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Category Archives: Cholesterol

Very few products available in your local pharmacy can claim as many uses as Omega-3 fatty acids. Omega-3s are a type of unsaturated fat that are found in high quantities in certain fish (such as salmon, herring, sardines) as well as plant sources (such as flax).

The two most common Omega-3s found in supplements are EPA and DHA. Some supplements will have their Omega-3s derived from fish oils while others will be derived from plant sources. Be sure to choose a product that lists the amount of EPA or DHA per capsule.

There has been some concern by patients over the levels of heavy metals (such as mercury) in Omega-3 fish oils. However, heavy metals tend to accumulate in the protein of the fish rather than the fats. In addition, Health Canada tests all Omega-3 products for their heavy metal content before being made available to the public.

Here are 5 common medical conditions that Omega-3s can help treat:

1. Arthritis – Omega-3s have been shown to help decrease inflammation in the body, therefore they may help relieve some of the pain associated with both osteoarthritis and rheumatoid arthritis. Between 3 – 5 grams of EPA and DHA for 12 weeks are needed for the anti-inflammatory effects.

2. Hyperlipidemia – Omega 3-s can help lower triglyceride (fat) levels circulating in the body. High triglyceride levels contribute to the formation of fat deposits in blood vessels. This can lead to hardening of the arteries, which allows for the formation of dangerous clots which can cause a heart attack or stroke. Studies have shown that 2 – 4 grams of fish oils can lower triglycerides by 20-50%.

3. Hypertension – Omega-3s have a modest effect on reducing blood pressure and may be a viable option for patients with mild hypertension who do not wish to start a prescription medication at this time. Omega-3s reduce the production of agents that constrict blood vessels and increases production of agents that open blood vessels. For cardiac health, 1 gram of EPA plus DHA daily is recommended.

4. Depression – Studies have shown that 1 gram of EPA twice daily may yield anti-depressant and/or mood stabilizing effects. Omega-3s may be suited for the treatment of specific populations, such as pregnant or lactating women where conventional antidepressants must be used with caution.

5. Loss of Vision – Recent studies have shown the beneficial effects of omega-3s on vision, specifically decreasing risk of age related macular degeneration. Further investigations are needed to confirm the results of these studies, however many ophthalmologists are now recommending that their patients take Omega-3 supplements.

If supplements are not for you, try to replace the meat in two of your meals per week with fish. Certain populations (such as Mediterranean and Inuit) that eat high amounts of fish and little amounts of red meats have much lower rates of cardiovascular disease compared to the North American populations.

Omega-3s are not for everyone. For patients on blood thinners such as Coumadin (warfarin) or Aspirin (ASA), be sure to check with your physician or pharmacist before starting on Omega-3s as they may increase the risk of bleeding.

 

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           Many patients come into the pharmacy and have questions about cholesterol and what they can do to decrease it. Whether they found out they have elevated cholesterol through routine blood work or have a family history of high cholesterol, patients are curious about natural ways of lowering their cholesterol.

            There are two types of cholesterol: a “good” cholesterol (HDL) and “bad” cholesterol (LDL). For patients with high cholesterol, the goal of therapy is to increase the amount of HDL and decrease the amount of LDL. Approximately 80% of cholesterol is made by the body and only 20% comes from the food you eat.

            Many commercials for food products such as cereals and margarines are advertising that they can help lower cholesterol. The goal of this article is to examine the evidence of the effectiveness of various natural health and food products on the market that claim to lower cholesterol.

            Products that contain soluble fibres such as psyllium (ie. Metamucil) or oat bran are known as bile acid binders. These products increase the excretion of cholesterol from the body as well as increase the breakdown of cholesterol in the body to less harmful products. Between 10 and 30 grams of psyllium fibre daily mixed with others foods has been shown to have a significant cholesterol lowering effect.

            Between 1.5 and 3 grams per day of Niacin (Vitamin B3) has been shown to lower bad cholesterol while increasing good cholesterol. In some patients, Niacin can cause skin flushing (redness of the skin) as well as itching. There are “flush-free” or “no flush” Niacin products available; however, their effectiveness has not been established.

            Plant sterols and stanols often found in margarines labeled heart healthy (such as Becel Pro-activ) have been shown to prevent some of the absorption of cholesterol from the diet and can be included as part of a healthy diet high in fruits and vegetables to lower cholesterol.

            Finally, some studies have shown that between 600 and 1200mg of garlic in three divided doses can lower the levels of cholesterol and triglycerides (fat) in the body. Unfortunately, some patients report bad breath as well as nausea and flatulence when taking this amount of garlic.

            Patients who have been prescribed a cholesterol lowering medication called a “statin” such as Crestor (rosuvastatin) or Lipitor (atorvastatin) can consider taking Coenzyme Q10. Statins inhibit the synthesis of Coenzyme Q10, which may lead to muscle weakness and impaired energy metabolism.

            If you have any questions about natural health products available to help lower your cholesterol, be sure to ask your physician or community pharmacist to see if those products are right for you.

