes would include the use of ACE inhibitors or excessive diuretics. I'd check on the kidney issue-the potassium is not a big deal and probably will correct if your kidneys start to work better.

Lowering Cholesterol [posted 11/5/98]
Question: I am interested to know if you have information as to a cholesterol reducing drug that does not have the side effects of muscular distress and joint pain. I have tried both zocor and lipitor and they both have produced side effects as described. The amount of each drug used was 10 mg. daily. I am a 56 year old male, very active 165 lb., 6 feet tall, with detected heart disease. I have been taking zocor for 3 years and switched to lipitor to avoid the side effects. I have been on a heart disease reversal program for the last 3 years and have had very positive results. I am only able to reduce my total cholesterol to 160 with diet, I need under 140 for the reduction program. Both zocor and lipitor produced the adequate lowering of the cholesterol, but also produced the side effects. I would like to find a drug that would reduce the LDLs, and not produce the muscular and joint pain.

Answer: Questran or lopid.

Family History of High Cholesterol [posted 10/30/98]
Question: My doctor recently put me on Lipitor for my cholesterol level of 301. Both my parents have high levels, I don't eat high cholesterol or fatty foods, am 28, weigh 110 lbs and excercise regularly. I have heard that the long term effects of lipitor have not yet been determined. Should I be concerned about being put on the drug at this young age for what is clearly a hereditary condition?

Answer:I would take the medication with your family history. But, also, is there a history of strokes etc or cardiac disease in those affected and what is the "good" cholesterol or HDL. All would be a factor. The long term side effects appear minimal.

An Aspirin a Day? [posted 10/30/98]
Question: I have been taking cholesterol lowering medication successfully for about one year.Cholesterol is in normal range, both total and LDL. A physian, not my regular physician, and family member suggested it may a good idea to take an aspirin a day, in addition to the Lipitor, as a blood thinner. Is that a good idea?

Answer: Generally for men over 50, maybe 40. The risk is GI bleeding, gastritis and the like, so use a coated or buffered aspirin. 81 mg(baby) to 325 mg would be the dosage. More is not better. If you have no history of GI problems with aspirin probably worth taking. Something, I recommend for all men over 50(over 40 with high risks)-doesn't have the same benefit in women by the way.

Triglycerides [posted 10/21/98]
Question: My wife had a cholesterol test that showed that her triglycerides was 556 about three months later she went to our family physican who looked at the coronary Risk profile and perscribed for her to take Gemfibrozil (600MB Tablets) one tablet two times a day. She did this and after taking these for three months had another cholesterol test taken which showed that her tyiglycerides were 84. My question is wether I should be concerned that it is too low now. And should I still continue taking Gemfibrozil?

Answer: What was her cholesterol levels? Does she have other risk factors-diabetes, hypertension etc. Lastly, was this taken fasting since triglycerides are very affected by dietary intake(as opposed to cholesterol levels). Many physicians would not treat elevated triglycerides unless they are several thousand since they are a minimal risk factor for coronary artery disease. Others disagree and would treat any elevation-this is one area that varies a lot. Weight loss and diet will often fix this problem. I would recheck the triglycerides fasting and not treat them if they are below 300 (maybe 500 depending on her other risks)-but, I wouldn't argue with physicians who would treat them

Cutting Pill in Half Yourself [posted 10/13/98]
Question: Is it ok to take 40 mg.every other day or do I need to cut the pill in half and take half one day and the other half the next. My insurance will pay for it if I cut it in half. this is a pain in the xxx. I need to take lipitor for high cholesterol

Answer: A lot of my patients save big $$$ by cutting a 40 in 1/2-go for it.

Cholesterol Testing [posted 10/1/98]
Question: I was recently tested for cholesterol levels, but was concerned when the nurse only took a drop of blood from a finger prick. Can they obtain a correct reading from this method? Please let me know as soon as possible. My dosage was upped to 40mg/day.

Answer:These tests are not accurate enough to proscribe treatment. They are accurate enough for screening. I would not use these tests to add/delete medications. Discuss this with your physician;but, you need a more accurate test if you are being medicated.

High Cholesterol [posted 8/4/98]
Question: I have very high cholesterol, total 400, LDL 330, HDL 50, normal triglycerides. After six months of 20 mg Pravachol my LDL was down to 290. My dose has been increased to 40 mg. I have a family history of heart disease (father 60). I follow a strict vegetarian diet, walk a brisk 5 miles per day and am 35 years of age. How low should my cholesterol be? Should I also take regular Niacin? I had some abnormal liver function tests 2 years ago when on slow release Niacin. My 10 year old twin sons have inherited my high cholesterol (total about 300) also. Should we be treating them? I try to give them a low fat diet.

