Now I have been told I have biliary cirrhosis. My doctor told me it was likely due to the statins.

DEAR READER:
Statins are well known for the side effect of liver damage. That is why doctors should check cholesterol and liver enzyme levels at least once a year on individuals taking these powerful medications. However, I can find nothing indicating that statins lead to biliary cirrhosis. This is not to say it is not caused by the medication, but there is a chance your biliary cirrhosis is completely unrelated.

Primary biliary cirrhosis is a condition in which the bile ducts of the liver become irritated and swollen. This in turn can block the flow of bile leading to liver damage. It is more common in middle-aged women and may be associated with autoimmune disorders such as arthritis, hypothyroidism and others.

Symptoms generally come on gradually and can include fatigue, itching, jaundice, abdominal pain and much more.

Treatment aims to relieve symptoms. Fat-soluble vitamins (A, K, D) and calcium may need to be supplemented. Medication may be needed to reduce itching and assist in the removal of bile from the bloodstream. Without treatment, most patients will require a liver transplant after about seven years.

Now to statins. Most cholesterol-lowering medications contain statins. These can cause an increase in liver enzymes. Mild elevations generally don’t call for treatment or cessation of the drug. More severe increases, however, often require stopping the medication. Enzymes usually return to normal with no permanent damage.

For those with drastically elevated enzymes that are ignored, permanent liver damage can occur. It is generally accepted that (again) stopping the statin can lead to improvement and reduction of symptoms.

Now comes the challenging part. Is your biliary cirrhosis due to liver damage caused by your long-term statin use, or is it an unrelated condition? This is something that you need to find out. A simple guess is not good enough. I strongly urge you to return to your physician and ask for a referral to an appropriate specialist for further testing and treatment.

If your biliary cirrhosis is not due to the statin, you may benefit from continuing it, as elevated cholesterol levels can result from the disorder. On the other hand, if your liver damage is due to the statin (and unchecked or ignored elevated enzyme levels), it will be important to stop the medication as soon as possible.

Because you also have a heart condition, you should not stop the medication without physician approval because elevated cholesterol levels and CAD (coronary artery disease) can increase the risk of heart attack, stroke and death. It is vital that you are closely monitored.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
You are in the majority when you think you can add your HDL, LDL and triglycerides to come up with a total cholesterol count. Unfortunately, that’s not how it works. Total cholesterol is a combination of high density lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (VLDL).

Before going any further, I would like to make an observation. You claim that your LDL is 16. If this is true, you might just have the lowest LDL in the world. But also, by taking your reading of 243 and subtracting your HDL and LDL, your VLDL is 149. This is incredibly high. Normal VLDL levels range between 5 and 40. LDL levels in general should be below 130. Below 100 is considered optimal. HDL should be 40 or higher. Triglycerides should be below 150.

So assuming you simply forgot to write a third number on your LDL level and you meant that it was 116 (meaning the VLDL would be 49) or 160 (VLDL would be 5), you are likely fine. Were I your physician, I would not be concerned your total cholesterol is slightly elevated. Based on your age (no disrespect intended), and the general normalcy of your numbers, I would leave well enough alone. My only recommendation would be for periodic lab testing since red yeast rice can affect the liver because it is a natural statin similar to Mevacor. Adverse effects of these products include muscle problems and kidney impairment commonly associated with prescription statins.

Also, a research study published in 2006 in JAMA, showed that policosanol did not improve cholesterol levels over that of a placebo.

For those readers who are considering alternative methods of cholesterol lowering, I urge you to speak with your physician for direction on the specific product you wish to try.

Those readers who would like more information should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Your help in this matter would be greatly appreciated.

DEAR READER:
As I have indicated numerous times in the past, almost every drug, even over-the-counter aspirin, carries side effects for some individuals. You don’t indicate what medications, other than your cholesterol-lowering drug, you may be on. Most major brands of cholesterol lowering medications can cause serious muscle pain and/or leg cramps.

