Q: I have low cholesterol. My LDL was 17 when last checked, and my total cholesterol was 82. My triglycerides were 32.
I weigh 160 pounds and am 6 feet tall. I cannot find a doctor who thinks my cholesterol numbers are a problem, but I feel awful and have no energy.
How do you raise cholesterol? I have tried shrimp, beef, eggs, butter, bacon, etc. So far, I haven’t had any success.
A: Doctors have focused almost exclusively on the dangers of elevated cholesterol. As a result, they may have a hard time conceiving of low cholesterol as a problem.
A study published in the journal Neurology (April 10, 2019) suggests that women with LDL cholesterol below 70 are at double the risk for a bleeding (hemorrhagic) stroke. Those with the lowest triglycerides (under 74 mg/dL) were also more susceptible to bleeding strokes. Data from the Taiwan Stroke Registry involving 40,000 patients demonstrate a link between low total cholesterol and a risk of bleeding in the brain (PLOS One, April 19, 2017).
There are no Food and Drug Administration-approved medications to raise cholesterol. Most health professionals discourage a diet high in saturated fat on the grounds that it might elevate cholesterol and the risk for a heart attack or clotting stroke. Please discuss your dilemma with your doctor, bolstered by the recent research.
Q: I wanted to respond to your column about generic levothyroxine. The person writing to you had taken levothyroxine from three different manufacturers within six months. She worried that such switching might pose a problem.
I am a pharmacist. The reason patients have been getting levothyroxine from different manufacturers is due to shortages. Believe me, pharmacists want patients to stay on levothyroxine from the same company. However, when the product is unavailable, we have to switch manufacturers.
Why don’t you write about all the shortages of common drugs? The public needs to understand that pharmacists are on their side, but sometimes our hands are tied.
A: We share your frustration about drug shortages. This crisis has been going on for years. Although the FDA publishes a list of medicines in short supply, it has not offered solutions to this supply-chain difficulty.
When drugmakers have quality-control problems, they frequently recall substandard medicines. Such has been the case with blood-pressure pills like losartan and valsartan. This is challenging for pharmacists, patients and physicians.
Q: I have suffered from severe heartburn that wakes me up at night. I just read on your website that the zolpidem I take to get to sleep might be responsible. I feel like I have to choose between insomnia and heartburn. Is there any way out of this mess?
A: You are caught in a classic double bind. You have become dependent upon zolpidem (Ambien) to fall asleep, but this medication can trigger heartburn that wakes you up.
Getting off zolpidem may require months of gradual tapering. You can learn about other approaches to overcoming insomnia in our eGuide to Getting a Good Night’s Sleep, available at www.PeoplesPharmacy.com. Some options that may be helpful include melatonin, magnesium, acupressure and cognitive behavioral therapy.