Answer: The lower the better. You should be aiming for LDL of less than 160. This is insufficient treatment. Better more effective drugs would be zocor or lipitor. Pravachol would be unlikely to lower your LDL sufficiently to achieve the goal of 160. If large doses of zocor/lipitor do not achieve this - add a drug like Questran . This can be combined easily with the HMG-CoA drugs without side effects. If you cannot tolerate the GI side effects of Questran, I would use Lopid instead of niacin, but close monitoring of liver functions would be necessary. You are currently undertreated by a lot. As to your sons, there is a big split in medical circles concerning the optimum time to start their treatment. Some advocate early treatment with medications. Others state that harm can be done to their growth cycle by lowering cholesterol levels and that it should be delayed until 18 or so. There is no current answer to this problem. I think it reasonable to do either until more research is done. However, clearly start them at 18 or so and emphasize the diet/exercise regimen that you are adhering to. Lastly, screen for any other cardiac risk factors regularly, BP, diabetes and even things like homocysteine levels to ensure that cholesterol is your only risk factor.

Cholesterol lowering drugs and effects
Question: Recently, there have been reports that certain cholesterol lowering drugs, such as Mevacor, have side effects which include diminished coordination and mental abilities. What are the sources of these reports and what percentage of patients taking these drugs are reporting these side effects?

Answer: I haven't seen this as a problem with this drug or its cousins. You can get specific information from the company Merck at: 800-672-6372.

Cholesterol - Zocor vs. Lipitor
Question: I have been taking 10 mg Lipitor since triple bypass in January with very good results. My insurance company has recommended that I change to 40 mg Zocor and my Cardiologist has agreed. I am skeptical of this change. My cholesterol was initially 254 and TG was 180. After taking Lipitor, the cholesterol was down to 171 and TG down to 114. Can I expect the same results with the change?

Answer: The major difference is the specificity/affinity for the enzyme that the drug is inhibiting. Lipitor is more potent, but judge by your cholesterol. This problem comes up all the time and frankly it doesn't seem to matter if your cholesterol doesn't change. There may be a slightly higher risk of liver toxicity, so monitor your enzymes. Switch and see what your levels are.

Cholesterol Lowering Medications
Question: I need to start taking a cholesterol reducing medicine. I'm 36 and my family has an early history of heart trouble. Diet and exercise has not helped. My doctor has recommended Zocor. I'd like to know which is better, Zocor or Lipitor. I'm currently taking Loestrin FE 1.5 for ovarian cysts and minocycline 50 mg, two times a day for acne. What, if any, conflicts can I expect with either drug? What side effects and long term effects can I expect with Zocor or Lipitor?

Answer: They are both very effective with minimal to no long term side effects. Lipitor is slightly more efficient, but this can be compensated by increasing the Zocor dosage. I use both and it is usually a cost issue. Zocor comes in 40 mg tablets which can be cut in half since the price is similar to the 20 mg. This is very cost effective. If it doesn't matter about cost, flip a coin. However, I would lean towards Lipitor slightly.

High Cholesterol Drug Treatment
Question: Is there an over the counter drug to reduce high cholesterol?

Answer: Yes - there are several. First, a high fiber diet will reduce cholesterol and in some patients taking metamucil and/or citrucel will help 5% or so at best. Secondly, there is niacin. This is a vitamin, and in large doses (1000-1500 mg) will reduce cholesterol. It is usually available in a slow release format since taking it without the time release really produces flushing and occasional diarrhea. Taking does over 750 mg a day can cause liver inflammation or damage and you should have regular liver function test. This can be increased to 2000 mg a day IF (notice a big IF) you closely monitor liver functions.

High Cholesterol Treatment
Question: Please comment on possible treatment for a 67 year old female with a cholesterol was 90, LDL's of 150, and no other risk factors who does not want to take cholesterol-lowering medication due to cost and possible side effects.

Answer: It depends a lot on her HDL(good) cholesterol and her family history. If the HDL is above 65 or 75 and no women in her family have a history of strokes or heart attacks, I'd just have her watch her diet. Diet means low fat and losing weight to improve the cholesterol. If her HDL is below 50, I'd treat her with medications if diet doesn't improve her condition.

Question: The various medications used for lowering cholesterol have side effects. The drug Mevacor was prescribed for me a year ago and side effects of depression and anxiety brought me to a decision of discontinuing the medication (with a doctors approval). Blood tests have revealed high levels of cholesterol again and it has been recommended for me to take the medication again. Are there any medications for high cholesterol that will not produce anxiety or depression?