Now we can approach the next issue. Restless leg syndrome (RLS) is characterized as an uneasiness, fatiguing, twitching, and itching deep in the muscles of the lower part of the leg. It is accompanied by an uncontrollable urge to move the legs, particularly when at rest. Massaging, muscle stretching or bicycling the legs while in bed provides some relief, but that relief is short lived. The overwhelming urge to move the extremities returns quickly and an individual so afflicted gets up from bed and walks the floors for countless hours for relief.

It is unknown what triggers RLS, but half of all reported cases are thought to have a hereditary connection.

Leg cramps from statin drugs feel like a charley horse, a painful contraction of the hamstring muscle marked by soreness and stiffness.

Did you have your condition prior to taking statin drugs? Did you strain, stress or tear a muscle that coincidentally occurred at the same time as initiating the new drug? Before a firm diagnosis can be made, you should return to your physician and provide a complete picture. In that way, he or she can differentiate between possible RLS and a drug reaction. Should it be the drug, your doctor might choose other possible methods of control for your high readings or adding co-enzyme Q10 to your daily regimen. Make an appointment promptly and get to the bottom of this troubling condition.

To give you related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I later told one of my friends (a nurse) who said that her husband (a physician) had high cholesterol but he didn’t want to take statins because of the side effects. They discussed the cinnamon and decided to try it as he had nothing to lose. At the time he was also having terrible bouts of angina and ate nitro pills by the handful. The pain was so severe that his wife also had to give him injections of pain killers just to relieve the pain. Both the nitro and pain medication were prescribed by their primary care physician.

After taking the cinnamon every day for three months, his wife wrote to me to tell me that he had not had a single angina attack in over two weeks. I asked him, since he is a physician, if he thought the cinnamon played a role and he said he thought it had to be because he hadn’t changed anything else. I don’t know if his cholesterol dropped, but I knew I had to write you to tell you.

I don’t believe it will help every one, but since it is harmless, I hope you will print my letter in the hopes of helping others. We use one 1000 mg capsule daily. I get mine for about $4 for 100 pills at a local drug store.

DEAR READER:
I had not heard of this “side effect” of cinnamon therapy. I am printing your letter for reader interest.

My personal experience with cinnamon to lower cholesterol was not successful, nor was it for several of my patients. However, many of my readers have had dramatic reductions in their levels. Some use cinnamon capsules, others use ground cinnamon from the baking aisle of grocery stores. Still others say only true cinnamon works as most products labeled as cinnamon are really cassia, a cinnamon-like spice. Some feel it doesn’t matter whether it is cassia or cinnamon, but rather what the dosage is, endorsing sprinkling a teaspoon on food one to three times a day being better than one large or several small doses a day. In the end, what works for one doesn’t work for everyone and it is simply a matter of trial and error to find what works best for you.

As for the angina connection, I am intrigued — especially because it worked for a physician. As you may know, we doctors are notoriously difficult to treat and to convince of anything. Before using any supplement, I recommend discussing it with your personal physician to ensure it is safe and will not interact with any prescription or over-the-counter medicines you might be taking.

When I receive a number of responses, either negative or positive, I will be sure to write a follow-up.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease”, “Compelling Home Remedies” and “Understanding Cholesterol”. Other readers would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Shortly after starting them I began having muscle pain in my legs and had heard warnings about statins, including those from your column. I was already taking co-enzyme Q10 so knew it wasn’t due to a depletion. I asked my cardiologist about a cholesterol lowering medication without statins but he said they weren’t any good and switched me to Crestor instead. It was still a statin and despite my concerns, I took it like a good patient. The pain returned so I stopped it and started watching my diet more closely. My cholesterol dropped to 217. During my next doctor visit, I again complained about the statins, hoping this time the doctor would listen. Instead he told me to find another cardiologist and left the room.

I left his office feeling pretty devastated. Was I wrong to refuse to take statins again or should I have just let him think I was still taking one even though I wasn’t? Should I really find another cardiologist?