Grapefruit and grapefruit juice are an excellent source of many nutrients that contribute to a healthy diet. Grapefruit is a good source of vitamin C, fiber, and the pink and red hues contain the beneficial antioxidant lycopene, thought to have a role in preventing various diseases such as cancer and heart disease. Studies have shown that grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties.

However, there are compounds in grapefruit called furanocoumarins that can interfere with the way your body metabolizes certain medications. This can lead to dangerously high levels of medication in the body and may increase the risk of rare but serious or life-threatening side effects such as slowed heart rate and muscle deterioration. For a few medications, it can lead to decreased effectiveness because these medications need to be metabolized in order to become active. Don’t take these interactions lightly, as some can cause potentially dangerous health problems.

Both grapefruit juice (either fresh or frozen) and the fruit itself can affect certain medications and the effects have been seen with as little as one 8-ounce (250 mL) glass of grapefruit juice. The effects of grapefruit juice on medications can last up to 3 days, so taking them at different times of day will not help. Naturally sweet orange juice has not been shown to affect medications the way grapefruit juice does, but tangelos (which are related to grapefruit), lime juice, andSeville(sour) oranges may affect medications.

Many medications may be affected by grapefruit juice, including medications for:

Allergies Fexofenadine (Allegra)
Anticoagulation Dabigatran (Pradax)
Anxiety/Sleep Buspirone (BuSpar), Diazepam (Valium), Triazolam (Halcion), Alprazolam (Xanax), Clonazepam (Rivotril)
Arrhythmia Amiodarone (Cordarone)
Blood Pressure Amlodipine (Norvasc), Felodipine (Renedil, Plendil), Nifedipine (Adalat)
Cholesterol Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
Depression Sertraline (Zoloft)
HIV Saquinavir (Invirase, Fortovase), indinavir (Crixivan)
Seizures/Epilepsy Carbamazepine (Tegretol, Mazepine), Clonazepam (Rivotril)
Sexual Dysfunction Sildenafil (Viagra), Taldafil (Cialis)
Transplants/Autoimmune Diseases Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf, Advagraf), sirolimus (Rapamune)

This is not a complete list; grapefruit juice may affect medications for conditions other than those listed here. Also, if you are taking any natural health products, check the labels to see if they contain grapefruit, tangelo, Seville orange, or lime juice. Avoid these fruits and juices until your doctor or pharmacist has told you it’s safe to have them.

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Most people are aware that it is important to have their cholesterol checked.  We know that “high” cholesterol may be a predictor of heart disease and stroke.  Confusion arises regarding what our cholesterol readings mean and what we should do about it.

Guidelines recommend men over forty and women over fifty should have their cholesterol tested.  Other high risk individuals should also be tested.  Even if you do not fit in to one of those categories it is a good idea to have your cholesterol screened even at a young age to have a baseline reading.  A new blood test looks at something called High-sensitivity C-reative protein (hsCRP).  This is an important test for individuals who may have a strong family history of heart disease, but their cholesterol levels are good.  It can predict cardiovascular risk in asymptomatic individuals.  Research is now suggesting if this number is higher than three, individuals should start on a statin medication like Crestor.  This may prevent a first heart attack.  Prevention is very important as fifty percent of patients will suffer sudden death with an initial heart attack.

Physicians use specific guidelines in order to determine when to use medication to treat high cholesterol.  Patients are classified in high, moderate, and low risk categories depending on their likelihood of having a heart attack within the next ten years.  Obviously patients in the highest risk category are treated most aggressively to reach specific cholesterol targets.

Physicians are interested in a patient’s LDL cholesterol often called bad cholesterol. They also look at a patient’s total cholesterol/HDL cholesterol ratio. The following is a chart of cholesterol targets.

High Risk Level

Moderate risk level

Low Risk level

LDL-C<2.0 mmo/L

LDL-C<3.5 mmol/L

LDL-C<5.0 mmol/L

TC/HDL-C<4.0mmol/L

TC/HDL<5.0 mmol/L

TC/HDL<6.0mmol/L

If you are interested in your cholesterol readings you may ask your physician for your laboratory results and your risk classification.

Cholesterol medications affect your cholesterol in different ways.  Depending on what your cholesterol readings are, certain meds will lower your bad cholesterol.  Others will raise your good cholesterol.  Sometimes patients need to be on more than one medication.  Medications called statins like Lipitor and Crestor work to decrease your body’s production of cholesterol.  Others like Ezetrol decrease the amount of cholesterol you absorb from your diet.  In general cholesterol medications are fairly well tolerated.

Diet and exercise may help your cholesterol but dietary intake only accounts for about 10% of the body’s cholesterol.  The rest is produced by the body.  This is an area where genetics plays a large role.  Some over-the-counter treatments may also help.  Niacin can be bought without a prescription and will help lower your bad cholesterol.  Unfortunately it is not always well tolerated and can cause redness and flushing.  Fish oil, specifically Omega 3’s, can help protect against heart disease and some of the negative effects of cholesterol. Of course it is always a good idea to check with a physician before taking any supplements.

The best way to check your cholesterol is with a 12 hour fasting laboratory test.  However, the pharmacy will sometimes run screening, and cholesterol clinics.  If you are interested please call to find out when we are having our next clinic.