Answer: I have over 500 patients on this class of drug and have not seen this side effect. These HMG-CoA reductase drugs are the most effective and I'd try them again. The newest one Lipitor is the most effective for the least milligrams and I'd try it first. If it doesn't work, the binding resins like Questran have the least systemic side effects since they do not get absorbed into the body. They will cause abdominal gas, distention, etc., but will not cause any CNS side effects.

Question: I am a 51 year old male. My main concern is my high cholesterol levels, which are as follows:

My results on 5/24/94 were as follows:

Triglycerides    317 mg/dl
Cholesterol      270 mg/dl

My results on 6/20/94 were as follows:

Triglycerides   209 mg/dl
Cholesterol     320 mg/dl
HDL cholesterol 45  mg/dl
LDL cholesterol 242 mg/dl

The results on the following dates were:

                    02/08/94      09/06/94     06/17/95        04/03/96

S. Cholesterol     307 mg/dl     242 mg/dl    258 mg/dl       299 mg/dl
Total lipids       1100 mg/dl    930 mg/dl    770 mg/dl      1219 mg/dl
HDL                  46 mg/dl     49 mg/dl     37 mg/dl        35 mg/dl
LDL                 242 mg/dl    171 mg/dl    198 mg/dl       231 mg/dl

I took zocor tablets for 30 days (1 full tablet daily) and a
half tablet daily after 30 days for fifteen days and results 
were as follows:

Date: 06/11/96

S. Cholesterol     168 mg/dl
Total lipids       659 mg/dl
HDL                 46 mg/dl
LDL                106 mg/dl

After these results of 06/11/96,  I stopped taking zocor due 
to which my cholesterol results were as follows:
                    07/22/96       08/17/96       01/08/97   
S. Cholesterol      212 mg/dl      227 mg/dl      277 mg/dl  
Lipids              983 mg/dl     1050 mg/dl      753 mg/dl
HDL                  41 mg/dl       40 mg/dl       46 mg/dl
LDL                 151 mg/dl      147 mg/dl      224 mg/dl

After the results of 01/08/97,  I again took zocor tablets
(half tablet daily of 10 mg) for 18 days and my results are 
as follows:

Date: 01/25/97

S. Cholesterol    174 mg/dl
Lipids            814 mg/dl 
HDL                50 mg/dl
LDL               112 mg/dl

I am worried that as soon as I take zocor my cholesterol level will shoot up even though I play tennis regularly. Please advise me as to what I should do to control my cholesterol levels and whether I should continue taking zocor. If applicable, please recommend some other medication.

Answer: These numbers pretty clearly show that your cholesterol is low on zocor and high when you stop it. Zocor is only effective when you take it. If it is stopped the cholesterol will regain its usual value within 24-36 hours. Zocor works by inhibiting one of the enzymes that "turns on" cholesterol. So if you stop the inhibition everything reverts to normal states. Zocor is one of the most effective agents and is clearly working for you. However, you have to take it for it to continue to work.

Question: I am a male, age 49, and I exercise daily. My previous total cholesterol tests were always around 205 - 212. My recent "new PCP" visit physical test showed 289. My new PCP has prescribed me for a Zocor regimen. A second test at a clinicms, days later showed reading of 206. Would you go on the zocor regimen or would you suggest other means to get the reading a bit lower? I am basically very health with no other risk factors present.

Answer: Risk factors are the following 1) Male, which you are 2) Age over 50, which you are approaching. 3) Family History of Coronary Disease before 60. 4) Diabetes Mellitus. 5) Elevated cholesterol (defined as LDL over 130, some say 160). 6) Smoking. 7) Obesity. For each risk factor the risk is multiplicative. You fail to mention what your HDL(good) and LDL(bad) are. If the HDL is above 45-50 I doubt that I would treat this with medications unless you have other risk factors above. If your LDL is above 130, but less than 160, some would advocate treatment. However, this can be diet and weight loss, which is the best place to start before any medical regimen.

Question: My cholesterol is 237, I am 63 years old, exercise moderately, and eat a balanced moderate fat intake diet. I do not smoke. My doctor prescribed Lescol to reduce the cholesterol. Is this a safe long-term product?

Answer: It is relatively safe. There have been problems with liver toxicity, but these can be avoided by periodic liver tests during the first year or two. Most patients have some GI symptoms with this drug (gas, diarrhea, etc.) There does not appear to be long term toxicity except for the mentioned liver. There are significantly more potent drugs than Lescol, but it is very effective for patients with mild elevations like yours. It has also been studied extensively and is a very effective drug.