DEAR READER:
You should absolutely find another cardiologist. Yours was rude and out of line. Having tried two separate brands and experiencing side effects from both, it is clear to me you cannot tolerate statins. While it is true that non-statin cholesterol lowering medications aren’t as effective as their statin counterparts, they are a a viable alternative given the situation. .

Find a new cardiologist, explain your situation and if he or she isn’t willing to work a little harder to help, then move on to another. Once you find someone willing to listen to and work with you, you should find your condition and outlook improving.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Understanding Cholesterol”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I don’t eat meat or fats and watch what I do eat. I also read that taking flaxseed is good for lowering cholesterol levels, so I take a tablespoon of flaxseed meal each morning.

Is my doctor correct in advising me that I shouldn’t be concerned? Is there anything else I should be doing to lower the numbers since I really do not want to take statins?

I would appreciate hearing your opinion on this.

DEAR READER:
More and more emphasis is being placed today on lowering total cholesterol levels. Excessive amounts of cholesterol in the blood have been linked to plaque developing in blood vessels. Over time, plaque buildup can lead to inadequate amounts of blood traveling through the arteries. This, in turn, can cause coronary artery disease, heart attack and stroke. Optimal values for total cholesterol are below 200 mg/dL. With a level of 258, you are above the normal range and are at an increased risk for related medical issues.

I fully appreciate your reluctance to go on statin drugs. There are a number of medications in the category that work by blocking a substance the liver requires to make cholesterol. While some individuals can take statins without experiencing any side effects, others have reported cramping, nausea and diarrhea. Follow-up laboratory blood testing is vital to be assured there is no liver involvement, another common side effect.

You already watch your diet, exercise and take flaxseed. If you smoke, which I doubt, you should discontinue the habit. Alcohol can be consumed in modest amounts. Excessive amounts can lead to liver, heart and other organ damage. My guess is that your problem may be genetic so you could have higher -than-normal levels despite all your efforts.

Consider oatmeal for breakfast and salmon once or twice weekly for dinner. Try adding cinnamon to breakfast cereals and other food items. Over-the-counter niacin can lower triglycerides by limiting the liver’s ability to produce low density lipoprotein (LDL or “bad”) cholesterol. A recommended initial dose is 250 mg daily with incremental increases to 1000 mg daily. Niacin can cause flushing and itching that can be counteracted by taking an antihistamine or an 81 mg aspirin about 15 minutes prior to the niacin. There are several other drugs available without prescription that might be a good first step. They generally contain plant sterols that have been reported to lower levels.

Speak with your physician regarding your concerns of being placed on a statin drug and discuss options. I’m inclined to agree that you needn’t worry, but he or she just might have some alternative suggestions.

To give you related information, I am sending you a copy of my newly revised Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Lipitor has been connected with severe leg cramps and pain that can appear anywhere in the body, but most commonly in the calf muscles that are used so often.

Co-Q10 is a naturally occurring enzyme in the body. Reports have revealed a deficiency of more than 50% in less than a month by those patients on Lipitor. The deficiency causes pain. Therefore, I recommend you purchase Co-Q10 over-the-counter and continue the reduced dose of Lipitor. Bring my recommendation to your physician’s attention for an opinion.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My first problem is that I have hair growing in places where hair should not be on women. Do you have any suggestions what I can do for this and why I have it?

My second problem is that I have very bad dry skin on my forehead and nothing has helped. What is worse is that my 5-month-old daughter has dry skin on her forehead and the back of her head. I have taken her to the pediatrician and have been told to use hydrocortisone on it. All that does is cover it up. Do you have any suggestions for this?

DEAR READER:
While not your first concern, I would be very interested to know the progression of your diabetes, high cholesterol and weight gain. These changes can manifest in a number of ways and can vary from person to person. Was the diabetes present prior to your pregnancy or did you have gestational diabetes? What about the weight increase? Was it present before your pregnancy or did you gain weight during the pregnancy that you have failed to lose? When was your high cholesterol level diagnosed?

Did a primary care physician prescribe both the Avandamet and Lipitor? Was one prescribed before the other? This would be important to know, since you may be suffering a drug interaction between the two.

