08/24/18 Newsletter – A Few Noteworthy Items

To my Patients and Friends,

Here are the latest medical news highlights… enjoy!

Are current cholesterol guidelines adequate?

Patients who are at low risk for heart disease but with LDL (“bad” cholesterol) levels above 160 mg/dL are at long-term risk for increased mortality, according to a large study of 36,000 adults recently published in the journal Circulation.  Current guidelines don’t recommend starting cholesterol lowering medications for low risk patients until their LDL levels reach 190 mg/dL.  However, these new findings suggest that we should strive for even lower cholesterol levels, even in low-risk individuals.  Keep in mind that, before resorting to prescriptions, a nutritional approach will often keep cholesterol levels under control.  And newer, more advanced blood tests and imaging modalities (that go beyond current guidelines) can provide a better glimpse into an individual’s cardiovascular health.

and can sleep affect cholesterol levels?

Obstructive sleep apnea (OSA) is correlated with higher total cholesterol, lower HDL (“good” cholesterol), higher LDL (“bad” cholesterol), and elevated triglycerides according to a study of over 8,500 European adults recently published in the journal Respirology.

Obstructive sleep apnea is a potentially serious sleep disorder in which the soft tissues in the back of a patient’s throat relax into the airway, which causes breathing to stop and start during sleep.  Although snoring is often associated with OSA, not everyone who snores suffers from the syndrome.  Common signs of OSA include excessive daytime sleepiness, headaches, elevated blood pressure, awakening with a dry mouth, waking up gasping or choking, pauses in breathing during sleep (often observed by a partner), decreased libido, difficulty with concentration and mood fluctuations.  People at risk for OSA include those who are overweight or are smokers, those who have diabetes, a family history of sleep apnea, lung problems such as asthma, narrowed airways, high blood pressure, or chronic nasal congestion.  Additionally, men are about twice as likely as women to have sleep apnea.  OSA should be taken seriously: if untreated, OSA can be associated with motor vehicle accidents due to sleepiness, increased risk for heart attack or heart rhythm abnormalities, and as we now know, cholesterol disturbances.  If you or your partners suspect sleep apnea, please speak to your doctor to discuss options for evaluation and management.

Carb confusion

Diets that are either very low or very high in carbohydrates are associated with increased mortality, according to a study recently published in the journal Lancet.

“Low-carb” diets have long been touted as beneficial for weight loss and overall health.  And it makes sense to limit intake of refined/processed carbohydrates (such as pasta and breads, sweets and junk foods) since these foods have very little nutritional value, are low in fiber and high in calories.  However, not all carbs are made alike.  Often, when people pursue low-carb diets, they also (1) mistakenly choose to eliminate healthy carbohydrate-based foods such as fruits, vegetables and whole grains- many of which contain essential micronutrients, antioxidants and fibers, and (2) fill the empty space on their dinner plate with excess meats and dairy products, which are loaded with cholesterol, saturated fats and other components that can lead to inflammation and chronic disease (you may recall the now-discredited Atkins Diet).

On the opposite end of the spectrum, people who consume large quantities of refined carbs are at increased risk for obesity and chronic disease as a result of this calorie-dense (but nutrient-sparse) dietary pattern.  One caveat: people who ingest large quantities of minimally-processed plant-based foods that contain more complex carbohydrates generally enjoy excellent health.

The take-home message from this study: if the goals are to maintain a healthy weight and live a longer, healthier life, it makes sense to limit intake of processed/refined carbohydrates as well as animal products, and to eat plenty of fruits, vegetables and whole grains

A Lyme mime

There’s a (sort of) new menace in town, and it can easily be mistaken for Lyme disease.  A bacterium called Borrelia miyamotoi was first reported in the U.S. in 2013 and is transmitted to humans by the same tick (i.e., Ixodes scpularis, or deer tick) that transmits Lyme disease.  The symptom patterns are similar, and B. miyamotoi can even lead to a false-positive Lyme blood test.  No FDA-approved tests for B. miyamotoi are currently available, but this may change soon.  In the meantime, familiarize yourself with the symptoms associated with this infection: typically, there is no rash, but relapsing fever, headache, body aches and fatigue often occur.  The good news is that the infection responds to the same antibiotics typically used to treat Lyme disease (including doxycycline and amoxicillin).

A thyroid medication recall notice

Westminster Pharmaceuticals, LLC has recently announced a voluntary recall of certain thyroid tablets, namely levothyroxine and liothyronine.  The recall is only precautionary.  No adverse events have been reported, and it is recommended that patients taking these medications continue doing so until prescription replacements can be supplied by their pharmacies.  NOTE: not all thyroid medications are affected by this recall… just certain lot numbers from this one generic manufacturer.  If you take thyroid tablets, please see the chart included in this article for a list of products and lot numbers that may be affected, and check your bottle to determine if you should contact your doctor or pharmacy to arrange a replacement.

That’s all for this week… I hope you have a great weekend!