High Cholesterol
Question: My doctor has prescribed Diovan (valsartan capsules) for high cholesterol and I would like to know a little more about it. I was wondering when should I take it (morning, afternoon, or evening)? My doctor did not say. What side effects does it have? I also take two Naprelan every morning for pain from Fibromyalgia. Can these two be taken together?

He also prescribed amitriptyline to help me sleep, but due to the side effects I have chosen not to take it and try natural ways to help me sleep. Are there other similar drugs to help me sleep with less side effects?

I was recently told I have fibromyalgia, but I am not real keen on taking many drugs. I would rather lower my cholesterol naturally, if possible. I am 43 years old and am quite active. I show dogs for a living, but the pain sometimes gets in the way. Do you have any suggestions?

Answer: Unfortunately, I've never heard of Diovan and can't find it listed in any pharmacy text or the PDR. Is this a natural herb? I'd like to hear more, but I'm unable to help you here. Same with Naprelan. Amitriptyline is given to increase stage IV sleep. It is one of the few drugs that I am aware of that increases stage IV sleep. This is thought to be necessary to relax muscles, which is one of the first steps to improving fibromyalgia.

The best natural way to decrease cholesterol is to lose weight. A vegetarian diet and a high fiber diet will also help. There are several books available in any library or book store focused on diet solutions for elevated cholesterol. The American Heart Association will also provide you with dietary assistance.

Question: What is a normal level for cholesterol? How high is the heart disease risk for a person with high cholesterol?

Answer: Elevated cholesterol levels are certainly a risk factor for vascular disease. Usually a LDL(low density lipoprotein) of greater than 130 is high and over 160 needs treatment. This can be modified somewhat if the HDL (high density lipoprotein) is high. This usually means over 50 and the higher the better. However, other risk factors are very important in determining treatment. For example, a smoking male with a family history of coronary disease will get treated far earlier than a non, smoking female with no family history of vascular disease.

Cholesterol and Blood
Question: I have very high cholesterol (450+) that I am able to control to about 200 with 40 mg of zocor a day and 12 pills a day of 1 gram of cholestid. I have very cold feet all the time and also gave blood a couple weeks ago at the red cross. After over an hour and three punctures they gave up on getting a pint out of me as my blood was so thick it kept cloting in the needle and that area. Is there anything I can do to thin my blood? Is it necessary? I am somewhat concerned about this and my doctor did not seem to be when I expressed my concern.

Answer: Off hand, I can't figure any correlation between "thick blood" and high cholesterol. Occasionaly patients will have high triglycerides, but this should not effect the clotting. You do not mention your triglycerids, so these should he checked. Any male patient that is at high risk of coronary disease should usually be on one aspirin a day. This will markedly decrease the risk of coronary infarction and stroke. The risk is bleeding from the GI tract. But small doses(a baby aspirin a day) will suffice. I would discuss this with your doctor and get formal clotting times checked.

Question: What is the difference between simvastatin and pravastatin? Patient has very high cholesterol. This has been the 10th week after surgery ( 4-by passes). Leg vain was taken out. What's the next medicine we can suggest to the Doctor?

Answer: Simvastatin and pravastatin are similar drugs used to lower cholesterol. The major difference is cost.

Question: Has any bulk/fiber laxative other than psyllium been approved for lipid lowering? What is the mechanism of action and minimum effective dose?

Answer: Any fiber agent will lower cholesterol. This appears to be by the mechanism of slowing absorbtion of fat and making it less accesible to the intestinal wall. These agents have not been technically "approved" by the FDA, but numerous studies have documented the effect. In general, this effect is insufficient to lower high or moderately high cholesterol levels to satisfactory levels. Fiber also has the effect of lowering glucose levels in diabetics by slowing absorbtion.

Question: I am taking zocor for a cholesterol level over 300. I seem to be having various side effects. Lack of sleep, my arms go numb, and now my dentist thinks its effecting my gums. What other medications are available?

Answer: I must have 200 patients on this drug or something equivalent and I've never seen anything close to these symptoms. Indeed, I rarely see any side effects. Try stopping the drug and see if the problems resolve. I doubt that the zocor is the main actor here.

Cholesterol Lowering
Question: I eat all the right foods, except have a few drinks over the weekend and my Cholesterol is somewhat high. While in Burma I caught Hep from Food. I do not seem to be able to get my Ch down since then and really do not want to take medication, can you give me some advise.

Answer: First, lose some weight. Watching your diet without weight loss is pointless. Second, check for secondary causes of hypercholestemia(other medical conditions that can cause an elevated cholesterol). These include thyroid disease, occult diabetes mellitus, and nephritic syndrome(spillage of protein in the urine).

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