Avandamet is prescribed as an adjunct to diet and exercise for type 2 diabetes. Weight loss, exercise and a restriction of dietary calories and sugar are vital for optimal results. Therefore, I assume that despite the additional work involved with a new baby, you are exercising and controlling your food intake. Dose-related weight gain has been observed in patients on Avandamet. The reason for this is unclear but likely involves fluid retention and fat accumulation.

Lipitor is a statin drug taken for lowering cholesterol levels. Side effects are weight gain, hyperglycemia, hypoglycemia, dry skin, seborrhea, contact dermatitis, eczema, leg cramps, arthritis, and more. Seborrhea can present as either very oily skin or dry scales.

My concern is that the two drugs you are on may be reacting against each other. I urge you to return to the prescribing physician to discuss this possibility. Since you don’t indicate what your cholesterol readings are, I am somewhat reluctant to recommend an over-the-counter product such as niacin, CholestOff, omega-3 oil, or others that might be adequate. If prescription medication is necessary, perhaps you can be switched to a different drug with fewer side effects.

As far as the hair growth issue is concerned, there are a number of possibilities. When a woman develops excessive amounts of hair on her chest, face or back, the condition is known as hirsutism. Up to 10% of all American women have some degree of the condition. It may be attributed to an adrenal gland abnormality, be caused by medications taken for endometriosis, from Cushing’s syndrome when the body is exposed to high levels of cortisol or from polycystic ovary syndrome. The latter results in obesity, irregular periods and more.

You should address the condition with your primary care physician or specialist who can do an examination, order laboratory blood testing for hormone levels, an ultrasound to check for tumors or cysts, or a CT scan to evaluate your adrenal glands.

Now, for your baby. Because you are on Lipitor, I assume you are not nursing. Were that to be the case, that might be the reason for her dry skin. I must question whether the dry skin on the back of her head might be cradle cap. This condition presents as a crusting, scaly rash common on the back of the head and in the area of the eyebrows. It can be treated with baby oil or olive oil rubbed onto the affected areas. The procedure should be followed with soap or shampoo especially designed for cradle cap. Cradle cap is harmless except for a possible accompanying itch and is not contagious. Generally speaking, the condition disappears by the time a baby reaches 12 months of age.

To give you related information, I am sending you copies of my Health Reports “Diabetes Mellitus” and “Understanding Cholesterol”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

In October, my local paper had an article that wrote there was an increased risk of prostate cancer in men who ate flax seeds. It recommended that men eat fish or omega oils instead. It also said that we could completely stay away from flaxseed oil and flaxseed oil pills.

For the past seven years I have been using flaxseed oil and flaxseed oil pills. I consume 2000 mg daily. My doctors have never told me there was a problem with my usage of the supplement. My PSA has varied from 4.9 to 6.9. I would like to know your opinion of this.

DEAR READER:
This is a complex issue. Not many studies have been done to determine the benefits of flaxseed.

The article you read may have been reporting on the results of several medical studies that showed a possible link between prostate cancer and alpha-linolenic acid (which is present in flaxseed). More studies are needed before an answer can be given because another study involving men with prostate cancer showed that flaxseed supplements did not increase PSA levels.

The Mayo Clinic recommends that men with or at risk for prostate cancer avoid flaxseed and alpha-linolenic acid supplements.

That being said, there are other reasons you may want to discontinue your flaxseed oil regimen. Flaxseed is omega-3 fatty acid which can be beneficial for most patients. But you have diabetes. Some studies have shown that omega-3’s can actually increase blood sugar levels. You also mention a high triglyceride level. While I often recommend flaxseed oil and omega-3 to aid cholesterol reduction, this may not be appropriate for individuals with elevated triglyceride levels as it may actually increase the level.

