Cholesterol

Aug 1, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I've got one pikachu, 2 rattata's and an egg. And I have no idea what any of that means. I do know I got them one morning while I was getting ready for work. Eric took my phone and went running around the neighborhood to catch them. Then oddly, during summer vacation, my 11 year old asked to be woken up at 6:30 am the next morning so he could get his running stuff on. He wanted to run to and around a neighborhood church for an hour before I went to work with my phone. Some of you will recognize this odd behaviour as Pokemon Go. For everyone else, Pokemon Go is smart phone video game. You have to move around your actual, physical neighborhood to catch mythical creatures. And it encourages 11 year old boys to go for a morning jog.

Who knew video games could encourage exercise? That is as heretical as saying eggs and butter don't effect your cholesterol. Or maybe lots of truisms out there aren't so true. Let's start with eggs. Eating foods high in cholesterol will not raise your blood cholesterol. Yes, you heard me right. Go get those 3 over easy eggs at Corrina's tomorrow. When the USDA 2015 Dietary Guidelines for Americans came out, they officially listed cholesterol as "not a nutrient of concern for overconsumption". In plain speak, that means eating cholesterol doesn't raise your blood cholesterol levels. Now the thinking is maybe saturated fat foods like butter aren't so bad either.

In a March 2014 meta-analysis in the Annual of Internal Medicine, Chowdhury et. al. found no association between the intake of saturated fats and the chance of having heart disease. More recently, Laura Pimpton et al, published a meta-analysis in the journal PLOS in June 2016. The review was called "Is butter back?" Their review of the evidence shows butter to be kind of neutral health wise. It is not as good as eating cold water fish or nuts, but not as bad as drinking pop.

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. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Your liver can makes all the cholesterol you need. So again, the cholesterol you eat doesn't go directly into your blood stream. Your liver makes cholesterol for you.

Why does your doctor test your blood for cholesterol if it is essential for life? Why does your doctor care if your blood cholesterol is too high? Your doctor cares about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke. Heart attacks and strokes account for about one third of all the deaths in Canada. That is why cholesterol medications are so common. In fact, Pharmacy Practice just published its Top Drugs List of 2015 based on the IMS Brogan databases. The 2015 top 4 most prescribed drugs in Canada contained two cholesterol drugs, atorvastatin and rosuvastatin.

Statins are so popular because HMG-CoA reductase inhibitors, or statins are the most potent LDL lowering medications we have. They seem to help in reducing hardening of the arteries or atherosclerosis. Statins have been shown to reduce death due to heart attacks and stroke. In fact, if we reduce someone's LDL with statins, we can reduce their chances of heart attacks and strokes by 25% to 35% with five years' use. As effective as statins are, like every other medication, they do have potential side effects. The statins may upset your stomach. Less common, but more serious problems can include liver issues. Our doctor will check your liver function with a blood test. Other signs of liver problems include flu like symptoms, yellow eyes or skin, dark urine and belly pain. If you start getting a lot of muscle pain, please contact your doctor. Severe muscle injury from statins is rare, but can damage the kidneys.

The statins do a good job of reducing LDL. But, what does all this LDL, and HDL stuff mean? Your liver makes cholesterol, and it puts it into the blood stream. Cholesterol is a kind of fat or lipid. Since blood is mostly water, cholesterol doesn't mix well with it. The liver has to mix the cholesterol with proteins to get it to stay in the blood. This mixture of cholesterol and protein is called a lipoprotein. If you take a blood sample and spin it really fast in a centrifuge, it separates based on density. Different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called "bad" cholesterol because it transports cholesterol 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 away from the cells lining the blood vessels. This can decrease the chance of blockages.

So if eating eggs and butter is okay and won't increase our blood cholesterol, what shouldn't we eat? That is more complicated. Eating lots of sugars and carbohydrates is probably bad. Eating lots of carbohydrates raises the blood triglycerides. Triglycerides are another blood lipid that does bad things to our blood vessels. Eating trans-fats is probably bad. Trans-fats are found in margarine, many commercial baked goods, such as cookies and cakes, and most deep-fried foods. A clue to their presence is the words "partially hydrogenated" on the list of package ingredients. If you are looking for good things to eat, you still can't go wrong with fruits and vegetables with lots of bright colors.

Last Wednesday, I came home from a meeting about the up coming 20th Anniversary MS Bike ride to Clear Lake in September. Instead of finding my family lying around in front of various screens, they were all missing. I wasn't alien abduction, Eric had dragged his mom, sister and dog out Poke hunting. They were gone for an hour. I'm sure like most fads, Pokemon Go will be short lived. But I have a suggestion for Niantic, the makers of Pokemon Go. Could they please develop games that require kids to eat their vegetables and do their homework next? Thanks

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.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

Heart Attack and Stroke Risk calculator: https://www.cvdriskchecksecure.com/FraminghamRiskScore.aspx

Butter not so bad http://www.huffingtonpost.ca/2016/07/05/butter-good-for-you_n_10814454.html?utm_hp_ref=canada-living

USDA dietary guidelines and cholesterol - http://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf

Chowdry et. al. "Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis" -http://annals.org/article.aspx?articleid=1846638&resultClick=3

The McGill Comprehensvie Health Improvement Program http://www.chiprehab.com/

Is Butter Back? - http://journals.plos.org/plosone/article?id=info%3Adoi%2F10.1371%2Fjournal.pone.0158118

 


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