Flaxseed is not without side effects. Some individuals may develop allergic reactions. It can also have laxative effects and in overdose can lead to a build-up of blood levels of the toxic chemical cyanide. Rarely, if whole flaxseeds are not taken correctly or too much is taken, it can lead to bowel obstruction or even a total stoppage of intestinal movement. Flaxseed oil is only the alpha-linolenic acid of the flaxseed and may not have all the potential benefits and side effects of the whole seed.

I suggest you speak to your physician about your consumption of flaxseed oil. He or she can give you information more specific to your situation. While flaxseed and its derivatives may have health benefits, more research needs to be done.

For readers who would like to learn more about flaxseed, I recommend you go check out the article on the Mayo Clinic’s website. It can be found at http://www.MayoClinic.com/health/flaxseed/NS_patient-flaxseed.

To give you related information, I am sending you copies of my Health Reports “The Prostate Gland”, “Living with Diabetes”, “Hypertension”, and “Understanding Cholesterol”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The doctor said it could be some damaged tissue. A nurse told me it could be stress.

Right now I am 6’5” tall, weigh 400 pounds, 40 years old and haven‘t had a cigarette in three years. My vision is blurred during the time my heart skips. I’m on Clonidine, Verapamil and Simvastatin to control my blood pressure and my (sometimes) escalated heart rate.

DEAR READER:
I can only interpret you are referring to palpitations, irregular beats of the heart. Fortunately, the vast majority of individuals that experience the sensation do not suffer from any cardiac disease or abnormal heart rhythms. If this is not the case and your physician has told you otherwise, you should request a referral to a cardiologist and have a complete workup done.

In many instances, palpitations can be relieved by reducing stress, caffeine, alcohol, and discontinuing smoking. With that in mind, I must admit your weight is of concern to me. While you are quite tall, I would feel better if you could incorporate exercise or a weight-reduction program into your schedule. Perhaps your place of employment has a gym, or you have a community center in your area that will allow you to stop by after work.

If diet modifications are appropriate, a referral to the dietician at your local hospital or health care center might be just the ticket.

While you don’t mention stress, a coordinated program of exercise should relieve that and might even bring the palpitations under control.

I feel confident that if you can bring your weight down, your blood pressure will drop accordingly and you might be able to discontinue some or all of the medication you are on. While this might sound like a monumental task, you are a young man with a lot of hopefully healthful years ahead. Simple steps taken now might certainly head off bigger problems down the road. I recommend you try my no flour, no sugar diet since it is easy and inexpensive.

I also urge you, if you have not done so already, to limit your salt and fat intake. You do not say if you have a high cholesterol level but you are on a lowering drug. This may simply be precautionary for your abnormal heart rhythm. If, on the other hand, your cholesterol is high, reducing your fat intake could lead to a reduce or even discontinuation of the statin drug.

To give you related information, I am sending you a copy of my Health Reports “Hypertension”, “Understanding Cholesterol” and “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR DR GOTT: This is pertaining to one of your recent columns where a lady suffered from halitosis and could not discern the cause. She mentioned she was a gum chewer.

In an attempt to stop smoking, I chewed gum all day and had exactly the same experience some years ago. I went to dentists and doctors to no avail. My family and colleagues at work learned to keep their distance. It was very embarrassing!

Eventually I discovered it was the aspartame in the chewing gum and many cups of coffee I devoured each day. Once I switched to another sweetener, the halitosis disappeared and has never returned.

I hope this helps the lady and any others suffering from this very embarrassing situation.

DEAR READER:
Aspartame is an artificial sweetener used in diet soft drinks, coffee, gums, sugar-free candies, and a host of other purposes. Some individuals can apparently include it within their regular diets and never be affected. In your case, you developed a mild but unwanted side effect from it. More severe cases, such as allergic reactions or perhaps from excessive use, are well documented. In any event, you were lucky to have found the source of your halitosis and took steps to correct the situation.

I am passing the information along through my column so others with a similar problem might be helped. Anyone who has suffered with halitosis and successfully treated it, please let me know what you have done. I will print a follow-up article with reader suggestions to pass on to others who suffer from this harmless but embarrassing problem. Thank you for sharing your experience.